Form PIT-ADJ Schedule of Additions and Deductions/Exemptions

Indian nation tribe or pueblo nation tribe or pueblo *120280200* 10 00 10 Income of a member of a New Mexico federally recognized Indian nation tribe or pueblo that was wholly earned on the lands of the reservation or pueblo of which the individual is an enrolled member while domiciled on that land reservation or pueblo + 10a I am enrolled as a member of the Indian 10b My spouse is enrolled as a member of the 11 00 11 Income of persons age 100 years or older If you or your spouse is age 100 or older you must check the box below or your exemption will be disallowed 11a 100 or older 11b Spouse 100 or older 12 00 12 Exemption for persons age 65 or older or blind 13 00 14 00 15 00 16 00 17 00 17 Medical care expense exemption for persons age 65 years or older + 18 00 18 Deduction for organ donation related expenses 19 00 20 00 2012 PIT ADJ 21 00 4 Charitable deduction amount claimed on federal Form 1040 Schedule A for a donation of land to 5 TOTAL ADDITIONS (Add lines 1 4 Also enter on line 11 of Form PIT 1) Act sick pay allowed the New Mexico Land Conservation Tax Credit Contributions refunded when closing a New Mexico approved Section 529 college savings plan account and certain contributions rolled out of a New Mexico approved Section 529 college savings plan account Deduction for contributions to a New Mexico approved Section 529 college savings plan Exemption for New Mexico medical care savings account (See PIT ADJ instructions) + Interest and dividends from federal tax exempt bonds Interest received on U S Government obligations + Military active duty pay (See PIT ADJ instructions) N E W M E X I C O DE DUC TI O N S /EXEMPTIONS FROM FEDERAL ADJUSTED GROSS INCOME Net capital gains deduction (See PIT ADJ instructions) + Net operating loss (See PIT ADJ instructions) + NEW MEXICO ADDITIONS TO FEDERAL ADJUSTED GROSS INCOME New Mexico National Guard member life insurance reimbursements tax exemption + New Mexico net operating loss (See PIT ADJ instructions) + NEW MEXICO SCHEDULE OF ADDITIONS AND DEDUCTIONS/EXEMPTIONS New Mexico tax exempt interest and dividends Print your name (first middle last) private non profit or public conservation agencies for conservation purposes from which you were Taxable Railroad Retirement Act annuities and benefits; taxable Railroad Unemployment Insurance Taxable refunds credits or offsets of state and local income taxes (From federal Form 1040 line 10) + This schedule must be completed by taxpayers who are required to make certain additions or are eligible to take certain deductions or exemp tions from federal adjusted gross income to compute New Mexico taxable income Please refer to the instructions Attach Schedule PIT ADJ to your Personal Income Tax Return Form PIT 1 TOTAL DEDUCTIONS/EXEMPTIONS (Add lines 6 20 Enter here and on line 15 of Form PIT 1 ) = We cannot accept statements in lieu of completing this schedule