Form N-109 - Application For Tentative Refund From Carryback Of Net Operating Loss Page 4
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4FORM N-109
(REV. 2015)
be refigured on the basis of your adjusted gross
original or amended return. If the return was ex-
on the Personal Exemptions Worksheet in your
income, determined after application of the NOL
amined, enter the amounts that were determined
Form N-11 instruction booklet.
carryback. Also, any credits based on or limited
as a result of the examination.
Line 13. Income Tax. — Refigure your tax af-
by the tax may be figured on the tax liability as
Note: If you carry back any portion of a NOL to
ter the carryback to determine the tax decrease.
determined after application of the NOL carry-
tax years before the 3 years preceding the year
Include in the tax before carryback, amounts
back.
of the NOL, use additional Forms N-109 to carry
shown on your original or amended return, and
K. COMPUTATION WHEN THE NOL IS
back the NOL. Complete lines 1 through 5 and
later adjusted, based on an examination of your
NOT FULLY ABSORBED IN PRECEDING TAX
Schedule A on only one Form N-109. Use this
return.
YEAR(S).—The amount of a NOL which you may
Form N-109 for the earliest preceding tax years.
Attach a detailed computation of the new tax
carry to the next year, after applying it to a prior
You must sign this Form N-109, but do not need
liability shown on line 13, columns (b), (d), and (f).
year or years, is the excess, if any, of the NOL
to sign the other Forms N-109.
The tax form and instructions for the applicable
carryback over the taxable income of such prior
Note: Only the portion of a NOL for a tax year
year will be helpful in making this computation.
year(s) figured with the following modifications:
that’s an “eligible loss” with respect to the
Include in the amount on line 13 any tax from
(1) Your deduction for capital losses must not
taxpayer may be carried back to the 3 preceding
Forms N-2, N-103, N-152, N-312, N-318, N-338,
be more than the capital gains included in gross
tax years. Farming losses may be carried back to
N-344, N-405, N-586, or N-814.
income.
the 5 preceding tax years.
Line 14. Refundable tax credits for tax
(2) You are not permitted any deduction for
Line 9. Deductions. — Individuals — Enter
years after 2009 (Nonrefundable tax credits
the excess of a net long-term capital gain over a
the amount of your itemized deductions, after any
for tax years prior to 2010). — Note: For tax-
net short-term capital loss.
limitations, or the standard deduction amount if
able years beginning on or after January 1, 2010,
you did not itemize your deductions.
when offsetting income tax liability, refundable
(3) Your taxable income for the prior tax
tax credits must be used first, followed by nonre-
year(s) is determined without taking into account
If your Hawaii adjusted gross income was
fundable tax credits.
the NOL carryback from the loss year or any later
more than $83,400 or if your federal adjusted
tax year. NOLs, otherwise allowable as carry-
gross income was more than $100,000 and you
If you are carrying back your NOL to tax years
backs or carryovers, occurring in tax years before
were not able to deduct all of your itemized de-
after 2009, enter the total of your refundable tax
such loss year, are taken into account in figuring
ductions, enter the amount you were able to de-
credits.
the taxable income for the prior tax year.
duct as calculated on the Total Itemized Deduc-
If you are carrying back your NOL to tax years
tions Worksheet in your Form N-11 instruction
(4) You may not claim any personal exemp-
prior to 2010, enter the total of your nonrefund-
booklet.
tions.
able tax credits. Do not enter an amount that is
For tax years after 2012, the standard deduc-
more than the amount of your income tax liability
(5) Any deductions claimed, except charitable
tion amounts are $2,200 for single or married fil-
on line 13.
contributions, which are based on or limited to a
ing separately filers; $3,212 for head of household
percentage of adjusted gross income (such as
Line 15. — If you are carrying back your NOL
filers; and $4,400 for married filing jointly or quali-
medical expenses) must be refigured on the ba-
to tax years prior to 2010, line 15 cannot be less
fying widow(er) filers. For tax years prior to 2013,
sis of the adjusted gross income after application
than zero.
the standard deduction amounts are $2,000 for
of adjustments (1), (2), and (3) above. The de-
Line 16. Nonrefundable tax credits for tax
single or married filing separately filers; $2,920
duction for charitable contributions is determined
years after 2009 (Refundable tax credits for
for head of household filers; and $4,000 for mar-
using the same adjustments except that you do
tax years prior to 2010). — Note: For taxable
ried filing jointly or qualifying widow(er) filers.
not take into account any NOLs being carried
years beginning on or after January 1, 2010,
back.
Line 11. Exemptions. — Individuals — For
when offsetting income tax liability, refundable
tax years after 2012, enter $1,144 times the num-
The taxable income as modified is to be con-
tax credits must be used first, followed by nonre-
ber of exemptions claimed. For tax years prior to
sidered not less than zero.
fundable tax credits.
2013, enter $1,040 times the number of exemp-
L. ATTACHMENTS.—Attach a copy of your
If you are carrying back your NOL to tax years
tions claimed.
original federal income tax return for the loss year
after 2009, enter the total of your nonrefundable
Those qualifying for the disability exemp-
to Form N-109. If a copy of your federal return is
tax credits. Do not enter an amount that is more
tion use the appropriate amounts instead of the
not attached, the processing of your return and
than the amount of your adjusted income tax li-
above.
refund may be delayed.
ability on line 15. If line 15 is zero or less, enter
If your Hawaii adjusted gross income was
zero on line 16.
Line-By-Line Instructions For
more than $89,981 and you were not able to de-
If you are carrying back your NOL to tax years
Form N-109
duct all of your personal exemptions, enter the
prior to 2010, enter the total of your refundable
amount you were able to deduct as calculated
tax credits.
Enter in columns (a), (c), and (e) your tax for
the applicable carryback year as shown on your
Page 4
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