Form It-540b - Louisiana Nonresident And Part-Year Resident Income Tax Return - 2011 Page 2
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92011 LOUISIANA NONRESIDENT
IT-540B - WEB
IMPORTANT!
You must enter your SSN below in the same
AND PART-YEAR RESIDENT
order as shown on your federal return.
Mark Box:
Your first name
Init. Last name
Suffix
Name
Your
Change
SSN
If joint return, spouse’s name
Init. Last name
Suffix
Decedent
Spouse’s
Filing
SSN
Present home address
(number and street including apartment number or rural route)
Spouse
Decedent
Area code and daytime telephone number
City, Town, or APO
State
ZIP
Amended
Return
FILING STATUS: Enter the appropriate number in the
fi ling status box. It must agree with your federal return.
6 EXEMPTIONS:
Enter a “1” in box if single.
65 or
Enter a “2” in box if married fi ling jointly.
6A
X
Yourself
Blind
older
Enter a “3” in box if married fi ling separately.
Total of
*
Enter a “4” in box if head of household.
6A & 6B
65 or
6B
Spouse
Blind
Enter a “5” in box if qualifying widow(er).
older
*
If the qualifying person is not your dependent, enter name here.
6C DEPENDENTS – Enter dependent information below. If you have more than 6 dependents, attach a statement to your return with the
required information. Enter the total number from Federal Form 1040A, Line 6c, or Federal Form 1040, Line 6c, in the boxes here.
6C
First Name
Last Name
Social Security Number
Relationship to you
Birth Date
(mm/dd/yyyy)
6D TOTAL EXEMPTIONS – Total of 6A, 6B, and 6C
6D
If you are not required to fi le a federal
Mark this box and enter zero “0” on Line 17.
return, indicate wages here.
FEDERAL ADJUSTED GROSS INCOME – Enter the amount of your Federal Adjusted Gross Income from the
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NPR worksheet, Federal column, Line 12.
LOUISIANA ADJUSTED GROSS INCOME – Enter the amount of your Louisiana Adjusted Gross Income from
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the NPR worksheet, Louisiana column, Line 33.
RATIO OF LOUISIANA ADJUSTED GROSS INCOME TO FEDERAL ADJUSTED GROSS INCOME – Divide
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Line 8 by Line 7. Carry out to two decimal places in the percentage. DO NOT ROUND UP. The percentage
cannot exceed 100%.
If you did not itemize your deductions on your federal return, leave Lines 10A, 10B, and 10C blank and go to
Line 10D.
10A
FEDERAL ITEMIZED DEDUCTIONS
10A
10B
FEDERAL STANDARD DEDUCTION
10B
10C
EXCESS FEDERAL ITEMIZED DEDUCTIONS – Subtract Line 10B from Line 10A.
10C
FEDERAL INCOME TAX – If your federal income tax has been decreased by a federal disaster
10D
10D
credit allowed by IRS, mark the box. See instructions for Schedule H-NR.
10E
10E
TOTAL DEDUCTIONS – Add Lines 10C and 10D.
6282
WEB
62828
66
12312011
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