Virginia Schedule Adj (Form 760-Adj) - 2012 Page 2
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1
2
Your Social Security Number
2012
Schedule ADJ
Virginia
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Page 2
Credit for Low Income Individuals or Virginia Earned Income Credit
Family VAGI
Name
Social Security Number
Virginia Adjusted Gross Income (VAGI)
You
Spouse
Dependent
Dependent
If more than 4 exemptions, attach schedule listing the name, SSN & VAGI.
10.
Total
,
00
LOSS
Enter total Family VAGI here.
.
11. Enter the total number of exemptions reported in the table above. Next, go to the Poverty Guidelines
Table shown in the Form 760 instructions for this Line to see if you qualify for this credit. .................... 11
12. If you qualify, enter the number of personal exemptions reported on your Form 760 ............................ 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 for Low Income Individuals but claimed an Earned Income Credit on your federal
,
00
.
return, enter $0 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
,
00
.
Earned Income Credit on your federal return, enter $0 .......................................................................... 14
,
00
15. Multiply Line 14 by 20% (.20) ................................................................................................................ 15
.
,
00
.
16. Enter the greater of Line 13 or Line 15 above ........................................................................................ 16
17. Compare the amount on Line 16 above to the amount of tax on Line 17 of Form 760 and enter the
,
00
.
lesser of the two amounts here and on Line 21 of Form 760. This is your credit amount ...................... 17
Adjustments and Voluntary Contributions
,
,
00
.
18. Addition to tax. Fill in oval if addition came
from:
Form 760C
Form 760F .... 18
19. Penalty
,
,
00
.
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.
.
,
00
22a
See instructions.
Amended Return
,
.
00
,
,
.
22b
00
00
22c
,
,
,
00
.
.
23. If contributing to a School Foundation,
,
,
00
00
,
.
23a
.
or a Library Foundation enter the code
for the foundation(s) and the contribution
,
,
.
00
,
amount(s) in boxes 23a - 23c. If contributing
.
00
23b
to more than 3 school or library foundations,
see Form 760 instructions.
.
,
,
,
00
00
.
23c
24. Total Adjustments (add Lines 18, 19, 20, 21, 22a-c and 23a-c).
,
,
00
,
,
.
00
00
.
Enter here and on Line 28 of Form 760 ....................................................................................... 24
2601050 03/12
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