Form It-203-X - New York Amended Nonresident And Part-Year Resident - 2012
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6IT-203-X
New York State Department of Taxation and Finance
Amended Nonresident and Part-Year Resident
New York State • New York City • Yonkers
Income Tax Return
1 2
For the year January 1, 2012, through December 31, 2012, or fiscal year beginning ...........
and ending ...........
See the instructions, Form IT-203-X-I, for help completing your amended return.
Your first name and middle initial
Your social security number
Your last name
(for a joint return, enter spouse’s name on line below)
Your date of birth (mm-dd-yyyy)
Spouse’s first name and middle initial Spouse’s last name
Spouse’s social security number
Spouse’s date of birth (mm-dd-yyyy)
New York State county of residence
Mailing address
(number and street or rural route)
Apartment number
City, village, or post office
State
ZIP code
Country
School district name
(if not United States)
Apartment no.
City, village, or post office
Permanent home address
(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
A Filing
Single
Enter your 2-character special condition code
F
status
if applicable
........................................
(see instructions)
Married filing joint return
(mark an
If applicable, also enter your second 2-character
(enter both spouses’ social security numbers above)
X in one
special condition code ...................................................
Married filing separate return
box):
(enter both spouses’ social security numbers above)
New York State part-year residents
G
Head of household
(with qualifying person)
Enter the date you moved into
.......................
or out of NYS
(mm-dd-yyyy)
Qualifying widow(er) with dependent child
On the last day of the tax year
:
(mark an X in one box)
Did you itemize your deductions on
1) Lived in NYS ...................................................................
B
your 2012 federal income tax return? ............. Yes
No
2) Lived outside NYS; received income from
C
Can you be claimed as a dependent
NYS sources during nonresident period .........................
on another taxpayer’s federal return? ............. Yes
No
3) Lived outside NYS; received no income from
D
Did you file an amended federal
NYS sources during nonresident period .........................
return?
.................................... Yes
No
(see instructions)
H
New York State nonresidents
New York City part-year residents only
E
Did you or your spouse maintain
(1) Number of months you lived in NY City in 2012 .........
living quarters in NYS in 2012? ...................Yes
No
(2) Number of months your spouse lived
(if Yes, complete Form IT-203-B)
in NY City in 2012 .......................................................
I
Dependent exemption information
First name and middle initial
Last name
Relationship
Social security number
Date of birth
(mm-dd-yyyy)
363001120094
If more than 7 dependents, mark an X in the box.
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