Form 760py - Virginia Part-Year Resident Income Tax Return - 2015 Page 2

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*VA760P215888*

2015 Form 760PY

Page 2

Your Name

Your SSN

Spouse

You

Include Spouse if

Filing Status 4 ONLY

Filing Status 2

14 Prorated exemption amount from Schedule of Income, Part 2, Line 11.

See instructions ....................................................................................................

15 Deductions from Schedule 760PY ADJ, Line 9. ...................................................

16 Add Lines 13, 14 and 15. ....................................................................................

17 Virginia Taxable Income. Subtract Line 16 from Line 10. ...............................

18 Tax amount from Tax Table or Tax Rate Schedule. ..............................................

19 Total Tax. Add Line 18, Column A and Line 18, Column B. ............................................................................

20a

20a Your Virginia income tax withheld. Enclose copies of Forms W-2, W-2G, 1099 and VK-1 ..................................

20b

20b Spouse's Virginia income tax withheld. Enclose copies of Forms W-2, W-2G, 1099 and VK-1 ...........................

Combined 2015 Estimated Tax Payments. ...........................................................................................................

2014 overpayment credited to 2015 estimated taxes. ..........................................................................................

Extension Payment - Enter amount paid on Form 760IP. .....................................................................................

Tax Credit for Low-Income Individuals or Virginia Earned Income Credit from Schedule 760PY ADJ, Line 17. ..

Total credit for taxes paid to another state from Schedule OSC...........................................................................

Credit for Political Contributions . .......................................................................................................................

Credits from Schedule CR, Section 5, Line 1A. ..................................................................................................

Total payments and credits. Add Lines 20a, 20b, 21, 22, 23, 24, 25, 26 and 27. ..........................................

If Line 19 is larger than Line 28, enter the difference. This is the INCOME TAX YOU OWE. ..............................

If Line 28 is larger than Line 19, enter the difference. This is the OVERPAYMENT AMOUNT. ...........................

Amount of overpayment on Line 30 to be CREDITED TO 2016 ESTIMATED INCOME TAX. ...................................

Virginia College Savings Plan Contributions from Schedule VAC, Section I, Line 6 ...........................................

Other Voluntary Contributions from Schedule VAC, Section II, Line 14 ...............................................................

Addition to Tax, Penalty and Interest from enclosed Schedule 760PY ADJ, Line 21. .........................................

Consumer’s Use Tax. You may be liable if sales tax was not paid on Internet or other purchases. See

instructions. ..........................................................................................................................................................

Add Lines 31 through 35. ...................................................................................................................................

If you owe tax on Line 29, add Lines 29 and 36 - OR - If Line 30 is an overpayment and Line 36 is larger than

Line 30, enter the difference. Enclose payment or pay at YOU OWE .....

Check here if paying by credit or debit card - See instructions. ............................................................

If Line 30 is larger than Line 36, subtract Line 36 from Line 30. ............................................ YOUR REFUND. .....

If the Direct Deposit section below is not completed, your refund will be issued by check.

DIRECT BANK DEPOSIT

Checking

Your Bank Routing Transit Number

Your Bank Account Number

Savings

Domestic Accounts Only.

No International Deposits.

I agree to obtain my Form 1099-G at

I (we) authorize the Department of Taxation to discuss this return with my (our) preparer.

I (We), the undersigned, declare under penalty of law that I (we) have examined this return and to the best of my (our) knowledge, it is a true, correct and complete

return.

Your Phone Number

Date

Your Signature

Spouse’s Signature (If a joint return, both must sign)

Spouse’s Phone Number

Date

Preparer’s Name

Preparer’s Phone Number

Date

Firm’s Name (or Yours if Self-Employed)

Preparer’s PTIN