Form 760py - Virginia Part-Year Resident Income Tax Return - 2015
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1
2*VA760P115888*
Form
2015
Virginia Part-Year Resident Income Tax Return
760PY
Due May 2, 2016
Page 1
See instructions before completing line items.
Dates of VA Residence
Enclose a complete copy of your federal tax return and all other required Virginia enclosures.
(mm/dd/yyyy)
A
Your Social Security Number
YOUR
MI
Your Last Name
Check if deceased
Suffix
You - From
You - To
First Name
B
Spouse's Social Security Number
SPOUSE'S
MI
Spouse's Last Name
Check if deceased
Suffix
Spouse - From
Spouse - To
First Name (filing status 2 or 4)
Present Home Address (Number and Street, or Rural Route)
City, Town or Post Office
State
ZIP Code
Locality Code
You
Last 5 Digits of
Virginia Driver's
License ID
Spouse
Combined Social Security for You and
Amended Return
Qualifying Farmer, Fisherman or Merchant
Spouse reported as taxable income on
Check if Result of NOL
Seaman
Check
Federal Return
Earned Income Credit Claimed on federal return
Applicable
Dependent on Another’s Return
$ ______________________.00
Boxes
$ ______________________.00
Overseas on Due Date
Filing Status Enter Filing Status Code in box below.
Exemptions Enter the number of exemptions being claimed.
{
You/
Federal head of household? YES
1 = Single (Column A) -
Dependents
65 or Over
Blind
Spouse
A - You
2 = Married, Filing Joint return (Column A)
Enter the numbers for both You
3 = Married, Filing Separate returns (Column A)
and Spouse if Filing Status 2
4 = Married, Filing Separately on this combined return (Columns A and B)
B - Spouse
If Filing Status 3, enter spouse's SSN in the Spouse's Social Security Number
Filing Status 4 Only
box at top of form and, enter Spouse’s Name
_______________________________
DATE OF BIRTH
-
-
Your Birth Date (mm-dd-yyyy)
You
B
A
Spouse
Include Spouse if
Filing Status 4 ONLY
-
-
Filing Status 2
Spouse’s Birth Date (mm-dd-yyyy)
Complete the Schedule of Income first and submit it with your Form 760PY.
1 FEDERAL ADJUSTED GROSS INCOME from Sch. of Income, Part 1, Line 7,
Column 1.
1
00
00
2 Additions from Schedule 760PY ADJ, Line 3. .................................................
2
00
00
3 Add Lines 1 and 2. .........................................................................................
3
00
00
4 Qualifying Age Deduction. Enter Birth Dates above. Complete Age Deduction
4a
00
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
00
00
4a, Column A and Spouse's on Line 4b, Column A. ........................................
4b
5 Social Security Act and equivalent Tier 1 Railroad retirement Act benefits
reported as taxable income on federal return and attributable to your period of
5
00
00
residence in Virginia. .......................................................................................
6 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
6
00
00
you reported adjusted gross income on Line 1................................................
7 Income attributable to your period of residence outside Virginia from Schedule of
Income, Part 1, Line 9, Column 3. ...................................................................
7
00
00
8 Subtractions from Schedule 760PY ADJ, Line 7. ............................................
8
00
00
9 Add Lines 4a, 4b, 5, 6, 7 and 8......................................................................
9
00
00
10 Virginia Adjusted Gross Income (VAGI). Subtract Line 9 from Line 3. .....
10
00
00
11 Itemized Deductions paid while a Virginia resident .....................................
11
00
00
12 State and local income taxes on Federal Schedule A and included on Line 11. 12
00
00
13 Subtract Line 12 from Line 11 if claiming itemized deductions. Otherwise, enter
13
00
00
standard deduction from Standard Deductions Worksheet in instructions. .....
For Local Use
Va. Dept. of Taxation
LTD
_________
$
2601039 REV. 09/15
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