Form It-203-X - Amended Nonresident And Part-Year Resident Income Tax Return - 2010
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5IT-203-X
New York State Department of Taxation and Finance
Amended Nonresident and Part-Year Resident
Income Tax Return
New York State • New York City • Yonkers
1 0
For the year January 1, 2010, through December 31, 2010, or fiscal year beginning ............
and ending ............
Important: You must enter your social security number(s) in the boxes to the right.
Your social security number
Your first name and middle initial
Your last name
( for a joint return, enter spouse’s name on line below )
Spouse’s first name and middle initial
Spouse’s last name
Spouse’s social security number
Mailing address
( number and street or rural route )
Apartment number
New York State county of residence
City, village, or post office
State
ZIP code
Country
School district name
( if not United States )
Permanent home address
Apartment no.
City, village, or post office
( no. and street or rural route )
School district
code number
State
ZIP code
Country
Taxpayer’s date of death Spouse’s date of death
( if not United States )
Decedent
information
See the instructions, Form IT-203-X-I, for help completing your amended return.
(A) Filing
Single
(D)
Did you file an amended federal
status —
return?
.......................... Yes
No
( see instructions )
Married filing joint return
mark an
( enter both spouses’ social
security numbers above )
X in
(E)
Married filing separate return
one box:
( enter both spouses’ social
New York City part-year residents only
security numbers above )
(1) Number of months you lived in NY City in 2010
Head of household
( with qualifying person )
(2) Number of months your spouse lived
Staple check
Staple check
or money order
or money order
here
here
in NY City in 2010 ...........................................
Qualifying widow(er) with dependent child
(F)
(B)
Enter your 2-character special condition code
Did you itemize your deductions on
if applicable
.................................
( see instructions )
your 2010 federal income tax return? .............. Yes
No
(C)
If applicable, also enter your second 2-character
Can you be claimed as a dependent
special condition code ...........................................
on another taxpayer’s federal return? .............. Yes
No
Federal income and adjustments
Federal amount
New York State amount
Enter federal amounts in the left column and NYS amounts in the right column.
Dollars
Cents
Dollars
Cents
1 Wages, salaries, tips, etc. . ................................................
1.
1.
2 Taxable interest income ....................................................
2.
2.
3 Ordinary dividends ...........................................................
3.
3.
4 Taxable refunds, credits, or offsets of state and local
4.
4.
income taxes
................................
( also enter on line 24 )
5 Alimony received ..............................................................
5.
5.
6 Business income or loss
6.
6.
( attach a copy of federal Sch. C or C-EZ, Form 1040 )
7 Capital gain or loss
7.
7.
( if required, attach a copy of federal Sch. D, Form 1040 )
8 Other gains or losses
...
8.
8.
( attach a copy of federal Form 4797 )
9 Taxable amount of IRA distributions. Beneficiaries: mark X in box
9.
9.
10 Taxable amount of pensions/annuities. Beneficiaries: mark X in box
10.
10.
11 Rental real estate, royalties, partnerships, S corporations,
trusts, etc.
11.
11.
( attach a copy of federal Schedule E, Form 1040 )
12 Farm income or loss
12.
12.
( attach a copy of federal Sch. F, Form 1040 )
13 Unemployment compensation .......................................... 13.
13.
14 Taxable amount of social security benefits
14.
14.
( also enter on line 26 )
15 Other income
Identify:
15.
15.
16 Add lines 1 through 15 ..................................................... 16.
16.
17 Total federal adjustments to income
Identify:
17.
17.
18 Federal adjusted gross income
18.
18.
( subtract line 17 from line 16 )
3631100094
You must file all five pages of this original scannable amended return with the Tax Department.
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