Form 1npr - Nonresident & Part-Year Resident Wisconsin Income Tax - 2012
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41NPR
Nonresident & part-year resident
2012
Wisconsin income tax
Check here
For the year Jan. 1-Dec. 31, 2012,
if this is an
or other tax year
amended
beginning:
, 2012
return
ending:
, 20
.
Legal first name
Your legal last name
M.I.
Your social security number
Spouse’s legal first name
If a joint return, spouse’s legal last name
M.I.
Spouse’s social security number
Home address (number and street). If you have a PO Box, see page 7
Apt. no.
Tax district
Check below then fill in either the name of Wisconsin city,
village, or town, and the county in which you lived at the
City or post office
State
Zip code
end of 2012 or before leaving Wisconsin (nonresidents
leave blank).
City
Village
Town
Special
Filing status
Conditions
City, village,
or town
Single
Married filing joint return (even if only one had income)
County of
Legal
Married filing separate return.
School district number
(see page 39)
last name
Fill in spouse’s SSN above and
M.I.
Legal
full name here .........................
first name
Head of household (with qualifying person), (see page 7).
Also, check here if married.
Resident status
Check the status that applies
You
Spouse
Full-year resident of Wisconsin
Nonresident of Wisconsin; state of residence
(2-letter state abbreviation)
Note: Complete residence questionnaire, page 47.
Part-year resident of Wisconsin from
to
mm
dd
yyyy
mm
dd
yyyy
Print numbers like this
NO COMMAS
Not like this
NO CENTS
A. Federal column
B. Wisconsin column
Income
.00
.00
1 Wages, salaries, tips, etc. (see page 10) . . . . . . . . . . . . . . . . . . . . . . . .
1
.00
.00
2 Taxable interest (see page 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Ordinary dividends (see page 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
.00
.00
4 Taxable refunds, credits, or offsets of state and local income taxes
.00
Not taxable
(from federal Form 1040, line 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
.00
.00
5 Alimony received (see page 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
.00
.00
6 Business income or (loss) (see page 12) . . . . . . . . . . . . . . . . . . . . . . . .
6
.00
.00
7 Capital gain or (loss) (see page 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
.00
.00
8 Other gains or (losses) (see page 12) . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 IRA distributions (see page 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
.00
.00
.00
.00
10 Pensions and annuities (see page 12) . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Rental real estate, royalties, partnerships, S corporations, trusts, etc.
.00
.00
(see page 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
.00
.00
12 Farm income or (loss) (see page 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
.00
.00
13 Unemployment compensation (see page 14) . . . . . . . . . . . . . . . . . . . . . 13
14 Social security benefits (see page 14) . . . . . . . . . . . . . . . . . . . . . . . . . . 14
.00
Not taxable
.00
.00
15 Other income (see pages 15-21). Enclose explanation . . . . . . . . . . . . . 15
.00
.00
16 Add lines 1 through 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
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