Form Tc-40b - Non And Part-Year Resident Schedule

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TC-40B
Non and Part-year Resident Schedule
40105
Rev. 12/11
Your last name
Your social security number
Residency status
(check applicable status)
:
/
/
/
/
Nonresident. Home state abbreviation:
Part-year Utah resident from ______________ to ______________
mm
dd
yy
mm
dd
yy
INCOME
COLUMN A - UTAH
COLUMN B - TOTAL
1. Wages, salaries, tips, etc. (1040/1040A line 7, 1040EZ line 1)
.00
.00
2. Taxable interest income (1040/1040A line 8a, 1040EZ line 2)
.00
.00
3. Ordinary dividends (1040/1040A line 9a)
.00
.00
4. Taxable refunds, credits, or offsets of state and local income taxes (1040 line 10)
.00
.00
5. Alimony received (1040 line 11)
.00
.00
6. Business income or (loss) (1040 line 12)
.00
.00
7. Capital gain or (loss) (1040 line 13, 1040A line 10)
.00
.00
8. Other gains or (losses) (1040 line 14)
.00
.00
9. IRA distributions - taxable amount (1040 line 15b, 1040A line 11b)
.00
.00
10. Pensions and annuities - taxable amount (1040 line 16b, 1040A line 12b)
.00
.00
11. Rental real estate, royalties, part., S corp., trusts, etc. (1040 line 17)
.00
.00
12. Farm income or (loss) (1040 line 18)
.00
.00
13. Unemployment compensation (1040 line 19, 1040A line 13, 1040EZ line 3)
.00
.00
14. Social Security benefits - taxable amount (1040 line 20b, 1040A line 14b)
.00
.00
15. Other income (1040 line 21)
.00
.00
1 . 6 Additions to income from TC-40A Part 1 (Utah portion only in Utah column)
.00
.00
17. Total income (add lines 1 through 16)
.00
.00
ADJUSTMENTS
COLUMN A - UTAH
COLUMN B - TOTAL
1 . 8 Educator expenses (1040 line 23, 1040A line 16)
.00
.00
1 . 9 Certain business expenses (1040 line 24)
.00
.00
20 Health savings account deduction (1040 line 25)
.
.00
.00
2 . 1 Moving expenses (1040 line 26; column A, only expenses moving into Utah)
.00
.00
2 . 2 One-half of self-employment tax (1040 line 27)
.00
.00
23 Self-employed SEP, SIMPLE, and qualified plans (1040 line 28)
.
.00
.00
2 . 4 Self-employed health insurance deduction (1040 line 29)
.00
.00
2 . 5 Penalty on early withdrawal of savings (1040 line 30)
.00
.00
2 . 6 Alimony paid (1040 line 31a)
.00
.00
2 . 7 IRA deduction (1040 line 32, 1040A line 17)
.00
.00
2 . 8 Student loan interest deduction (1040 line 33, 1040A line 18)
.00
.00
2 . 9 Tuition and fees (1040 line 34, 1040A line 19)
.00
.00
30. Domestic production activities deduction (1040 line 35)
.00
.00
3 . 1 State tax refund included on federal form 1040, line 10
.00
.00
3 . 2 Subtractions from income from TC-40A Part 2 (Utah portion only in Utah column)
.00
.00
See instr. (page 10)
.00
.00
33. Total adjustments (add lines 18 through 32)
.00
.00
34.
Subtract line 3 from line 1 for
3
7
both COLUMNS A and B. Line 34, Column B
must equal TC-40, line 9
.00
.00
NON OR PART-YEAR RESIDENT TAX
.
35. Divide line 34 column A by line 34 column B (to 4 decimal places)
_ _
_
_ _ _ _ _ _ _ _
_
_
_
_
Do not enter a number greater than 1.0000 or less than “0”.
36. Enter tax amount from TC-40, line 24
.00
37. Multiply the tax on line 36 by the decimal on line 35 and enter the result on TC-40, page 2, line 25
.00
Submit this page ONLY if data entered.
Attach completed schedule to your 2011 Utah income tax return.

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