Form It-540b Web - Louisiana Nonresident And Part-Year Resident - 2014 Page 5

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Enter your Social Security Number.
ATTACH TO rETUrN IF COMPLETEd.
Nonresident and Part-year resident (NPr) Worksheet
See instructions for completing the NPR worksheet beginning on page 15.
Federal
Louisiana
1
Wages, salaries, tips, etc.
2
Taxable interest
3
Dividends
4
Business income (or loss) and Farm income (or loss)
5
Gains (or losses)
6
IRA distributions, Pensions and Annuities.
7
Rental real estate, royalties, partnerships, S corporations, trusts, etc.
8
Social Security benefits
9
Other income
10
Total Income – Add the income amounts on Lines 1 – 9 for each column.
11
Total Adjustments to Income
Adjusted Gross Income – Subtract Line 11 from Line 10 for each column. Enter the amount
in the Federal column on IT-540B, Line 7. The amount shown in the Federal column should
12
agree with Federal Form 1040EZ, Line 4, OR Federal Form 1040A, Line 21, OR Federal Form
1040, Line 37.
2014 Adjustments to Income
13
Interest and dividend income from other states and their political subdivisions
14
Recapture of START contributions
15
Total – Add Lines 12, 13, and 14.
16
Interest and Dividends on U.S. Government Obligations
Louisiana State Employees’ Retirement Benefits –
17
Taxpayer date retired: ____________________ Spouse date retired: ____________________
Louisiana State Teachers’ Retirement Benefits –
18
Taxpayer date retired: ____________________ Spouse date retired: ___________________
19
Federal Retirement Benefits – Date retired: Taxpayer ____________ Spouse: _____________
Other Retirement Benefits – Date retired: Taxpayer _____________ Spouse: _____________
20
Provide name or statute: _______________________________________________________________
Annual Retirement Income Exemption for Taxpayers 65 or over –
21
Provide name of pension or annuity: ___________________________________________________
22
Native American Income
23
START Savings Program Contribution
24
Military Pay Exclusion
25
Road Home
26
Recreation volunteer or volunteer Firefighter
27
voluntary Retrofit Residential Structure
28
IRC 280C Expense Adjustment
Elementary and Secondary School Tuition, Educational Expenses for Home-Schooled
29
Children, Educational Expenses for quality Public Education
30
Capital Gain from Sale of Louisiana Business
Other Exempt Income
31
Identify: ____________________________________________________________________________
Total Exempt Income – Add Lines 16 through 31.
32
LOUISIANA AdJUSTEd GrOSS INCOME. Subtract Line 32 from Line 15. Also, enter this
33
amount on Form IT-540B, Line 8.
WEB
61575

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