Form N-15 - Individual Income Tax Return Nonresident And Part-Year Resident - 2015 Page 3
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4Form N-15 (Rev. 2015)
Page 3 of 4
Your Social Security Number
Your Spouse’s SSN
Name(s) as shown on return
JCF153
33
Exceptional trees deduction (attach affidavit)
33
(see page 21 of the Instructions) ................................
34
Add lines 21 through 33 ..........Total Adjustments
34
†
If negative number, place a minus sign (-)
If negative number, place a minus sign (-)
-
-
35
Line 20 minus line 34 .....Adjusted Gross Income
35
†
If negative number, place a minus sign (-)
-
36
Federal adjusted gross income (see page 21 of the Instructions)
........36
37
Ratio of Hawaii AGI to Total AGI. Divide line 35, Column B, by line 35, Column A (Compute to 3 decimal places and round to 2 decimal places) ..
37
CAUTION: If you can be claimed as a dependent on another person’s return, see the Instructions on page 21, and place an X here.
38
If you do not itemize deductions, enter zero on line 39 and go to line 40a. Otherwise go to page 21 of the Instructions and enter your Hawaii itemized deductions here.
38a
Medical and dental expenses
ID NO 01
38a
(from Worksheet NR-1 or PY-1) .............................
38b
38b
TOTAL ITEMIZED
Taxes (from Worksheet NR-2 or PY-2) ...................
DEDUCTIONS
39 If your federal and/or Hawaii
38c
Interest expense (from Worksheet NR-3 or PY-3) ...........
38c
adjusted gross income is above
a certain amount, you may not
38d
38d
be able to deduct all of your
Contributions (from Worksheet NR-4 or PY-4) .......
itemized deductions. See the
38e
Casualty and theft losses
Instructions on page 26. Enter
38e
total here and go to line 41.
(from Worksheet NR-5 or PY-5) .............................
38f
Miscellaneous deductions
38f
(from Worksheet NR-6 or PY-6) ..............................
40a
If you checked filing status box: 1 or 3 enter $2,200;
40a
2 or 5 enter $4,400; 4 enter $3,212 .................................
-
40b
Multiply line 40a by the ratio on line 37 .................................. Prorated Standard Deduction
† 40b
If negative number, place a minus sign (-)
41
41
Line 35, Column B minus line 39 or 40b, whichever applies. (This line MUST be filled in) ...........
42a
If line 35, Column B is $89,981 or less, multiply $1,144 by the total number of exemptions claimed on line 6e. Otherwise, see page 27 of the Instructions. If you and/or
your spouse are blind, deaf, or disabled, place an X in the applicable box(es)
Yourself
Spouse, and see the Instructions
.............42a
42b
Multiply line 42a by the ratio on line 37 ............................................. Prorated Exemption(s)
† 42b
43
Taxable Income. Line 41 minus line 42b (but not less than zero) ................ Taxable Income
† 43
44
Tax. Place an X if from:
Tax Table;
Tax Rate Schedule; or
Capital Gains Tax Worksheet on page 45 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-348, N-405,
(
N-586, N-615, or N-814 is included.) ............................................................................................ Tax
† 44
44a
If tax is from the Capital Gains Tax Worksheet, enter
the net capital gain from line 8 of that worksheet
.............................................44a
45
Refundable Food/Excise Tax Credit
(attach Schedule X) DHS, etc. exemptions
45
......
46
Credit for Low-Income Household
46
Renters (attach Schedule X) .............................................
47
Credit for Child and Dependent Care
47
Expenses (attach Schedule X) ..........................................
48
Credit for Child Passenger Restraint
48
System(s) (attach a copy of the invoice)............................
49
Total refundable tax credits from
49
-
Schedule CR (attach Schedule CR) ...................
50
Add lines 45 through 49 ..................................................Total Refundable Credits
† 50
If negative number, place a minus sign (-)
51
51
Line 44 minus line 50. If line 51 is zero or less, see Instructions.. ..................................
FORM N-15
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