Form Schedule A, B, CR, DC Itemized Deductions, Interest and Dividend Income,Credit for Taxes Paid to Other States and Donation Checkoffs (Form 40) (blank)

(FORM 40) (Schedules B CR and DC are on back page) ATTACH TO FORM 40 SEE INSTRUCTIONS FOR SCHEDULE A *120003401283* *120004401283* 00 00 00 00 00 00 00 00 1 2012 taxable income as shown on the state return 1 00 If more than one other state skiplines 1 4 and use Schedule CR worksheet If using the worksheet line 5 (below) will equalworksheet Part 4 line 21 1 I N T E R E S T 1 00 1 00 1 You may donate allor part of your overpayment (Enter the amount in the appropriate boxes ) 2 (nameof state) Tax due the other state using Alabama tax rates 2 00 2 D I V I D E N D S 2 00 2 Total Donations Add lines 1a b c d e f g h i j k l m n o p q r and s Enter here and on Form 40 page 1 line 32 ADOR Schedules B CR & DC (Form 40) 2012 3 Tax due the other state as shown on that state s return or Form W 2G 3 00 3 TOTAL TAXABLE INTEREST AND DIVIDENDS Enter here and on Form 40 page 1 line 6 3 00 4 Tax due Alabama from Form 40 page 1 line 17 4 00 5 CREDIT ALLOWABLE Enter the amount from line 2 3 4 or the amount from the worksheet on page 21 of the booklet whichever issmallest If you have no other credits enter amount from line 5 to Form 40 page 1 line 18 If you have other credits enter the amount from line 5 to Schedule OC Part A line 1 and complete 5 00 A B CR &DC ScheduleA ItemizedDeductions 2012 a Senior Services Trust Fund b Alabama Arts Development Fund c Alabama Nongame Wildlife Fund d Child Abuse Trust Fund e Alabama Veterans Program f Alabama Indian Children s Scholarship Fund g Penny Trust Fund h Foster Care Trust Fund i MentalHealth If you received more than $1500 of interest and dividend income you must complete Schedule B See instructions on page 21 j Neighbors Helping Neighbors k Alabama Breast & CervicalCancer Program l Alabama 4 H Club List Payers and Amounts A Exempt Interest B Taxable Interest and Dividends m Alabama Organ Center Donor Awareness Fund n Alabama National Guard Foundation Incorporated Name(s) as shown on Form 40 Name(s) as shown on Form 40 (Do not enter name and socialsecurity number if shown on other side) o Cancer Research Institute p Alabama Alternative Fuels Fund q Alabama Military Support Foundation r Alabama Veterinary Medical Foundation s Alabama Association of Rescue Squads Sch A B CR & DC (Form 40) 2012 Page 2 SCHEDULE B Interest And Dividend Income SCHEDULE CR Credit For Taxes Paid To Other States SCHEDULE DC Donation Check Offs SCHEDULES Alabama Department of Revenue See instructions on page 21 PLEASE NOTE: You may need to use the example computation on page 21 to calculate your income from the other state before completing this schedule This credit willNOT be allowed unless you file a nonresident income tax return with the other state and attach a copy of that 2012 return to your Alabama return Spay Neuter Program The itemized deductions you may claim for the year 2012 are similar to the itemized deductions claimed on your Federal return however the amounts may differ Please see instructions before completing this schedule PART YEAR RESIDENTS: A resident of Alabama for only a part of the year should list below only those deductions actually paid while a resident of Alabama Your socialsecurity number