Form Sp-01 - Personal Income Tax - Credit For Qualifying Surviving Spouse - 2010
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1
2SP-01
S
R
I
P
P
2010
TATE OF
HODE
SLAND AND
ROVIDENCE
LANTATIONS
D
R
EPARTMENT OF
EVENUE
D
T
IVISION OF
AXATION
O
C
H
NE
APITOL
ILL
P
, RI 02908
ROVIDENCE
P
I
T
- C
Q
S
S
ERSONAL
NCOME
AX
REDIT FOR
UALIFYING
URVIVING
POUSE
NAME
SOCIAL SECURITY NUMBER
ADDRESS
CITY
STATE
ZIP CODE
DECEASED SPOUSE’S NAME
DECEASED SPOUSE’S SOCIAL SECURITY NUMBER
DATE OF DEATH
C
O
HECK
NE
S
I - Q
Q
:
Y
No
ECTION
UALIFICATION
UESTIONS
ES
A.
Did you file your federal income tax return for 2010 as a “surviving spouse”?
B.
Were you legally domiciled in Rhode Island for all of 2010?
C.
Were you 65 years of age or older as of December 31, 2010?
D.
Was your adjusted gross income for Rhode Island less than $25,000.00?
E.
Do you have a dependent child that can be claimed on your Federal tax return?
IF YOU ANSWERED “NO” TO ANY ONE OF THE QUESTIONS ABOVE, YOU ARE NOT ELIGIBLE.
DO NOT COMPLETE THIS FORM.
S
II - C
C
:
ECTION
REDIT
ALCULATION
$
1.
Enter your adjusted gross income from RI-1040, Line 3 ........................................
2%
2.
Credit Rate - 2% .....................................................................................................
$
3.
Tentative Credit - Multiply Line 1 times Line 2 ........................................................
$500.00
4.
Maximum Credit Allowed - $500.00 ........................................................................
5.
Rhode Island Tax from RI-1040 - Line 10 minus Line 11A .....................................
$
Credit - The smaller of Lines 3, 4 and 5 - Enter here and on RI-1040, Schedule
6.
$
CR, Line 4 ...............................................................................................................
S
III - T
C
:
ECTION
AXPAYER
ERTIFICATION
Under penalties of perjury, I declare that I have examined this form, and to the best of my knowledge and belief, it is
true, correct and complete.
Taxpayer SIgnature
Date
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