STATE OF HAWAII—DEPARTMENT OF TAXATION
SCHEDULE X
TAX CREDITS FOR HAWAII RESIDENTS
FORM N-11/N-12/N-13/N-15
2002
Attach to Form N-11, N-12, N-13, or N-15
(Rev. 2002)
Name(s) as shown on Form N-11, N-12, N-13, or N-15
Your social security number
Caution:
Please read the Instructions for Schedule X in your tax return instruction booklet carefully before completing this schedule.
PART I: LOW-INCOME REFUNDABLE TAX CREDIT
1 Is your adjusted gross income (Form N-11, line 19; Form N-12, line 32; Form N-13, line 11; or Form N-15, line 33, Column A) $20,000 or less?
If “No”, STOP. You cannot claim this credit. However, you may claim the credit for a minor child receiving support from the Department of Human
Services, etc. In this situation, only complete lines 3, 9, and 10. If “Yes”, go to line 2.
2 List YOURSELF, YOUR SPOUSE, AND YOUR DEPENDENTS if all the requirements in the box below are met.
You must provide more than half of the support for any dependent listed. Do not list minor children supported by public assistance.
Name
Name
2 Listed Person Must Meet All Requirements
a) Resident of Hawaii
c) Not in prison, youth correctional
facility, or jail for entire taxable
b) Present in Hawaii more
year
than 9 months during
2002
d) Cannot be claimed as a
dependent by another taxpayer
Enter the number of qualified persons listed above ................................................................................................................................
2
3 List all MINOR CHILDREN RECEIVING MORE THAN HALF OF THEIR SUPPORT FROM PUBLIC AGENCIES, such as the Department of Human
Services, who meet all the requirements in the box below.
Caution: Do not list any children already listed on line 2 above.
3 Listed Person Must Meet All Requirements
Name
Social Security Number
Relationship to You
a) Resident of Hawaii
d) More than half of support
from public agency
b) Present in Hawaii more than
9 months during 2002
e) Not listed on any other
Hawaii tax return
c) Not in prison, youth
correctional facility, or jail for
entire taxable year
Enter the number of children listed above. Also enter this number in the space provided on Form N-11, line 33;
Form N-12, line 46; Form N-13, line 19c; or Form N-15, line 48 .............................................................................................................
3
4 Enter the amount of your adjusted gross income (Form N-11, line 19; Form N-12, line 32; Form N-13, line 11; or
Form N-15, line 33, Column A).....................................................................................................................................
4
5 If you are married filing a separate return, enter your spouse’s adjusted gross income ..............................................
5
6 Add lines 4 and 5. Enter the total here .........................................................................................................................
6
7 Enter on line 7 the amount of the tax credit shown below that applies to the amount on line 6.
If line 6 is:
Tax credit per qualified exemption is:
Under $10,000 ........................................................................................$35
$10,000 under $15,000 .............................................................................25
$15,000 to $20,000 ...................................................................................10
Over $20,000 ..............................................................................................0
................................................
7
8 Multiply line 2 by line 7. Enter the total here.................................................................................................................
8
9 Multiply line 3 by $35. Enter the total here ...................................................................................................................
9
10 Add lines 8 and 9. Enter the result here and on Form N-11, line 33; Form N-12, line 46; Form N-13, line 19c; or
00
Form N-15, line 48. This is your low-income refundable tax credit. (Whole dollars only) .............................................
10
PART II: CREDIT FOR LOW-INCOME HOUSEHOLD RENTERS
1 Is your adjusted gross income (Form N-11, line 19; Form N-12, line 32; Form N-13, line 11; or Form N-15, line 33, Column A) less
than $30,000? If “No”, STOP. You cannot claim this credit. If “Yes”, go to Question 2.
2 Are you a resident who was present in Hawaii more than nine months of the taxable year? If “No”, STOP. You cannot claim this credit. If “Yes”, go to Question 3.
3 Can you be claimed as a dependent by another taxpayer? If “Yes”, STOP. You cannot claim this credit. If “No”, proceed to line 4.
4 Enter required information for each rental unit that was fully subject to real property tax. DO NOT list rental units that were wholly or partially exempt
from real property tax. If you occupied more than one qualified unit, submit the required information for each additional unit on a separate sheet. If
you shared the unit with others, enter only YOUR SHARE of the rent.
Address (give Apt. No., if any)
Occupied From
, 2002, To
, 2002. Total rent paid for this period. $ ______________
month
month
Owned by (or agent for owner)
#
name
address
(General Excise Tax License)
5 Add up YOUR SHARE of rent paid during the taxable year for all the units you have listed. ......................................
5
6 Enter the amount of your exclusions
......
6
(e.g. utilities, parking stalls, ground rent, rental subsidies such as public assistance)
7 Line 5 minus line 6. If this amount is less than $1,000, STOP. You cannot claim this credit .....................................
7
8 Enter the number of qualified exemptions from the worksheet in the Instructions. ......................................................
8
9 Multiply the number of exemptions on line 8 by $50 and enter the result here and on Form N-11, line 34; Form N-12,
00
line 47; Form N-13, line 19d; or Form N-15, line 49. This is your low-income household renter’s credit. (Whole dollars only).......
9
SCHEDULE X