Fillable Form Tc-40s - Income Tax Supplemental Schedule

Form Tc-40s - Income Tax Supplemental Schedule - 2005

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TC-40S

Income Tax Supplemental Schedule

40053

Rev. 12/05

Taxpayer's social security number

Taxpayer's last name

Part 1 - Additions to Income (write the code and amount of each addition to income, see pages 5 and 6)

Code

Amount

Code

51 Lump sum distribution

56 Child's income excluded from parent's return

57 Municipal bond interest

52 State taxes allocated from estate/trust

53 Medical Savings Account (MSA)

60 Untaxed income of a resident trust

61 Untaxed income of a nonresident trust

54 Utah Educational Savings Plan (UESP)

55 Reimbursed adoption expenses

Total additions to income (add all additions to income and enter total here and on TC-40, line 6)

Part 2 - Other Deductions (write the code and amount of each other deduction, see pages 7 through 9)

Amount

Code

71 Interest from U. S. Government Obligations

78 Railroad retirement income

72 Medical Savings Account (MSA)

79 Equitable adjustments - attach explanation

73 Utah Educational Savings Plan (UESP)

81 Gains on capital transactions

82 Nonresident active duty military pay

74 Health care insurance premiums

83 National Guard/Reserve military pay

75 Long-term care insurance premiums

Enrollment number

Tribe code

76 Adoption expenses

Primary

taxpayer

77 Native American income

Secondary

taxpayer

Total other deductions (add all other deductions and enter total here and on TC-40, line 13)

Part 3 - Nonrefundable Credits (write the code and amount of each nonrefundable credit, see pages 10 through 12)

Code

Amount

Code

01 At-home parent

09 Hiring disabled

02 Qualified sheltered workshop

10 Recycling market

Name

11 Tutoring disabled

12 Research activities

03 Renewable energy systems

13 Research machinery/equipment

05 Clean fuel vehicle

17 Tax paid to another state (attach TC-40A)

06 Historic preservation

19 Live organ donation expenses

07 Enterprise zone

08 Low-income housing

Total nonrefundable credits (add all nonrefundable credits and enter total here and on TC-40, line 19)

Part 4 - Refundable Credits (write the code and amount of each refundable credit, see pages 14 through 15)

Code

Amount

Code

40 Targeted business tax credit

46 Mineral production withholding

41 Special needs adoption credit

47 Agricultural off-highway gas/undyed diesel

43 Nonresident shareholder's withholding

48 Farm operation hand tools

FEIN

Total refundable credits (add all refundable credits and enter total here and on TC-40, line 29)

Form Tc-40s - Income Tax Supplemental Schedule - 2005

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