Income Tax Supplemental Schedule
TC-40A
Pg. 1
40404
2014
SSN
Last name
USTC ORIGINAL FORM
Part 1 - Additions to Income (write the code and amount of each addition to income)
Code
Amount
.00
Code
Code
51 Lump sum distributions
57 Municipal bond interest
.00
53 Medical Savings Account (MSA) addback*
60
54 Utah Educational Savings Plan (UESP) addback*
61 Untaxed income of a nonresident trust
.00
56 Child’s income excluded from parent’s return
69
* to the extent previously deducted or credited on Utah return
.00
.00
.00
Total additions to income (add all additions to income and enter total here and on TC-40, line 5)
Part 2 - Subtractions from Income (write the code and amount of each subtraction from income)
Code
Amount
.00
Code
Code
71 Interest from U.S. Government Obligations
78 Railroad retirement income
.00
77 Native American Income:
Tribe
79
Enrollment Number
Code
82 Nonresident active duty military pay
.00
85
88 Nonresident military spouse income
.00
.00
.00
Total subtractions from income (add all subtractions from income and enter total here and on TC-40, line 8)
Part 3 - Apportionable Nonrefundable Credits (write the code and amount of each credit)
Code
Amount
.00
Code
Code
04 Capital gain transactions credit
22 Medical Care Savings Account (MSA) credit
.00
18 Retirement tax credit (attach TC-40C)
23
20 Utah Educational Savings Plan (UESP) credit
24 Qualifying solar project credit
.00
26
.00
.00
.00
Total apportionable nonrefundable credits (add all Part 3 credits and enter total here and on TC-40, line 24)
Part 4 - Nonapportionable Nonrefundable Credits (write the code and amount of each credit)
Code
Amount
.00
Code
Code
01 At-home parent credit
12 Research activities credit
.00
02 Qualified sheltered workshop credit - name:
13
17 Tax paid to another state (attach TC-40S)
.00
05 Clean fuel vehicle credit
19
06 Historic preservation credit
21 Renewable residential energy systems credit
.00
07 Enterprise zone credit
25
08 Low-income housing credit
27 Veteran employment tax credit
.00
10
.00
Total nonapportionable nonrefundable credits (add all Part 4 credits and enter total here and on TC-40, line 26)
Submit page ONLY if data entered.
Attach completed schedule to your Utah Income Tax Return.