Form 511nr - Oklahoma Nonresident/ Part-Year Income Tax Return - 2012 Page 39
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2012 Form 511NR - Nonresident/Part-Year Income Tax Return - Page 3
NOTE: Enclose this page ONLY if you have an amount shown on a schedule.
Name(s) shown
Your Social
on Form 511NR:
Security Number:
Oklahoma Additions
See instructions for details on
Schedule 511NR-A
qualifications and required enclosures.
federal amount
oklahoma amount
State and municipal bond interest ....................................
00
00
1
1
00
00
Lump sum distributions
......
(not included in your Federal AGI)
2
2
00
00
Federal net operating loss .................................................
3
3
Recapture depletion claimed on a lease bonus or
4
add back of excess Federal depletion ...............................
00
00
4
00
00
Expenses incurred to provide Okla. child care programs ..
5
5
Recapture of contributions to Oklahoma 529 College
6
Savings Plan and OklahomaDream 529 Account(s) .........
00
00
6
Miscellaneous: Other additions .........................................
7
(enter number in box for the type of addition
)
00
00
7
Total additions .................................................................
8
00
00
(add lines 1-7, enter total here and on line 20 of Form 511NR)
8
Oklahoma Subtractions
See instructions for details on
Schedule 511NR-B
qualifications and required enclosures.
federal amount
oklahoma amount
Interest on U.S. government obligations ...........................
00
00
1
1
Taxable Social Security (from Form 511NR, line 14) ...........
00
00
2
2
00
00
Federal civil service retirement in lieu of social security ....
3
3
- Retirement
Taxpayer Number
Spouse Number
Claim Number:
Military Retirement (see instructions for limitation) ............
00
00
4
4
Oklahoma government or Federal civil service retirement
00
00
5
5
Other retirement income ....................................................
00
00
6
6
00
00
U.S. Railroad Retirement Board Benefits ..........................
7
7
Additional depletion ...........................................................
00
00
8
8
Oklahoma net operating loss .............................................
00
00
9
9
Exempt tribal income .........................................................
00
00
10
10
Gains from the sale of exempt government obligations ....
00
00
11
11
Nonresident military wages (enclose W-2) ........................
00
12
12
Oklahoma Capital Gain Deduction
..
00
00
(Enclose Form 561NR)
13
13
Miscellaneous: Other subtractions ...................................
14
00
00
(enter number in box for the type of deduction
)
14
Total subtractions ......................................................................
15
00
00
(add lines 1-14, enter total here and on line 22 of Form 511NR)
15
Oklahoma Adjustments
See instructions for details on
Schedule 511NR-C
qualifications and required enclosures.
Military pay exclusion - Active Duty, Reserve and National Guard (not retirement) .......
00
1
1
00
Qualifying disability deduction (residents and part-year residents only)..........................
2
2
Political contribution (limited to $100 [$200 for joint return])............................................
00
3
3
Interest qualifying for exclusion (limited to $100 [$200 for joint return]) ..........................
00
4
4
Qualified adoption expense .............................................................................................
00
5
5
Contributions to Oklahoma 529 College Savings Plan and OklahomaDream 529 Account(s) .....
00
6
6
00
Miscellaneous: Other adjustments
..
(enter number in box for the type of deduction
)
7
7
00
Total Adjustments (add lines 1-7, enter total here and on line 26 of Form 511NR) ......
8
8
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