Form 760PY 760PY - Part-Year Resident Individual Income Tax Return

(1) Single Use Column A (Claiming federal Head of Household? YES (2) Married Filing Joint Return Use Column A (Even if only one had income) (3) Married Filing Separate Returns Use Column A (Enter spouse s SSN above) (4) Married Filing Separately on this Combined Return Use Column A: You Column B: Spouse A Your Social Security Number Add Lines 1 and 2 Add Lines 13 14 and 15 Add Lines 29 and 30 Add Lines 4a 4b 5 6 7 and 8 Additions from Schedule 760PY ADJ Line 3 ADJUSTED GROSS INCOME from Sch of Income Part 1 Line 7 Column 1 Adjustments and Voluntary Contributions from attached Schedule 760PY ADJ Line 24 Amended Return Check if Result of NOL Amount of overpayment on Line 28 to be CREDITED TO 2013 ESTIMATED INCOME TAX B Spouse's Social Security Number Check here if credit card payment has been made Checking City Town or Post Office Combined 2012 Estimated Tax Payments (Include credit from 2011) Credits from Schedule CR Section 5 Line 1A If claiming Political Contribution Credit only check box Deductions from Schedule 760PY ADJ Line 9 Dependent on Another s Return Enter spouse's full name on line below Extension Payment Enter amount paid on Form 760IP Filing Election For Local Use I (we) authorize the Department of Taxation to discuss this return with my (our) preparer If Line 19 is larger than Line 26 enter the difference This is the INCOME TAX YOU OWE Skip to Line 30 If Line 26 is larger than Line 19 enter the difference This is the OVERPAYMENT AMOUNT If Line 28 is larger than Line 31 subtract Line 31 from Line 28 This is the amount to be REFUNDED TO YOU If you owe tax on Line 27 add Lines 27 and 31 OR If Line 28 is an overpayment and Line 31 is larger than Line 28 enter the difference This is the AMOUNT YOU OWE Attach payment Income attributable to your period of residence outside Virginia from Schedule of Income Part 1 Line 9 Column 3 Itemized Deductions paid while a Virginia resident See instructions Overseas on Due Date Preparer s Name Preparer s Phone Number Preparer s PTIN Prorated exemption amount from Schedule of Income Part 2 Line 11 Qualifying Age Deduction Enter Birth Dates above Complete Age Deduction Worksheet in instructions Enter Spouse's Age Deduction on Line 4b Column B when using Filing Status 4 ONLY Otherwise claim Your Age Deduction on Line 4a Column A and Spouse's on Line 4b Column A Qualifying Farmer Fisherman or Merchant Seaman Social Security Act and equivalent Tier 1 Railroad Retirement Act benefits reported as taxable income on federal return and attributable to your period of residence in Virginia Spouse Spouse From Spouse s Business Phone Number Spouse To Spouse's Last Name Check if deceased Spouse's Virginia income tax withheld Attach Forms W 2 W 2G 1099 and VK 1 State State and local income taxes on Federal Schedule A and included on Line 11 State income tax refund or overpayment credit reported as income on your federal return and received while a Virginia resident Claim in the same column you reported the income on Line 1 Subtract Line 12 from Line 11 if claiming itemized deductions Otherwise enter standard deduction from Standard Deductions Worksheet in instructions Subtractions from Schedule 760PY ADJ Line 7 Suffix Tax amount from Tax Table or Tax Rate Schedule Tax Credit for Low Income Individuals or Virginia Earned Income Credit from Schedule 760PY ADJ Line 17 Total credit for taxes paid to another state from Schedule OSC Total payments and credits Add Lines 20a 20b 21 22 23 24 and 25 Total Tax Add Line 18 Column A and Line 18 Column B Virginia Adjusted Gross Income (VAGI) Subtract Line 9 from Line 3 Virginia Taxable Income Subtract Line 16 from Line 10 You From You Include Spouse if Filing Status 2 You To Your Business Phone Number Your Home Phone Number Your Last Name Check if deceased Your Signature Your SSN Your Virginia income tax withheld Attach Forms W 2 W 2G 1099 and VK 1 ZIP Code (mm/dd/yyyy) *VA760P112888* *VA760P212888* 2601039 REV 06/12 65 or over Account number and Spouse if Filing Status 2 Attach a complete copy of your federal tax return and all other required Virginia attachments Blind Check this box to have your refund issued on a prepaid debit card Combined Social Security for You and Spouse reported as taxable Complete the Schedule of Income first and be sure DATE OF BIRTH Dates of VA Residence DEBIT CARD Dependents DIRECT BANK DEPOSIT Due May 1 2013 Earned Income Credit Claimed on Federal Return $ 00 EXEMPTIONS Enter the number of exemptions being claimed in the appropriate column (See Prorated Exemptions Worksheet from Schedule of Income Part 2 ) FILING INFORMATION FILING STATUS (CHECK ONLY ONE) Filing Status 4 ONLY Filing Status 4 ONLY Firm s Name (or Yours if Self Employed) Form 760PY (2012) Page 2 Form760PY I (We) the undersigned declare under penalty of law that I (we) have examined this return and to the best of my (our) knowledge it is a true correct and complete return Include Spouse if Filing Status 2 income on Federal Return $ 00 Locality Code LTD $ Page 1 PAPER REFUND CHECKS WILL NOT BE ISSUED Choose Debit Card or Direct Deposit below Please Sign Here Preparer s Use Only Present Home Address (Number and Street or Rural Route) Savings See instructions before completing line items Spouse Spouse s Birth Date (mm dd yyyy) Spouse s Signature (If a joint return both must sign) SPOUSE'S First Name (filing status 2 or 4) Staple check or money order here Staple Forms W 2 W 2G 1099 and VK 1 here STAPLE HERE to submit it with your Form 760PY Type: Va Dept of Taxation Virginia Part Year Resident Income Tax Return You/Spouse Your bank routing transit number Your Birth Date (mm dd yyyy) YOUR First Name Your Name