Form N-11- Individual Income Tax Return - Resident/schedule Cr - Schedule Of Tax Credits - 2012 Page 3
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6Form N-11 (Rev. 2012)
Page 3 of 4
Your Social Security Number
Your Spouse’s SSN
JBF123
Name(s) as shown on return
25
If line 20 is $89,981 or less, multiply $1,040 by the total number of exemptions claimed on
line 6e. Otherwise, see page 21 of the Instructions. If you and/or your spouse are blind, deaf,
or disabled, place an X in the applicable box(es), and see page 21 of the Instructions.
Spouse ............................................................................................... 25
Yourself
26
Taxable Income. Line 24 minus line 25 (but not less than zero) ...................Taxable Income ä 26
27
Tax. Place an X if from
Tax Table;
Tax Rate Schedule; or
Capital Gains Tax
Worksheet on page 37 of the Instructions.
(
Place an X if tax from Forms N-2, N-103, N-152, N-168, N-312, N-318, N-338,
N-344, N-405, N-586, N-615, or N-814 is included.) .......................................................... Tax ä 27
27a
If tax is from the Capital Gains Tax Worksheet, enter
the net capital gain from line 14 of that worksheet .......... 27a
28
Refundable Food/Excise Tax Credit
(attach Schedule X) DHS, etc. exemptions
.... 28
29
Credit for Low-Income Household
Renters (attach Schedule X) ............................................. 29
30
Credit for Child and Dependent
Care Expenses (attach Schedule X) ................................. 30
31
Credit for Child Passenger Restraint
System(s) (attach a copy of the invoice)............................ 31
32
Total refundable tax credits from
Schedule CR (attach Schedule CR) .................................. 32
33
Add lines 28 through 32 ................................................................. Total Refundable Credits ä 33
t
IF NEGATIVE, PLACE MINUS SIGN
-
34
Line 27 minus line 33. If line 34 is zero or less, see Instructions. .................................................. 34
35
Total nonrefundable tax credits (attach Schedule CR) .................................................................. 35
t
IF NEGATIVE, PLACE MINUS SIGN
-
36
Line 34 minus line 35 ................................................................................................. Balance ä 36
37
Hawaii State Income tax withheld (attach W-2s)
(see page 26 of the Instructions for other attachments) .................. 37
38
2012 estimated tax payments............................................ 38
39
Amount of estimated tax applied from 2011 return ........... 39
40
Amount paid with extension............................................... 40
41
Add lines 37 through 40 ................................................................................. Total Payments ä 41
42
If line 41 is larger than line 36, enter the amount OVERPAID (line 41 minus line 36) (see Instructions) .. 42
43
Contributions to (see page 27 of the Instructions): ........................
Yourself
Spouse
43a Hawaii Schools Repairs and Maintenance Fund .....................
$2
$2
43b Hawaii Public Libraries Fund ...................................................
$2
$2
43c Domestic and Sexual Violence / Child Abuse and Neglect Funds .............
$5
$5
44
Add the amounts of the Xs on lines 43a through 43c and enter the total here ............................. 44
45 Line 42 minus line 44 ........................................................................................................ 45
ID NO 99
FORM N-11
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