Form N-11- Individual Income Tax Return - Resident/schedule Cr - Schedule Of Tax Credits - 2012

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STATE OF HAWAII — DEPARTMENT OF TAXATION

FORM

N-11

Individual Income Tax Return

(Rev. 2012)

RESIDENT

2012

Calendar Year

JBF121

**These date fields are used by Fiscal Year filers only.** If you are not sure, then

leave them blank. Enter the dates MM DD YY format. For example: 09 30 12

AMENDED Return

Fiscal Year

Beginning

and Ending

NOL Carryback

INSTRUCTIONS

- The data that you enter into this Adobe Acrobat form cannot be saved. You must

FOR OFFICE USE ONLY

print, sign and mail the forms to the Hawaii Department of Taxation. Don't forget to

attach all required forms.

- Use the blue Print Form button at the top of this page to print the form. If you are

not claiming any credits on Schedule CR, select the 4 page print option.

- This form uses a 2D barcode on the first page of the form to gather all the form’s

Do NOT Submit a Photocopy!!

data. If you print the form and need to make changes, then type in the changes

and re-print the entire form. Do not make changes to the return data using a pen

or pencil.

- Click on the red Reset button at the top of this page to clear all of the form data

Place an X in applicable box, if appropriate

and start over.

- Use the Tab key to move forward between fields, Shift+Tab to move backwards

First Time Filer

Address or Name Change

between fields, or use your mouse pointer to click on the field you want.

- To mark a checkbox either click on it using your mouse pointer, or press the

space key.

Your First Name

M.I.

Your Last Name

u IMPORTANT — Complete this Section u

Enter the first four letters

Spouse’s First Name

M.I.

Spouse’s Last Name

of your last name.

Use ALL CAPITAL letters

Care Of (See Instructions, page 7.)

Your Social

Security Number

Present mailing or home address (Number and street, including Rural Route)

Enter the first four letters

of your Spouse’s last name.

City, town or post office.

State

Postal/ZIP code

Use ALL CAPITAL letters

Spouse's Social

If Foreign address, enter Province and/or State

Country

Security Number

(Place an X in only ONE box)

Single

Head of household (with qualifying person). If the qualifying

Married filing joint return (even if only one had income).

person is a child but not your dependent, enter the child’s full

Married filing separate return. Enter spouse’s SSN and

name.

†

the first four letters of last name above. Enter spouse’s full

__________________________________

name here.

Qualifying widow(er) with dependent child. Enter the year

_____________________________________

your spouse died

CAUTION: If you can be claimed as a dependent on another person’s tax return (such as your parents’), DO NOT place an X on line 6a, but be sure to place an X above line 21.

}

Yourself ............................................

Age 65 or over ........................................................

Enter the number of Xs

on 6a and 6b ................

Spouse.............................................

Age 65 or over ........................................................

If you placed an X on lines 3 and 6b above, see the Instructions on page 9 and if your spouse meets the qualifications, place an X here

Enter the number of your dependent children (see page 9 of the Instructions) ............................................................................... 6c

Enter the number of other dependents (see page 9 of the Instructions) .......................................................................................... 6d

Total number of exemptions claimed. Add numbers entered in boxes 6a thru 6d above .............................................................. 6e

ID NO 99

FORM N-11