Form It-360.1 - Change Of City Resident Status - 2014
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1
2
3New York State Department of Taxation and Finance
IT-360.1
Change of City Resident Status
New York City • Yonkers
Submit this form with Form IT-201 or Form IT-203.
Name(s) as shown on return
Social security number
Change of resident status – If you are married and filing separate New York State returns, each of you must complete a
separate Form IT-360.1
.
(see instructions, Form IT-360.1-I, front page)
New York City change of residence – Complete Parts 1, 2, 3, and 4.
Mark an X in only one box (A)
(B)
Yonkers change of residence – Complete Parts 1 and 5.
(C)
New York City and Yonkers change of residence – Complete the entire form.
Column A
Column B
Column C
Part 1 – New York adjusted gross
Federal income
Amount of Column A
Amount of Column A
and adjustments
for New York City
for Yonkers
income
(see instructions, page 3)
resident period
resident period
(all sources)
1 Wages, salaries, tips, etc . ......................
.
.
.
1
00
00
00
.
.
.
2 Taxable interest income .........................
2
00
00
00
.
.
.
3 Ordinary dividends .................................
3
00
00
00
4 Taxable refunds, credits, or offsets of
.
.
.
state and local income taxes ..............
4
00
00
00
.
.
.
5 Alimony received ...................................
5
00
00
00
6 Business income or loss
(submit copy of
.
.
.
...
6
federal Schedule C or C-EZ, Form 1040)
00
00
00
7 Capital gain or loss
(submit copy of federal
.
.
.
........................
7
Schedule D, Form 1040)
00
00
00
8 Other gains or losses
(submit copy of
.
.
.
................................
8
federal Form 4797)
00
00
00
.
.
.
9 Taxable amount of IRA distributions ......
9
00
00
00
.
.
.
10 Taxable amount of pensions and annuities 10
00
00
00
11 Rental real estate, royalties,
partnerships, S corporations, trusts, etc.
.
.
.
11
(submit copy of federal Schedule E, Form 1040)
00
00
00
12 Farm income or loss
(submit copy of
.
.
.
............... 12
federal Schedule F, Form 1040)
00
00
00
.
.
.
13 Unemployment compensation ............... 13
00
00
00
14 Taxable amount of social security benefits 14
.
.
.
00
00
00
15 Other income .........................................
Identify:
15
.
.
.
00
00
00
.
.
.
16 Total
.................... 16
(add lines 1 through 15)
00
00
00
17 Total federal adjustments to income
Identify:
.
.
.
17
00
00
00
18 Federal adjusted gross income
.
.
.
.................. 18
(subtract line 17 from line 16)
00
00
00
.
.
.
19 New York adjustments
...
19
(submit schedule)
00
00
00
20 New York adjusted gross income
(line 18 and add or subtract line 19;
transfer the amount from Column B to
.
.
.
................................................. 20
line 43)
00
00
00
360001140094
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