Form 1120-Sn - Schedule K-1n - Shareholder'S Share Of Income, Deductions, Modifications, And Credits - 2016

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FORM 1120-SN
Nebraska Schedule K-1N —
Schedule K-1N
Shareholder’s Share of Income, Deductions, Modifications, and Credits
2016
Corporation’s Name and Mailing Address
Shareholder’s Name and Mailing Address
Name Doing Business As (dba)
Name
Legal Name
Street or Other Mailing Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
Nebraska ID Number
Federal ID Number
Social Security Number/Federal ID Number
Spouse’s Social Security Number
Taxable Year of Organization
Check One:
Resident Individual
Nonresident Individual
Estate or Trust
Beginning _________________ , 20 _____ and Ending _________________ , 20 _____
Exempt Organization
S Corporation’s Nebraska Apportionment Factor
Shareholder’s Ownership Percentage
If applicable, check the appropriate box:
%
%
Final
Amended
Part A
Shareholder’s Share of Income and Deductions
1 Ordinary business income (loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2 Net income (loss) from rental real estate activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Net income (loss) from other rental activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4 Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5 Dividend income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6 Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Net short-term capital gain (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8 Net long-term capital gain (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Net Section 1231 gain (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10 Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Charitable contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Section 179 expense deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Other deductions and losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Part B
Shareholder’s Share of Modifications
14 Qualified U.S. government interest deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 State and local government interest and dividend income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Income (loss) from non-Nebraska sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Part C
Shareholder’s Share of Credits
17 Community Development Assistance Act credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Form 3800N credits (see instructions)
a Employment and Investment Growth Act . . . . . . . . . . . . . . . . . . . . . . . . . 18 a $ ___________
b Nebraska Advantage Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 b $ ___________
c Nebraska Advantage Rural Development Act . . . . . . . . . . . . . . . . . . . . . . 18 c $ ___________
d Nebraska Advantage Research and Development Act . . . . . . . . . . . . . . . 18 d $ ___________
e New Markets Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 e $ ___________
f Nebraska Historic Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 f $ ___________
Total of 18a through 18f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Contractor withholding (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Nebraska income tax withheld (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
8-687-2016

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