Form It-201-X - Amended Resident Income Tax Return - 2012 Page 2
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6Page 2 of 6 IT-201-X (2012)
Your social security number
Federal income and adjustments
Whole dollars only
1 Wages, salaries, tips, etc. ...........................................................................................................
.
1
00
2 Taxable interest income ...............................................................................................................
.
2
00
3 Ordinary dividends ......................................................................................................................
.
3
00
4 Taxable refunds, credits, or offsets of state and local income taxes
.
...........
4
(also enter on line 25)
00
5 Alimony received .........................................................................................................................
.
5
00
6 Business income or loss
.
..........................
6
(submit a copy of federal Schedule C or C-EZ, Form 1040)
00
7 Capital gain or loss
.
..............................
7
(if required, submit a copy of federal Schedule D, Form 1040)
00
8 Other gains or losses
.
.............................................................
8
(submit a copy of federal Form 4797)
00
9 Taxable amount of IRA distributions. If received as a beneficiary, mark an X in the box ...
.
9
00
10 Taxable amount of pensions and annuities. If received as a beneficiary, mark an X in the box
.
10
00
11 Rental real estate, royalties, partnerships, S corporations, trusts, etc.
.
11
(submit copy of federal Schedule E, Form 1040)
00
12 Rental real estate included in line 11 ................................. 12
.
00
13 Farm income or loss
.
............................................. 13
(submit a copy of federal Schedule F, Form 1040)
00
14 Unemployment compensation ..................................................................................................... 14
.
00
15 Taxable amount of social security benefits
.................................................. 15
.
(also enter on line 27)
00
16 Other income
.
Identify:
16
00
17 Add lines 1 through 11 and 13 through 16 ................................................................................ 17
.
00
18 Total federal adjustments to income
.
Identify:
18
00
.
19 Federal adjusted gross income (
) ..................................................... 19
subtract line 18 from line 17
00
New York additions
20 Interest income on state and local bonds and obligations
(but not those of NYS or its local governments)
.
20
00
21 Public employee 414(h) retirement contributions from your wage and tax statements ............... 21
.
00
22 New York’s 529 college savings program distributions ............................................................... 22
.
00
.
23 Other
Identify:
23
00
24 Add lines 19 through 23 .............................................................................................................. 24
.
00
New York subtractions
25 Taxable refunds, credits, or offsets of state and local income taxes
.
25
(from line 4)
00
26 Pensions of NYS and local governments and the federal government 26
.
00
27 Taxable amount of social security benefits
.
........ 27
(from line 15)
00
28 Interest income on U.S. government bonds ...................... 28
.
00
29 Pension and annuity income exclusion ............................. 29
.
00
30 New York’s 529 college savings program deduction/earnings 30
.
00
Identify:
.
31 Other
31
00
32 Add lines 25 through 31 .............................................................................................................. 32
.
00
.
33 New York adjusted gross income
.................................................. 33
(subtract line 32 from line 24)
00
361002120094
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