Schedule I (Form 1040n) - Nebraska Adjustments To Income - 2014

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FORM 1040N

Nebraska Schedule I

— Nebraska Adjustments to Income

Schedule I

(Nebraska Schedule II reverse side.)

2014

• Attach this page to Form 1040N.

Name on Form 1040N

Social Security Number

Nebraska Schedule I —

Nebraska Adjustments to Income for Nebraska Residents, Partial-Year Residents, and Nonresidents

• Attach additional pages if necessary.

Part A — Adjustments Increasing Federal AGI

45 Interest income from all state and local obligations exempt from federal tax

a List type:

b Amount: $

List type:

Amount:

Total interest income exempt from federal tax. Enter total of lines 45b ............................................................ 45

46 Exempt interest income from Nebraska obligations

a List type:

b Amount: $

List type:

Amount:

Total exempt interest income from Nebraska obligations. Enter total of lines 46b ........................................... 46

47 Total taxable interest income. Enter the result of line 45 minus line 46 ................................................................ 47

48 Financial Institution Tax Credit claimed. Enter amount from line 25, Form 1040N ............................................... 48

49 Long-Term Care Savings Plan recapture (also subject to 10% penalty) (see instructions) ................................. 49

50 Nebraska College Savings Program recapture (see instructions)........................................................................ 50

51 Federal net operating loss deduction ..................................................................................................................

52 S corporation or LLC Non-Nebraska loss ............................................................................................................ 52

53 Total adjustments increasing federal AGI (total lines 47 through 52). Enter here and on line 12, Form 1040N .....

Part B — Adjustments Decreasing Federal AGI

54 State income tax refund deduction. Enter line 10, Federal Form 1040 ................................................................ 54

55 U.S. government obligations exempt for state purposes (list below or attach schedule)

a List type:

b Amount: $

List type:

Amount:

Total U.S. government obligations exempt for state purposes. Enter total of lines 55b .................................... 55

56 List fund name, total dividend, and percent of regulated investment company dividends from

a U.S. obligation:

b Total dividend: $

x c

% =

d $

a U.S. obligation:

b Total dividend: $

x c

d $

% =

Total regulated investment company dividends. Enter total of lines 56d .......................................................... 56

57 Total U.S. government obligations. Enter total of lines 55 and 56. ....................................................................... 57

58 Benefits paid by the Railroad Retirement Board (RRB) included in the federal AGI. Attach all Forms 1099

and W-2 from the RRB.

a List type:

b Amount: $

List type:

Amount:

Total benefits paid by the RRB included in federal AGI. Enter total of lines 58b .............................................. 58

59 Special capital gains/extraordinary dividend deduction [attach Form 4797N; a copy of Federal Schedule D;

and Form 8949 (or Federal Schedule B when claiming extraordinary dividend deduction)] (see instructions) ...... 59

60 Nebraska College Savings Program contribution (see instructions) .................................................................... 60

61 Nebraska Long-Term Care Savings Plan contribution ......................................................................................... 61

62 Nebraska Long-Term Care Savings Plan earnings.................................................................................................. 62

63 S corporation and LLC Non-Nebraska income (attach Nebraska Schedules K-1N, see instructions) .................... 63

64 Nonresident military servicemember active duty pay (attach active duty Form W-2, identifying the income as

attributable to another state, see instructions) ......................................................................................................... 64

65 Native American Indian Reservation income ........................................................................................................... 65

66 Claim of right repayment ......................................................................................................................................... 66

67 Nebraska NOL carryforward (attach a copy of the Nebraska NOL Worksheet for each loss year claimed on this line) 67

68 Nebraska agricultural revenue bond interest ........................................................................................................... 68

69 Federally taxable Nebraska Investment Finance Association (NIFA) bond interest ................................................. 69

70 Interest from federally taxable Build America Bonds issued by Nebraska governmental units ................................ 70

71 Total adjustments decreasing federal AGI (total lines 54 and 57 through 70). Enter here and on line 13, Form 1040N . 71

8-418-2014