Form 1040n - Nebraska Individual Income Tax Return - 2014 Page 2

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18 Amount from line 17 (Total Nebraska tax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Nebraska personal exemption credit for residents only ($128 per exemption) . . . . . 19
00
20 Credit for tax paid to another state, line 76, Nebraska Schedule II
(attach Nebraska Schedule II and the other state's return) . . . . . . . . . . . . . . . . . . 20
00
21 Credit for the elderly or disabled (attach copy of Federal Schedule R) . . . . . . . . . . 21
00
22 Community Development Assistance Act credit (attach Form CDN) . . . . . . . . . . . . . 22
00
23 Form 3800N nonrefundable credit (attach Form 3800N) . . . . . . . . . . . . . . . . . . . . . 23
00
24 Nebraska child/dependent care nonrefundable credit, only if line 5 is more
than $29,000 (attach a copy of Federal Form 2441 and see instructions) . . . . . . . . . . 24
00
25 Credit for financial institution tax (attach Form NFC) . . . . . . . . . . . . . . . . . . . . . . . . 25
00
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26 Total nonrefundable credits (add lines 19 through 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27 Subtract line 26 from line 18 (if line 26 is more than line 18, enter -0-) . If the result is greater than your
federal tax liability, complete the Federal Tax Liability Worksheet in the instructions . If entering federal tax,
and attach a copy of the federal return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
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check box
28 Total Nebraska income tax withheld (attach 2014 Forms, see instructions)
a W-2 $ ________________
b K-1N $ ________________
c W-2G, 1099-R,1099-MISC, or others $ ________________ . . . . . . . . . . . . . . . . 28
00
29 2014 estimated tax payments (include any 2013 overpayment credited to 2014 and
any payments submitted with an extension request) . . . . . . . . . . . . . . . . . . . . . . . . . 29
00
30 Form 3800N refundable credit (attach Form 3800N) . . . . . . . . . . . . . . . . . . . . . . . . 30
00
31 Nebraska child/dependent care refundable credit, if line 5 is $29,000 or less
(attach a copy of Form 2441N) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
00
32 Beginning Farmer credit (from Form 1099 BFC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
00
33 Nebraska earned income credit . Enter number of qualifying children
97
Federal credit
$
.00 x .10 (10%) (attach federal return,
98
pages 1 and 2 – see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
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34 Angel Investment Tax Credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
00
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35 Total refundable credits (add lines 28 through 34) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Penalty for underpayment of estimated tax (see instructions) . If you calculated a Form 2210N penalty of -0-
or greater, or used the annualized income method, attach Form 2210N, and check this box
. . . . . . . . 36
00
96
00
37 Total tax and penalty. Add lines 27 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
38 Use tax due on taxable purchases where applicable sales tax was not collected . (see instructions)
Enter purchases subject to state tax
$__________ State tax
$___________ (purchases x 5 .5%);
91
92
Enter purchases subject to local tax
$__________ Local tax
$_______ (purchases x local rate of ____%)
93
94
Local code__ __ __(see local rate schedule);
95
00
Add state and local taxes and enter on line 38 . If no use tax is due, enter -0- on line 38 . . . . . . . . . . . . . . . . . . 38
39 Total amount due . If line 35 is less than total of lines 37 and 38, subtract line 35 from the total of lines 37
00
and 38 . Pay this amount in full . For electronic or credit card payment, check here
and see instructions . . . . 39
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40 Overpayment. If line 35 is more than total of lines 37 and 38, subtract total of lines 37 and 38 from line 35 . . . 40
41 Amount of line 40 you want applied to your 2015 estimated tax . . . . . . . . . . . . . . .
41
00
42 Wildlife Conservation Fund donation of $1 or more . . . . . . . . . . . . . . . . . . . .
42
00
43 Amount of line 40 you want refunded to you (line 40 minus lines 41 and 42) .
File early! It may take three months to receive your refund if you file a paper
return . . . . . . . . . . . . . . . . . 43
00
Expecting a Refund? Have it sent directly to your bank account!
(see instructions)
44a Routing Number
44b Type of Account
1 = Checking
2 = Savings
(Enter 9 digits, first two digits must be 01 through 12, or 21 through 32;
use an actual check or savings account number, not a deposit slip)
44c Account Number
(Can be up to 17 characters . Omit hyphens, spaces, and special symbols . Enter from left to right and leave any unused boxes blank .)
44d
Check this box if this refund will go to a bank account outside the United States .
Under penalties of perjury, I declare that, as taxpayer or preparer, I have examined this return and to the best of my knowledge and belief, it is correct and complete .
sign
here
Your Signature
Date
Email Address
(
)
Keep a copy of
this return for
Spouse’s Signature (if filing jointly, both must sign)
Daytime Phone
your records .
paid
preparer’s
Preparer’s Signature
Date
Preparer’s PTIN
use only
(
)
Print Firm’s Name (or yours if self-employed), Address and Zip Code
EIN
Daytime Phone
Mail returns requesting a refund to: Nebraska Department of Revenue, PO Box 98912, Lincoln, NE 68509-8912.
Mail returns not requesting a refund to: Nebraska Department of Revenue, PO Box 98934, Lincoln, NE 68509-8934.

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