IT-203
New York State Department of Taxation and Finance
Nonresident and Part-Year Resident
Income Tax Return
New York State • New York City • Yonkers
1 2
For the year January 1, 2012, through December 31, 2012, or fiscal year beginning ...........
and ending ...........
For help completing your return, see the instructions, Form IT-203-I.
Your first name and middle initial
Your last name
(for a joint return, enter spouse’s name on line below)
Your social security number
Your date of birth (mm-dd-yyyy)
Spouse’s first name and middle initial Spouse’s last name
Spouse’s social security number
Spouse’s date of birth (mm-dd-yyyy)
New York State county of residence
Mailing address
Apartment number
(see instructions, page 13) (number and street or rural route)
City, village, or post office
State
ZIP code
Country
School district name
(if not United States)
Permanent home address
Apartment no.
City, village, or post office
(see instr., pg. 13) (no. and street or rural route)
School district
code number
State
ZIP code
Country
(if not United States)
Taxpayer’s date of death Spouse’s date of death
Decedent
information
Single
A Filing
F
Enter your 2-character special condition code
status
if applicable
.............................................
(see page 14)
Married filing joint return
(mark an
(enter both spouses’ social security numbers above)
If applicable, also enter your second 2-character
X in one
special condition code ...................................................
box):
Married filing separate return
(enter both spouses’ social security numbers above)
G
New York State part-year residents
(see page 15)
Head of household
(with qualifying person)
Enter the date you moved into
....................
or out of NYS (mm-dd-yyyy)
Qualifying widow(er) with dependent child
On the last day of the tax year
:
(mark an X in one box)
B
1) Lived in NYS ...................................................................
Did you itemize your deductions on
your 2012 federal income tax return? ............. Yes
No
2) Lived outside NYS; received income from
NYS sources during nonresident period .........................
C
Can you be claimed as a dependent
on another taxpayer’s federal return? ............. Yes
No
3) Lived outside NYS; received no income from
D
NYS sources during nonresident period .........................
Did you have a financial account
located in a foreign country?
......... Yes
No
(see pg. 14)
H
New York State nonresidents
(see page 15)
E
New York City part-year residents only
(see page 14)
Did you or your spouse maintain
(1) Number of months you lived in NY City in 2012 .........
living quarters in NYS in 2012? ...................Yes
No
(if Yes, complete Form IT-203-B)
(2) Number of months your spouse lived
in NY City in 2012 .......................................................
I
Dependent exemption information
(see page 15)
First name and middle initial
Last name
Relationship
Social security number
Date of birth
(mm-dd-yyyy)
203001120094
If more than 7 dependents, mark an X in the box.