Form It-203-X - New York Amended Nonresident And Part-Year Resident - 2012 Page 2
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6Page 2 of 6 IT-203-X (2012)
Enter your social security number
Federal amount
New York State amount
Federal income and adjustments
Whole dollars only
Whole dollars only
.
.
1 Wages, salaries, tips, etc. ..............................................
1
1
00
00
.
.
2 Taxable interest income .................................................
2
2
00
00
.
.
3 Ordinary dividends
3
3
..............................................
00
00
4 Taxable refunds, credits, or offsets of state and local
.
.
4
4
income taxes
..............................
(also enter on line 24)
00
00
.
.
5 Alimony received ............................................................
5
5
00
00
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.
6 Business income or loss
6
6
(submit a copy of federal Sch. C or C-EZ, Form 1040)
00
00
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.
7 Capital gain or loss
7
7
(if required, submit a copy of federal Sch. D, Form 1040)
00
00
.
.
8 Other gains or losses
8
8
(submit a copy of federal Form 4797)
00
00
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.
9 Taxable amount of IRA distributions. Beneficiaries: mark X in box
9
9
00
00
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.
10 Taxable amount of pensions/annuities. Beneficiaries: mark X in box
10
10
00
00
11 Rental real estate, royalties, partnerships, S corporations,
.
.
11
11
trusts, etc.
(submit a copy of federal Schedule E, Form 1040)
00
00
12 Rental real estate included
.
12
00
in line 11
(federal amount)
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.
13 Farm income or loss
13
13
(submit a copy of federal Sch. F, Form 1040)
00
00
.
.
14 Unemployment compensation......................................... 14
14
00
00
15 Taxable amount of social security benefits
.
.
15
15
(also enter on line 26)
00
00
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.
16 Other income
16
16
Identify:
00
00
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.
17 Add lines 1 through 11 and 13 through 16 .................. 17
17
00
00
18 Total federal adjustments to income
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.
18
18
Identify:
00
00
.
.
19 Federal adjusted gross income
19
19
(subtract line 18 from line 17)
00
00
New York additions
20 Interest income on state and local bonds
(but not those
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.
.................................... 20
20
of New York State or its localities)
00
00
21 Public employee 414(h) retirement contributions ........... 21
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.
21
00
00
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.
22 Other
22
22
Identify:
00
00
.
.
23 Add lines 19 through 22 ................................................. 23
23
00
00
New York subtractions
24 Taxable refunds, credits, or offsets of state and
.
.
.................................... 24
24
local income taxes
(from line 4)
00
00
25 Pensions of NYS and local governments and the
.
.
federal government...................................................... 25
25
00
00
.
.
26 Taxable amount of social security benefits
. 26
26
(from line 15)
00
00
.
.
27 Interest income on U.S. government bonds ................... 27
27
00
00
28 Pension and annuity income exclusion .......................... 28
.
.
28
00
00
.
.
29 Other
29
29
Identify:
00
00
.
.
30 Add lines 24 through 29 ................................................. 30
30
00
00
.
.
31 New York adjusted gross income
31
31
(subtract line 30 from line 23)
00
00
.
32 Enter the amount from line 31, Federal amount column .......................................................... 32
00
363002120094
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