Form N-15 - Nonresident And Part-Year Resident Individual Income Tax Return - 2011

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FORM
STATE OF HAWAII — DEPARTMENT OF TAXATION
N-15
Individual Income Tax Return
(Rev. 2011)
NONRESIDENT and PART-YEAR RESIDENT
2011
Calendar Year
JCF111
OR
Enter tax year dates in MMDDYY format. Do not enter dash (-) e.g. 123111.
AMENDED Return
NOL
Tax Year
thru
Carryback
† Place an X in the applicable box(es):
Part-Year Resident
Nonresident
Nonresident Alien or Dual-Status Alien
FOR OFFICE USE ONLY
THIS
There are features on this form that are only supported by Adobe 6.0 or higher. You must use Adobe 6.0 or higher with this form.
SPACE
Do NOT Submit a Photocopy!!
RESERVED
Place an X in the applicable box, if appropriate
First Time Filer
Address or Name Change
2011
ATTACH A COPY OF YOUR
FEDERAL
INCOME TAX RETURN
Your First Name
M.I.
Your Last Name
u IMPORTANT — Complete this Section u
Enter the first four letters
Spouse’s First Name
M.I.
Spouse’s Last Name
of your last name.
Use ALL CAPITAL letters
Care Of (See Instructions, page 7.)
Your Social
Security Number
Present mailing or home address (Number and street, including Rural Route)
Enter the first four letters
of your Spouse’s last name.
Use ALL CAPITAL letters
City, town or post office.
State
Postal/ZIP code
Spouse's Social
If Foreign address, enter Province and/or State
Country
Security Number
(Place an X in only ONE box)
4
Head of household (with qualifying person). If the qualifying
1
Single
person is a child but not your dependent, enter the child’s full
2
Married filing joint return (even if only one had income).
!
name.
†
3
Married filing separate return. Enter spouse’s SSN and
__________________________________
the first four letters of last name above. Enter spouse’s full
5
Qualifying widow(er) with dependent child. Enter the year
name here.
_____________________________________
your spouse died
.
CAUTION: If you can be claimed as a dependent on another person’s tax return (such as your parents’), DO NOT place an X on line 6a, but be sure to place an X below line 36.
Enter the number of Xs
6a
}
Yourself ........................................
Age 65 or over ...............................................................
Â
on 6a and 6b ..................
6b
Spouse ........................................
Age 65 or over ...............................................................
If you placed an X on lines 3 and 6b above, see the Instructions on page 9 and if your spouse meets the qualifications, place an X here
6c
Dependents:
If more than 6 dependents
2. Dependent’s social
and
1. First and last name
use attachment
security number
3. Relationship
Â
Enter number of
your children listed .. 6c
6d
Â
Enter number of
other dependents ...... 6d
Â
6e
Total number of exemptions claimed. Add numbers entered in boxes 6a thru 6d above...............................................
6e
ID NO 01
FORM N-15

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