Form 200-01 - Delaware Individual Resident Income Tax Return - 2013 Page 2

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R
2013
Page 2
2013 DELAWARE RESIDENT FORM 200-01, PAGE 2
(Reconcile your Federal
COLUMNS: Column A is reserved for the spouse of those couples choosing filing status 4.
totals to the appropriate individual. See Page 9 worksheet.) Taxpayers using filing statuses 1, 2, 3, or 5 are to complete Column B only.
Filing Status 4 ONLY
All other filings statuses
Spouse Information
You or You plus Spouse
MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME
COLUMN A
COLUMN B
SECTION A - ADDITIONS (+)
29.
Enter Federal AGI amount from Federal 1040, Line 37; 1040A, Line 21; or 1040EZ, Line 4...........................................
29
00
00
30. Interest on State & Local obligations other than Delaware...................................................................................
00
00
30
31. Fiduciary adjustment, oil depletion......................................................................................... ..........................
31
00
00
32. TOTAL - Add Lines 30 and 31.............................................................................................. ............................
00
00
32
33. Subtotal. Add Lines 29 and 32.....................................
00
00
33
SECTION B - SUBTRACTIONS (-)
34. Interest received on U.S. Obligations...............................................................................................................
00
00
34
35. Pension/Retirement Exclusions (For a definition of eligible income, see instructions on Page 10)
00
00
.....
35
36.
Delaware State tax refund, fiduciary adjustment, work opportunity tax credit,
Delaware NOL Carry forward.- please see instructions on Page 10........................................................................
00
00
36
Taxable Soc Sec/RR Retirement Benefits/Higher Educ. Excl/Certain Lump Sum Dist. (See instr. on Pg 11).......
37.
37
00
00
00
00
38. SUBTOTAL. Add Lines 34, 35, 36 and 37 and enter here.................................................................................
38
39. Subtotal. Subtract Line 38 from Line 33.......................
00
00
39
00
00
40
40. Exclusion for certain persons 60 and over or disabled (See instructions on Page 11)...........................................
41
00
00
41. TOTAL - Add Lines 38 and 40....................................................................................................... ..................
00
00
42
42.
DELAWARE ADJUSTED GROSS INCOME. Subtract line 41 from Line 33. Enter here and on Front, Line 1........
SECTION C - ITEMIZED DEDUCTIONS (MUST ATTACH FEDERAL SCHEDULE A) If Columns A and B are used and you are unable to specifically
allocate deductions between spouses, you must prorate in accordance with income.
43. Enter total Itemized Deductions from Schedule A, Federal Form, Line 29...............................................................
00
00
43
44. Enter Foreign Taxes Paid (See instructions on Page 11).............................................................................. .......
00
00
44
45. Enter Charitable Mileage Deduction (See instructions on Page 11).....................................................................
00
00
45
46. SUBTOTAL. - Add Lines 43, 44, and 45 and enter here.....................................................................................
00
00
46
47a. Enter State Income Tax included in Line 43 above (See instructions on Page 11)................................................
47a
00
00
47b. Enter Form 700 Tax Credit Adjustment (See instructions on Page 11).................................................................
00
00
47b
48. TOTAL - Subtract Line 47a and 47b from Line 46. Enter here and on Front, Line 2 (See instructions)...............
00
00
48
SECTION D - DIRECT DEPOSIT INFORMATION If you would like your refund deposited directly
to your checking or savings account, complete boxes a, b, c and d below. See instructions for details.
a. Routing Number
b. Type:
Checking
Savings
d. Is this refund going to or through an account that is
c. Account Number
located outside of the United States?
Yes
No
NOTE: If your refund is adjusted by $100.00 or more, a paper check will be issued and mailed to the address on your return.
BE SURE TO SIGN YOUR RETURN BELOW AND KEEP A COPY FOR YOUR RECORDS
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and believe it is true, correct and complete.
o Y
r u
S
g i
a n
u t
e r
a D
e t
S
g i
a n
u t
e r
f o
a P
d i
P
e r
a p
r e r
a D
e t
Spouse's Signature (if filing joint or combined return) Date
Address
o H
m
e
P
o h
e n
B
i s u
e n
s s
P
o h
e n
C
y t i
S
a t
e t
Z
p i
EIN, SSN OR PTIN
E-Mail Address
Business Phone
E-Mail Address
NET BALANCE DUE (LINE 27):
NET REFUND (LINE 28):
ZERO (LINE 28):
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
P.O. BOX 508
P.O. BOX 8765
P.O. BOX 8711
WILMINGTON, DE 19899-0508
WILMINGTON, DE 19899-8765
WILMINGTON, DE 19899-8711
MAKE CHECK PAYABLE TO : DELAWARE DIVISION OF REVENUE
PLEASE REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN
*DF20113029999*
(Rev 10/31/13)

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