Clear Form
THIS SPACE FOR DATE RECEIVED STAMP
FORM
STATE OF HAWAII
N-13
DEPARTMENT OF TAXATION
(Rev. 2012)
Individual Income Tax Return
2012
RESIDENT
JDF121
(FOR USE BY TAXPAYERS WHO HAVE LESS THAN
$100,000 TAXABLE INCOME, DO NOT ITEMIZE
DEDUCTIONS, AND DO NOT CLAIM
ADJUSTMENTS TO INCOME)
AMENDED Return
First Time Filer
Address or Name Change
Your first name and initial
Last name
Your social security number
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
Present mailing or home address (Number and street, including apartment number or rural route)
IMPORTANT
You must enter your SSN(s).
Your occupation / Spouse’s occupation
City, town or post office, State and Postal/ZIP code. If you have a foreign address, see Instructions.
HAWAII ELECTION
Do you want $3 to go to the Hawaii Election Campaign Fund? .................
Yes
No
Note: Checking “Yes” will
not increase your tax or
CAMPAIGN FUND
If joint return, does your spouse want $3 to go to the fund? ......................
Yes
No
reduce your refund.
1
(Check only ONE box)
Single
4
Head of household (with qualifying person). If the qualifying
2
person is a child but not your dependent, enter this child’s name
Married filing joint return (even if only one had income).
here. ä
3
Married filing separate return. Enter spouse’s SSN above and
5
Qualifying widow(er) with dependent child (Year spouse died _______ ).
full name here. ________________________________
Caution: If you can be claimed as a dependent on another person’s tax return (such as your parents’), do not check box 6a, but be sure to check the box below line 11.
6a
}
Yourself ...........................
Age 65 or over ..............................................................................
Enter number of
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6b
boxes checked
Spouse ...........................
Age 65 or over ..............................................................................
on 6a and 6b
If you checked box 3 and 6b above, see the Instructions on page 9 and if your spouse meets the qualifications, check here
6c
Dependents:
If more than 6
2. Dependent’s social
Enter number
dependents, use
security number
3. Relationship
and
of your children
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1. First and last name
attachment
6c
listed
6d
Enter number
of other
ç
6d
dependents
Add numbers
entered in
ç
6e Total number of exemptions claimed .....................................................................................................
6e
boxes above
ROUND TO THE NEAREST DOLLAR
00
7 Wages, salaries, tips, etc. (attach Form(s) W-2; if unavailable, see item 5 on page 11 of Instructions) .................................
7
00
8 Interest income (complete Part I on page 2 if over $1,500) ..............................................................................
8
00
9 Ordinary dividends (complete Part II on page 2 if over $1,500) ........................................................................
9
00
10 Unemployment compensation (insurance). .......................................................................................................
10
00
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11 Add lines 7, 8, 9 and 10 ......................................................................................Adjusted Gross Income
11
Caution:
If you can be claimed as a dependent on another person’s return,
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see page 12 of the Instructions and check here ..............................................
If you are married filing separately and your spouse itemizes deductions,
see page 8 of the Instructions.
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12 Standard deduction.
1 or 3, enter $2,000
If you checked filing status box:
2 or 5, enter $4,000
00
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4, enter $2,920 ...............................................Standard Deduction
12
00
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13 Line 11 minus line 12. (This line MUST be filled in) ....................................................................................
13
14 Multiply $1,040 by the total number of exemptions claimed on line 6e. If you and/or your spouse are blind, deaf,
00
or disabled, check applicable box(es)
14
Yourself
Spouse, and see page 12 of Instructions.
00
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15 Line 13 minus line 14. Enter the result (but not less than zero). .................................... Taxable Income
15
Continue on other side
Continue on other side
FORM N-13