Virginia Schedule 760py Adj (Form 760py Adj) - 2015 Page 2
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2015 Virginia Schedule 760PY ADJ
Page 2
Your Name
Your SSN
Tax Credit for Low-Income Individuals or Virginia Earned Income Credit
• List below the name, Social Security Number (SSN) and Guideline Income for you, your spouse and each dependent.
• If more room is needed, enclose a schedule with the name, SSN and Guideline Income for each additional dependent.
• Failure to complete Lines 10 - 17 may result in this credit being reduced or disallowed.
Family VAGI
Guideline Income
Name
Social Security Number (SSN)
You
-
-
00
Spouse
-
-
00
Dependent
-
-
00
Dependent
-
-
00
10. Total Family Guideline Income (Be sure to include information from enclosed schedule, if
00
applicable)
10
11.
Enter the total number of exemptions reported in the table above and on any enclosed schedule.
Based on this total, the total Family Guideline Income from Line 10 and the poverty guidelines in
the instructions, determine your eligibility. ..................................................................................
11
12.
If you qualify, enter the number of personal and dependent exemptions reported on your Form
760PY (see instructions).............................................................................................................
12
00
13.
Multiply Line 12 by $300. Enter the result on Line 13 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 Earned Income Credit on your federal return, enter $0. If you are married filing separately,
00
see the instructions.
14
00
15.
Multiply Line 14 by 20% (.20). ....................................................................................................
15
00
16.
Enter the greater of Line 13 or Line 15. ......................................................................................
16
17.
Compare the amount on Line 16 above to the amount of tax on Form 760PY, Line 19. Enter the
00
lesser of the two amounts here and on Form 760PY, Line 24. This is your credit amount. ........
17
Addition to Tax, Penalty and Interest
00
18.
Addition to tax. Check if addition came from: .......
Form 760C
Form 760F ..................
18
00
19.
Penalty. .................................................................
Late Filing Penalty
Extension Penalty
19
00
20.
Interest (accrued on the tax you owe). ........................................................................................
20
21.
Total Addition to Tax, Penalty and Interest (add Lines 18-20). Enter here and on Form 760PY,
00
Line 34 .........................................................................................................................................
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