Schedule In-113 - Vermont Income Adjustment Calculations - 2012
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1
2*121131199*
2012
Income Adjustment
SCHEDULE
113
IN-
Calculations
VERMONT
* 1 2 1 1 3 1 1 9 9 *
Nonresidents and Part-Year Residents Must Complete Parts I and II
Full-Year Residents with Adjustments Complete Part II only
Please PRINT in BLUE or BLACK INK
ATTACH TO FORM IN-111
Taxpayer’s Social Security Number
Taxpayer’s Last Name
First Name
Initial
-
-
PART I. Enter figures as they appear on your federal return or recomputed federal return in Column A and list the VT portion in
Column B. See instructions starting on page 12.
Month
Day
Year
Month
Day
Year
From
to
Dates of VT residency in 2012: . . . . . . . . . . .
Name of state(s), Canadian province or country during non-VT residency . . . . .
B. VT Portion $
A. Federal Amount $
.
.
0 0
0 0
1. Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . .1.
1.
.
.
0 0
0 0
2. Taxable interest . . . . . . . . . . . . . . . . . . . . . . . . . . .2.
2.
.
.
0 0
0 0
3. Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . .3.
3.
.
.
4. Taxable refunds of state and local
0 0
0 0
income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4.
4.
.
.
0 0
0 0
5. Alimony received . . . . . . . . . . . . . . . . . . . . . . . . .5.
5.
Check to
Check to
.
.
0 0
0 0
ç indicate
ç indicate
loss
loss
6. Business income or loss . . . . . .
6.
6.
Check to
Check to
.
.
0 0
0 0
ç indicate
ç indicate
loss
loss
7. Capital gain or loss . . . . . . . . . .
7.
7.
.
.
0 0
0 0
8. Taxable IRA distributions . . . . . . . . . . . . . . . . . .8.
8.
.
.
0 0
0 0
9. Taxable pensions and annuities . . . . . . . . . . . . . .9.
9.
Check to
Check to
.
.
10. Partnerships/S Corporations,
0 0
0 0
ç indicate
ç indicate
loss
loss
and LLCs . . . . . . . . . . . . . . . . .
10.
10.
Check to
Check to
.
.
11. Rents, royalties, estates,
0 0
0 0
ç indicate
ç indicate
loss
loss
trusts, etc. . . . . . . . . . . . . . . . . .
11.
11.
Check to
Check to
.
.
0 0
0 0
ç indicate
ç indicate
loss
loss
12. Farm income or loss . . . . . . . . .
12.
12.
.
.
0 0
0 0
13. Unemployment compensation . . . . . . . . . . . . . .13.
13.
.
.
0 0
0 0
14. Taxable social security . . . . . . . . . . . . . . . . . . . .14.
14.
Check to
Check to
.
.
0 0
0 0
ç indicate
ç indicate
loss
loss
15. Other: Specify____________ . .
15.
15.
(See instructions on page 13)
Check to
Check to
.
.
16. TOTAL INCOME
0 0
0 0
ç indicate
ç indicate
loss
loss
(Add Lines 1–15) . . . . . . . . . . .
16.
16.
Please be sure to print your name and Social Security number at the top of this page.
continued on back
21
Schedule IN-113
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