Form R-210r - Underpayment Of Individual Income Tax Penalty Computation 2012 Taxable Year

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R-210R (1/13)
2012
Underpayment of Individual Income Tax
Penalty Computation 2012 Taxable Year
Resident Filers
PLEASE PRINT OR TYPE.
Name as shown in the order on tax return
Social Security Number
Yours
Yours
Spouse’s
Spouse’s
Section 1 – Required Annual Payment Computation
1
2012 tax liability - See instructions.
00
2
2011 tax liability - See instructions.
00
3
Print the smaller of Line 1 or Line 2
00
4
Number of payments required for year
Section 2 – Underpayment Computation
04/15/12
06/15/12
09/15/12
01/15/13
Required payment - From Section 1, divide amount on
5
00
00
00
00
Line 3 by amount on Line 4 . See instructions.
6
Amount paid for each period - See instructions.
00
00
00
00
Carryforward - Overpayment or underpayment from
previous period shown on Line 9 of each column.
Carryforward amounts from the previous period can
7
00
00
00
be a positive number or a negative number.
Note: No carryforward amount can be shown for the
first period. See instructions.
8
Amount available for period. Add Lines 6 and 7.
00
00
00
00
Underpayment or overpayment - Subtract Line 5
from Line 8. A positive number indicates an over-
9
payment. A negative number indicates an underpay-
00
00
00
00
ment. Move the number on this line to Line 7 in next
column.
Section 3 – Exceptions
Exception 1 – See worksheet on page 3. If you meet this exception, you do not owe an underpayment penalty. STOP – You
10
do not need to file this form.
11 Exception 2 – Prior Year’s Tax Liability
00
00
00
00
12 Exception 3 – Prior Year’s Income.
00
00
00
00
no exception
13 Exception 4 – Annualized Income
00
00
00
available
14 Exception 5 – Installment Period Income
00
00
00
00
Section 4 – Penalty Computation
15
Amount of underpayment (from Line 9 above)
00
00
00
00
16
Date of Payment – See instructions.
17
Number of days from due date of installment
18
Penalty – See instructions.
00
00
00
00
Penalty – Add amounts on Line 18. Enter total here and on Form IT-540, Line 31 if you have an overpayment.
19
00
Enter the total here and on Form IT-540, Line 45 if you have a balance due.

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