Form Ia 126 - Iowa Nonresident And Part-Year Resident Credit - 2012

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Iowa Department of Revenue
2012 IA 126
Iowa Nonresident and Part-year Resident Credit
Name(s) as shown on page 1 of the IA 1040
Social Security Number
YOU MUST FILE THIS FORM IF...
MARK THE APPROPRIATE BOX FOR YOU AND YOUR SPOUSE
• You are a nonresident of Iowa with income
You are a nonresident of Iowa
L
from Iowa sources, or
L
You are a part-year resident of Iowa
• You are a part-year Iowa resident
• Enclose this form and a copy of your federal
Date moved into Iowa: ______________________
return with your Iowa return. (IA 1040)
and/or
Date moved out of Iowa: _____________________
• Report only Iowa-source income on the IA 126.
• You may benefit by using filing status 3 or 4.
L
Your spouse is a nonresident of Iowa
L
IOWA-SOURCE INCOME
Your spouse is a part-year resident of Iowa
B.
A.
Date moved into Iowa: ______________________
SPOUSE
YOU OR JOINT
and/or
Filing Status 3 Only
Date moved out of Iowa: _____________________
1. Wages, salaries, tips, etc. ............................................................................................................... 1 . __________________ .00 _________________ .00
2. Taxable interest income .................................................................................................................... 2. __________________ .00 _________________ .00
3. Ordinary dividend income ................................................................................................................ 3 . __________________ .00 _________________ .00
4. Alimony received ............................................................................................................................... 4 . __________________ .00 _________________ .00
5. Business income or (loss) ............................................................................................................... 5 . __________________ .00 _________________ .00
6. Capital gain or (loss) ........................................................................................................................ 6 . __________________ .00 _________________ .00
7. Other gains or (losses) .................................................................................................................... 7 . __________________ .00 _________________ .00
8. Taxable IRA distributions ................................................................................................................ 8 . __________________ .00 _________________ .00
9. Taxable pensions and annuities .................................................................................................... 9 . __________________ .00 _________________ .00
10. Rents, royalties, partnerships, estates, etc. .............................................................................. 10. __________________ .00 _________________ .00
11. Farm income or (loss) ..................................................................................................................... 11. __________________ .00 _________________ .00
12. Unemployment compensation ....................................................................................................... 12. __________________ .00 _________________ .00
13. Taxable Social Security benefits. ................................................................................................. 13. __________________ .00 _________________ .00
14. Other income, gambling income, bonus depreciation/section 179 adjustment ................... 14. __________________ .00 _________________ .00
L
15. GROSS INCOME. ADD lines 1-14. .............................................................................................. 15. __________________ .00 _________________ .00
16. Payments to an IRA, Keogh, or SEP while an Iowa resident ................................................. 16. __________________ .00 _________________ .00
17. Deduction for self-employment tax ............................................................................................... 17. __________________ .00 _________________ .00
18. Health insurance deduction ........................................................................................................... 18. __________________ .00 _________________ .00
19. Penalty on early withdrawal of savings ....................................................................................... 19. __________________ .00 _________________ .00
20. Alimony paid ..................................................................................................................................... 20. __________________ .00 _________________ .00
21. Pension/retirement income exclusion .......................................................................................... 21. __________________ .00 _________________ .00
22. Moving expense deduction into Iowa only .................................................................................. 22. __________________ .00 _________________ .00
23. Iowa capital gain deduction ........................................................................................................... 23. __________________ .00 _________________ .00
24. Other adjustments ........................................................................................................................... 24. __________________ .00 _________________ .00
L
25. Total adjustments. ADD lines 16-24. ........................................................................................... 25. __________________ .00 _________________ .00
26. IOWA NET INCOME. SUBTRACT line 25 from line 15. ........................................................... 26. __________________ .00 _________________ .00
27. All-source net income from line 26, IA 1040 .............................................................................. 27. __________________ .00 _________________ .00
100.0%
100.0%
28. Iowa income percentage: Divide line 26 by line 27 and enter percentage rounded to
the nearest tenth of a percent. This can be no more than 100.0% and no less than 0.0%. ..... 28. ___________________ % __________________ %
.
.
29. Nonresident/part-year resident credit percentage:
-1.0
-1.0
Subtract the percentage on line 28 from 100.0%. .................................................................... 29. ___________________ % __________________ %
.
.
30. Iowa tax on total income from line 43, IA 1040 ......................................................................... 30. __________________ .00 _________________ .00
31. Total credits from line 49, IA 1040 ............................................................................................... 31. __________________ .00 _________________ .00
32. Tax after credits. Subtract line 31 from line 30. ........................................................................ 32. __________________ .00 _________________ .00
33. Nonresident/part-year resident tax credit. Multiply line 32 by the percentage on line 29. ........ 33. __________________ .00 _________________ .00
ENTER THIS AMOUNT ON LINE 51, IA 1040
*1241126019999*
41-126 (09/26/12)

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