Form D-40 - Individual Income Tax Return - 2011 Page 9
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Government of the
2011
SCHEDULE I Additions
*110400180002*
District of Columbia
to and Subtractions from
Federal Adjusted Gross Income
Make entries using black ink. Attach to your D-40.
Last name
Social Security Number
OFFICIAL USE ONLY
Vendor ID#0002
Calculation A Additions to federal adjusted gross income.
Dollars only, do not enter cents
Fill in only those that apply.
.00
1 Part-year DC resident – enter the portion of adjustments
1
$
(from Line 36, Form 1040;
that relate to the time you resided outside DC.
Line 20, Form 1040A; or Line 34, 1040NR)
For Lines 2 – 7 below include only the amounts related to the time you resided in DC.
.00
2 Income distributions eligible for income averaging on your federal tax return
2
$
f
rom federal Form 4972, Lines 6 and 8 Add Lines 6 and 8 and enter here.
.00
3 30% or 50% federal bonus depreciation and/or extra IRC §179 expenses claimed
3
$
on federal return
.00
4 Any part of a discrimination award subject to income averaging.
4
$
.00
5 Deductions for S Corporations from Schedule K-I, Form 1120 S.
5
$
.00
6 Other (see instructions on other side). _____________________________________________ 6
$
.00
RESERVED
7
$
7
8 Total additions
8
$
.00
Add entries on Lines 1– 7. Enter the total here and on D-40, Line 5.
Calculation B Subtractions from federal adjusted gross income.
Fill in only those that apply.
.00
1 Taxable interest from US Treasury bonds and other obligations.
1
$
See instructions on other side.
.00
2 Disability income exclusion
2
$
from DC Form D-2440, Line 10. See instructions on other side.
.00
3 Interest and dividend income of a child from federal Form 8814*.
3
$
.00
4 Awards, other than front and back pay, received due to unlawful
4
$
employment discrimination.
.00
5 Excess of DC allowable depreciation over federal allowable depreciation.
5
$
See instructions.
.00
6 Long-term care insurance premiums paid in 2011, $500 annual limit per person.
6
$
7 Amount paid (or carried over) to DC College Savings plan in 2011 (maximum $4,000 per
7
$
.00
person, $8,000 for joint filers if each is an account owner).
Part-year residents see instructions.
.00
8 Exclusion of up to $10,000 for DC residents (certified by the Social Security Adm.
8
$
as disabled) with adjusted annual household income of less than $100,000.
See instructions.
.00
$
9 Expenditures by DC teachers for necessary classroom teaching materials,
9
$500 annual limit per person.
See instructions on other side.
.00
10 Expenditures by DC teachers for certain tuition and fees, $1500 annual limit per person
10
$
.
See instructions on other side.
.00
11 Loan repayment awards received by health-care professionals from DC government.
11
$
See instructions on other side.
.00
12 Health-care insurance premiums paid by an employer for an employee’s registered
12
$
domestic partner or same sex spouse.
Make no entry if the premium was deducted on your federal return, see instructions on other side.
.00
13 DC Poverty Lawyer Loan Assistance.
13
$
See instructions on other side.
.00
14 Other
_____________________________________________
14
$
See instructions on other side.
.00
RESERVED
15 Military Spouse Residency Relief Act.
15
$
See instructions on other side.
.00
16 Total subtractions.
16
$
Add entries on Lines 1–15. Enter the total here and on D-40, Line 13.
* Note: Since income reported on Federal Form 8814, Parents’ Election to Report Child’s Interest and Dividends, and included in the parents’ federal
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return income is subtracted above on Line 3 of Calculation B, the child must file a separate DC return reporting this income.
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Revised 09/11
2011 SCHEDULE I
P1
Additions to and Subtractions from Federal Adjusted Gross Income
File order 8
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