Schedule A (Form It-140) - Schedule Of Income - Nonresidents/part-Year Residents - 2013

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SCHEDuLE
13
Nonresidents/Part-Year Residents
a
Schedule of Income
IT-140)
(F
W
orm
PRIMaRY LaST NaME
SOCIaL
SHOWN ON FORM
SECuRITY
IT-140
NuMbER
PaRT-YEaR RESIDENTS:
ENTER PERIOD OF
FROM:
TO:
WEST VIRgINIa RESIDENCY
MM
DD
YYYY
MM
DD
YYYY
SChEDUlE a
(To Be Completed By Nonresidents and Part-Year Residents only)
INComE
COLUMN A
AMOUNT FROM
FEDERAL RETURN
All deductions from Form 1040
COLUMN B
COLUMN C
or 1040A not itemized on lines
ALL INCOME DURING
WV SOURCE INCOME
69-74 should be totaled and
PERIOD OF WV
DURING
entered on line 75.
RESIDENCY
NONRESIDENT PERIOD
.00
.00
.00
55. Wages, salaries, tips (complete Form IT-140W).....................
55
.00
.00
.00
56. Interest..................................................................................... 56
.00
.00
.00
57. Dividends................................................................................. 57
58. Refunds of state and local income tax (see line 46 of Schedule M)..............
.00
.00
58
.00
.00
59. alimony received...................................................................... 59
60. Business profit (or loss)........................................................... 60
.00
.00
.00
.00
.00
.00
61. Capital gains (or losses).......................................................... 61
.00
.00
.00
62. Supplemental gains (or losses)...............................................
62
.00
.00
.00
63. Total taxable pensions and annuities....................................... 63
.00
.00
.00
64. Farm income (or loss).............................................................
64
.00
.00
.00
65. unemployment compensation insurance................................
65
66. Total taxable Social Security and Railroad Retirement benefits (see line 44
of Schedule M for Railroad Retirement benefits).......................................... 66
.00
.00
67. Other income from federal return (identify source)
.00
.00
.00
______________________________________________
67
.00
.00
.00
68. Total income (add lines 55 through 67)...................................
68
aDJUSTmENTS
.00
.00
.00
69. IRa deduction.......................................................................... 69
.00
.00
.00
70. Moving expenses..................................................................... 70
.00
.00
.00
71. Self-employment tax deduction...............................................
71
.00
.00
.00
72. Self-employment health insurance deduction.........................
72
73. Self Employed SEP, SIMPLE and qualified plans...................
.00
.00
.00
73
.00
.00
.00
74. Penalty for early withdrawal of savings...................................
74
.00
.00
.00
75. Other adjustments...................................................................
75
.00
.00
.00
76. Total adjustments (add lines 69 through 75)...........................
76
77. adjusted gross income (subtract line 76 from line 68 in each
.00
.00
.00
column..................................................................................... 77
.00
78. West Virginia income (line 77, Column b plus line 77, column C).............................................................................
78
.00
79. Income subject to West Virginia state tax but exempt from federal tax...........................
79
.00
80. Total West Virginia income (line 78 plus line 79). Enter here and on line 2 on the next page...................................
80
*p40201307W*
–8–

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