Virginia Schedule 760py Adj (Form 760py Adj) - 2012

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2012
*VAPADJ112888*
Virginia Schedule 760PY ADJ
(Form 760PY ADJ)
Page 1
Your Name
Your SSN
Additions to Adjusted Gross Income
B
A
Spouse
You
Filing Status 4 ONLY
Include Spouse if Filing Status 2
1. Interest earned while a Virginia resident on obligations of
other states, exempt from federal income tax, but not from
00
00
state tax. ..................................................................................
1
2. Other additions to adjusted gross income.
00
00
2a Fixed date conformity addition. See instructions. .............
2a
00
00
2b - 2c Refer to Form 760PY Instructions for
Other Addition Codes.
2b
2b
00
00
2c
2c
3. Total Additions. Add Lines 1, 2a - 2c.
00
00
Enter here and on Form 760PY, Line 2. ..................................
3
Subtractions from Adjusted Gross Income
B
A
Spouse
You
4. Income (interest, dividends or gains) received while a Virginia
resident from obligations or securities of the U.S. exempt
00
00
from state income tax, but not from federal tax. ......................
4
5. Disability income received while a Virginia resident and
reported as wages (or payments in lieu of wages) on your
federal return. If claiming this subtraction you cannot also
claim Age Deduction. Claim the one that benefits you most.
5a Enter YOUR disability subtraction on Line 5a, Column A.
00
5a
5b Enter SPOUSE’S disability subtraction on Line 5b,
Column B if claiming Filing Status 4 or Line 5b, Column
00
00
A if claiming Filing Status 2. .............................................
5b
6. Other subtractions as provided in instructions.
00
00
6a Fixed date conformity subtraction. ...................................
6a
6b - 6d See Form 760PY instructions for
00
00
Other Subtraction Codes.
6b
6b
00
00
6c
6c
00
00
6d
6d
7. Total subtractions. Add Lines 4, 5a, 5b, and 6a - 6d.
00
00
Enter here and on Form 760PY, Line 8. ..................................
7
Deductions from Virginia Adjusted Gross Income
B
A
Spouse
You
8. Deduction codes. See Form 760PY instructions for Deduction
Codes.
00
00
8a
8a
00
00
8b
8b
00
00
8c
8c
9. Total Deductions. Add Lines 8a - 8c.
00
00
Enter here and on 760PY, Line 15. ..........................................
9
Avoid delays - If completed, attach Schedule 760PY ADJ to Form 760PY
VA Dept. of Taxation
2601038
760PYADJ
REV 03/12

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