Form N-11 - Individual Income Tax Return Resident - 2015 Page 2
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6Form N-11 (Rev. 2015)
Page 2 of 4
Your Social Security Number
Your Spouse’s SSN
JBF152
Name(s) as shown on return
ROUND TO THE NEAREST DOLLAR
t
IF NEGATIVE, PLACE MINUS SIGN
-
7
Federal adjusted gross income (AGI) (see page 11 of the Instructions) .......................................
7
8
Difference in state/federal wages due to COLA, ERS,
etc. (see page 12 of the Instructions) .................................. 8
9
Interest on out-of-state bonds
(including municipal bonds) ................................................. 9
10
Other Hawaii additions to federal AGI
(see page 12 of the Instructions) ...................................... 10
11
Add lines 8 through 10 .................. Total Hawaii additions to federal AGI
11
t
IF NEGATIVE, PLACE MINUS SIGN
-
12
Add lines 7 and 11 ......................................................................................................................... 12
13
Pensions taxed federally but not taxed by Hawaii
(see page 14 of the Instructions) ....................................... 13
14
Social security benefits taxed on federal return................. 14
15
First $6,198 of military reserve or Hawaii national
guard duty pay ................................................................... 15
16
Payments to an individual housing account ...................... 16
17
Exceptional trees deduction (attach affidavit)
(see page 15 of the Instructions) ....................................... 17
18
Other Hawaii subtractions from federal AGI
(see page 15 of the Instructions) ....................................... 18
19
Add lines 13 through 18
............................................ Total Hawaii subtractions from federal AGI
19
t
IF NEGATIVE, PLACE MINUS SIGN
-
ä
20
Line 12 minus line 19 ............................................................................................ Hawaii AGI
20
CAUTION: If you can be claimed as a dependent on another person’s return, see the Instructions on page 16, and place an X here.
21
If you do not itemize your deductions, go to line 23 below. Otherwise go to page 17 of the Instructions
and enter your itemized deductions here.
21a
Medical and dental expenses
(from Worksheet A-1) ...................................................... 21a
TOTAL ITEMIZED
21b
Taxes (from Worksheet A-2) ............................................ 21b
DEDUCTIONS
22 Add lines 21a through 21f.
If your federal and/or Hawaii
21c
Interest expense (from Worksheet A-3) ........................... 21c
adjusted gross income is above
a certain amount, you may not
be able to deduct all of your
21d
Contributions (from Worksheet A-4) ................................ 21d
itemized deductions. See the
Instructions on page 21. Enter
total here and go to line 24.
21e
Casualty and theft losses (from Worksheet A-5) ............. 21e
21f
Miscellaneous deductions (from Worksheet A-6) ............. 21f
23
If you checked filing status box: 1 or 3 enter $2,200;
ä
2 or 5 enter $4,400; 4 enter $3,212 ........................................................Standard Deduction
23
t
IF NEGATIVE, PLACE MINUS SIGN
-
24 Line 20 minus line 22 or 23, whichever applies. (This line MUST be filled in) .................. 24
ID NO 99
FORM N-11
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