Form Mo-Nri - Missouri Income Percentage - 2013
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1
22013
Attachment Sequence No. 1040‑04
MISSOURI DEPARTMENT OF REVENUE
MISSOURI INCOME
FORM
Attach Federal Return. See Instructions and
MO-NRI
PERCENTAGE
Diagram on page 2 of Form MO-NRI.
PART A — RESIDENT/NONRESIDENT STATUS — Check your status in the appropriate box below.
NAME (YOURSELF)
NAME (SPOUSE)
ADDRESS
ADDRESS
CITY, STATE, ZIP CODE
SOCIAL SECURITY NUMBER
CITY, STATE, ZIP CODE
SOCIAL SECURITY NUMBER
1. NONRESIDENT OF MISSOURI
1. NONRESIDENT OF MISSOURI
What was your state of residence during 2013?
What was your state of residence during 2013?
2. PART-YEAR MISSOURI RESIDENT
2. PART-YEAR MISSOURI RESIDENT
a. Indicate the date you were a Missouri resident in 2013.
Date From:
Date To:
a. Indicate the date you were a Missouri resident in 2013.
Date From:
Date To:
b. Indicate other state of residence and date you resided there. Date From:
Date To:
b. Indicate other state of residence and date you resided there.
Date From:
Date To:
Based on the Military Spouse’s Residency Relief Act, if you are the spouse of a military servicemember residing outside of Missouri solely
because your spouse is there on military orders, and Missouri is your state of residence, any income you earn is taxable to Missouri.
Do not complete Form MO-NRI. You must report 100% on Line 27 of MO-1040.
3. MILITARY/NONRESIDENT TAX STATUS — Indicate your tax
3. MILITARY/NONRESIDENT TAX STATUS — Indicate your tax
status below and complete Part C—Missouri Income Percentage.
status below and complete Part C—Missouri Income Percentage.
a. Missouri Home of Record
a. Missouri Home of Record
I did not at any time during the 2013 tax year maintain a permanent place of
I did not at any time during the 2013 tax year maintain a permanent place of
abode in Missouri nor did I spend more than 30 days in Missouri during the
abode in Missouri nor did I spend more than 30 days in Missouri during the
year. I did maintain a permanent place of abode in the state of ___________.
year. I did maintain a permanent place of abode in the state of ___________.
b. Non-Missouri Home of Record
b. Non-Missouri Home of Record
I resided in Missouri during 2013 solely because my spouse or I was stationed
I resided in Missouri during 2013 solely because my spouse or I was stationed
at ___________________________________ on military orders, my home of
at ___________________________________ on military orders, my home of
record is in the state of _________________________________________.
record is in the state of _________________________________________.
PART B — WORKSHEET FOR MISSOURI SOURCE INCOME
YOURSELF OR
SPOUSE (ON A
FEDERAL
FEDERAL
ADJUSTED GROSS INCOME
FORM
FORM
ONE INCOME FILER
COMBINED RETURN)
1040A
1040
COMPUTATIONS
LINE
LINE
MISSOURI SOURCES
MISSOURI SOURCES
NO.
NO.
00
00
A. Wages, salaries, tips, etc. ........................................................
7
7
A
A
00
00
B. Taxable interest income ...........................................................
8a
8a
B
B
00
00
C. Dividend income ......................................................................
9a
9a
C
C
00
00
D. State and local income tax refunds ..........................................
none
10
D
D
00
00
E. Alimony received .....................................................................
none
11
E
E
00
00
F. Business income or (loss) ........................................................
none
12
F
F
00
00
G. Capital gain or (loss) ................................................................
10
13
G
G
00
00
H. Other gains or (losses) ............................................................
none
14
H
H
00
00
I. Taxable IRA distributions .........................................................
11b
15b
I
I
00
00
J. Taxable pensions and annuities ..............................................
12b
16b
J
J
00
00
K. Rents, royalties, partnerships, S corporations, trusts, etc........
none
17
K
K
00
00
L. Farm income or (loss) ..............................................................
none
18
L
L
00
00
M. Unemployment compensation .................................................
13
19
M
M
00
00
N. Taxable social security benefits ...............................................
14b
20b
N
N
00
00
O. Other income ...........................................................................
none
21
O
O
00
00
P. Total — Add Lines A through O. ..............................................
15
22
P
P
00
00
Q. Less: federal adjustments to income .......................................
20
36
Q
Q
R. SUBTOTAL (Line P – Line Q) If no modifications to income,
00
00
....
21
37
R
R
STOP and ENTER this amount on reverse side, Part C, Line 1.
S. Missouri modifications — additions to federal adjusted gross income
00
00
(Missouri source from Form MO‑1040, Line 2) ....................................................
S
S
T. Missouri modifications — subtractions from federal adjusted gross income
00
00
(Missouri source from Form MO‑1040, Line 4) ....................................................
T
T
U. MISSOURI INCOME (Missouri sources). Line R plus Line S,
00
00
minus Line T. Enter this amount on reverse side, Part C, Line 1. .................
U
U
MO-NRI (Revised 12-2013)
For Privacy Notice, see instructions.
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