Virginia Schedule 760py Adj (Form 760py Adj) - 2012 Page 2
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2012 Virginia Schedule 760PY ADJ
Page 2
Your Name
Your SSN
Tax Credit For Low Income Individuals or Virginia Earned Income Credit
• List below the name, Social Security Number (SSN) and Guideline Income for you, your spouse and each dependent.
• If more room is needed, attach a schedule with the name, SSN and Guideline Income for each additional dependent.
• Failure to complete Lines 10 - 17 may result in this credit being reduced or disallowed.
Family VAGI
Name
Social Security Number (SSN)
Guideline Income
You
-
-
00
Spouse
-
-
00
a. Dependent
-
-
00
b. Dependent
-
-
00
10. Total Family Guideline Income (Be sure to include information from attached schedule, if
00
applicable)
10
11.
Enter the total number of exemptions reported in the table above and on any attached schedule.
Based on this total, the total Family Guideline Income from Line 10 and the poverty guidelines in
the instructions, determine your eligibility. If you do not qualify for the Tax Credit for Low Income
Individuals but claimed an Earned Income Credit on your federal return, go to Line 14. ...........
11
12.
If you qualify, enter the number of personal exemptions reported on your Form 760PY. ...........
12
13.
Multiply Line 12 by $300. Enter the result on Line 13 and proceed to Line 14. If you do not
qualify for the tax credit but claimed an Earned Income Credit on your federal return, enter $0
00
and proceed to Line 14. ..............................................................................................................
13
14.
Enter the amount of Earned Income Credit claimed on your federal return. If you did not claim
an Earned Income Credit on your federal return, enter $0. If you are married filing separately,
00
see the instructions.
14
00
15.
Multiply Line 14 by 20% (.20). ....................................................................................................
15
00
16.
Enter the greater of Line 13 or Line 15. ......................................................................................
16
17.
Compare the amount on Line 16 above to the amount of tax on Form 760PY, Line 19. Enter the
00
lesser of the two amounts here and on Form 760PY, Line 23. This is your credit amount. ........
17
Adjustments and Voluntary Contributions
00
18.
Addition to tax. Check if addition came from: .......
Form 760C
Form 760F ..................
18
00
19.
Penalty. .................................................................
Late Filing Penalty
Extension Penalty
19
00
20.
Interest (interest accrued on the tax you owe). ..........................................................................
20
00
21.
Consumer’s Use Tax. ..................................................................................................................
21
22.
Voluntary Contributions. Enter the code for the contribution(s) and
00
the contribution amount(s) in boxes 22a - 22c. If contributing to
22a
22a
more than 3 voluntary contributions, see Form 760PY instructions
00
for Voluntary Contribution Codes.
22b
22b
00
22c
22c
23.
If contributing to a School Foundation, or a Library Foundation
00
enter the code for the foundation(s) and the contribution amount(s)
23a
23a
in boxes 23a - 23c. If contributing to more than 3 school or
00
library foundations, see Form 760PY instructions for Voluntary
23b
23b
Contribution Codes.
00
23c
23c
00
24.
Total Adjustments (add Lines 18 - 23c). Enter here and on Form 760PY, Line 30. .....................
24
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