Virginia Schedule 763 Adj (Form 763 Adj) - 2014 Page 2
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2*VA3ADJ214888*
2014 Virginia Schedule 763 ADJ
Page 2
Your Name
Your SSN
Tax Credit for Low-Income Individuals or Virginia Earned Income Credit - SEE INSTRUCTIONS
Family VAGI
Name
Social Security Number (SSN)
Guideline Income
Yourself
00
-
-
Spouse
00
-
-
Dependent
00
-
-
Dependent
00
-
-
10. If more than 4 exemptions, attach schedule listing the name, SSN & VAGI.
10
00
Enter total Family Guideline Income here.
11.
Enter the total number of exemptions reported in the table above. Next, go to the Poverty Guidelines
Table shown in the Form 763 instruction book for this Line to see if you qualify for this credit ........
11
12.
If you qualify, enter the number of personal and dependent exemptions reported on your Form
763 (see instructions). .......................................................................................................................
12
13.
Multiply Line 12 by $300. Enter the result on Line 13 and proceed to Line 14. If you do not qualify
for the Tax Credit for Low-Income Individuals, but claimed an Earned Income Credit on your federal
00
return, enter $0 and proceed to Line 14 ............................................................................................
13
14.
Enter the amount of Earned Income Credit claimed on your federal return. If you did not claim an
00
Earned Income Credit on your federal return, enter $0 .....................................................................
14
15.
Multiply Line 14 by 20% (.20) ............................................................................................................
15
00
16.
Enter the greater of Line 13 or Line 15 ..............................................................................................
16
00
17.
Compare the amount on Line 16 above to the amount of tax on Form 763, Line 19. Enter the lesser
00
of the two amounts here and on Form 763, Line 24. This is your credit amount. ..............................
17
Addition to Tax, Penalty and Interest
00
18. Addition to tax. Check if addition came
from:
.......
Form 760C
Form 760F
18
00
19. Penalty..................................................................
Late Filing Penalty
Extension Penalty
19
20. Interest (accrued on the tax you owe) ................................................................................................
20
00
21. Total Addition to Tax, Penalty and Interest (add Lines 18 - 20). Enter here and on Form 763, Line
00
34........................................................................................................................................................
21
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