Form 43 (State Form Tc43011) - Idaho Part-Year Resident And Nonresident Income Tax Return - 2001
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1
243
F
2001
O
IDAHO PART-YEAR RESIDENT & NONRESIDENT INCOME TAX RETURN
R
TC43011
M
10-05-01
.
Amended Return
.
A R F W M
.
See instructions page 10, for THE REASONS
FOR AMENDING, and enter the number.
_______
For calendar year 2001, or fiscal year beginning ______________________, ending ______________________
Your Social Security Number
Your first name and initial
Last name
Use IDAHO
Spouse's Social Security Number
Spouse's first name and initial
Last name
label.
Otherwise,
Address (number, street and apartment number)
please print or
IMPORTANT!
type.
You must enter your
City, State and Zip Code
SSN(s)
above.
.
.
Do you need Idaho income tax forms mailed to you next year?
Yes
No
Residency status
Resident
Idaho Resident on Active Military Duty
Nonresident
. .
Part-Year Resident
. .
. .
Military Nonresident
. .
. .
Check one for yourself
1. Yourself
3
5
2
4
1
and one for your spouse
2. Spouse
if a joint return.
.
.
Full months in Idaho this year
Yourself _______
Spouse _______
Filing status
6. Exemptions Enter the same number
Election campaign fund
f filing married joint or separate
I
return, enter spouse's name and
claimed on federal return.
I want $1 of my income tax to go to the Idaho
social security number above.
Election Campaign Fund ($2 on joint return).
1.
Single
a.
{
I
f parents, or someone
Yourself
else, can claim you (or
7. Yourself 8. Spouse
7. Yourself 8. Spouse
2.
Married filing joint return
.
.
your spouse) as
b.
Spouse
dependents, enter "0").
Reform
Constitution
3.
Married filing separate return
c.
.
.
Other dependents
4.
Head of household
Republican
Democratic
d.
Total exemptions
.
.
5.
Qualifying widow(er)
Libertarian
No Specific
.
.
None
Natural Law
IDAHO INCOME. See instructions, page 10.
Idaho Amounts
.
9. Wages, salaries, tips, etc. Attach Form(s) W-2. ..................................................................................
00
9
.
10. Taxable interest income. Attach federal Schedule B if over $400. .........................................................
00
10
.
11. Dividend income. Attach federal Schedule B if over $400. ...................................................................
00
11
.
12. Alimony received .............................................................................................................................
00
12
.
13. Business income or (loss). Attach federal Schedule C or C-EZ. ...............................................................
00
13
.
14. Capital gain or (loss). If required, attach federal Schedule D. ................................................................
00
14
.
15. Other gains or (losses). Attach federal Form 4797. .............................................................................
00
15
.
16. IRA distributions (taxable amount) ...............................................................................................................................
00
16
.
00
17
17. Pensions and annuities (taxable amount) .....................................................................................................................
.
00
18
18. Rents, royalties, partnerships, S corporations, trusts, etc. Attach federal Schedule E. ................................................
.
00
19
19. Farm income or (loss). Attach federal Schedule F. .....................................................................................................
.
00
20
20. Unemployment compensation ......................................................................................................................................
.
00
21
21. Other income. Attach explanation. ...............................................................................................................................
00
22
22. TOTAL INCOME. Add lines 9 through 21.
IDAHO ADJUSTMENTS. See instructions, page 11.
.
00
23. Deductions for IRAs and medical savings accounts ....................................................................................................
23
.
24. Moving expenses. Attach federal Form 3903 or 3903-F. .............................................................................................
00
24
.
25. Deductions for self-employment tax, health insurance and retirement plan ..................................................................
00
25
.
00
26. Penalty on early withdrawal of savings .........................................................................................................................
26
.
27. Deductions for student loan interest and alimony paid .................................................................................................
00
27
00
28. TOTAL ADJUSTMENTS. Add lines 23 through 27. ....................................................................................................
28
.
29. ADJUSTED GROSS INCOME. Subtract line 28 from line 22.
00
29
.
Within 180 days of receiving this return, the Idaho State Tax Commission may contact the paid preparer to discuss it.
Under penalties of perjury, I declare that to the best of my knowledge and belief this return is true, correct and complete.
Your signature
Paid preparer's signature
Preparer's EIN, SSN, or PTIN
Date
.
.
.
SIGN
Spouse's signature (if a joint return, BOTH MUST SIGN)
HERE
Daytime phone
Address and phone number
.
MAIL TO: Idaho State Tax Commission, PO Box 56, Boise, ID 83756-0056
ATTACH A COMPLETE COPY OF YOUR FEDERAL RETURN.
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