Form 1041n Draft - Schedule K-1n - Beneficiary'S Share Of Income, Deductions, Modifications, And Credits - 2015

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Form 1041N
Nebraska Schedule K-1N —
Schedule K-1N
Beneficiary’s Share of Income, Deductions, Modifications, and Credits
2015
Estate’s or Trust’s Name and Mailing Address
Beneficiary’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
Nebraska ID Number
Federal ID Number
Taxable Year of Organization
Social Security Number
Spouse’s Social Security Number
Beginning _________________ , 20 _____ and Ending _________________ , 20 _____
If applicable, check the appropriate box:
Check One:
Resident Individual
Nonresident Individual
Estate or Trust
Final
Amended
Other (describe) ___________________________________________________
Part A
Beneficiary’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 Net short-term capital gain (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Net long-term capital gain (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8 Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Estate tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10 Other deductions and losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Part B
Beneficiary’s Share of Modifications
11 Qualified U.S. government interest deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 State and local bond interest and dividend income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Part C
Beneficiary’s Share of Credits
13 Community Development Assistance Act credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Form 3800N credits (see instructions)
a Employment and Investment Growth Act . . . . . . . . . . . . . . . . . . . . . . . . . 14 a $ ___________
b Nebraska Advantage Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 b $ ___________
c Nebraska Advantage Rural Development Act . . . . . . . . . . . . . . . . . . . . . 14 c $ ___________
d Nebraska Advantage Research and Development Act . . . . . . . . . . . . . . 14 d $ ___________
e New Markets Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 e $ ___________
f Nebraska Historic Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 f $ ___________
Total of 14a through 14f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Angel investment tax credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Nebraska income tax withheld (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
8-693-2015

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