Form It-540b - Louisiana Nonresident And Part-Year Resident Income Tax Return - 2011 Page 6
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9Enter your Social Security Number.
PLEASE PAPERCLIP W-2S AND SCHEDULES
Nonresident and Part-Year Resident (NPR) Worksheet
46
SUBTOTAL – Subtract on Line 45 from Line 32 to determine the amount of overpayment available for
46
credit or refund.
See instructions for completing the NPR worksheet beginning on page 17.
Federal
Louisiana
1
Wages, salaries, tips, etc.
47
CREDIT
47
AMOUNT OF LINE 46 TO BE CREDITED TO 2012 INCOME TAX
2
Taxable interest
48
AMOUNT TO BE REFUNDED – Subtract Line 47 from 46. Use Address 2 below. If you
REFUND
48
3
Dividends
fi le a paper return, you will receive your refund on a debit card.
4
Business income (or loss) and Farm income (or loss)
49
49
AMOUNT YOU OWE – If Line 19 is greater than Line 29, subtract Line 29 from Line 19.
5
Gains (or losses)
50
50
ADDITIONAL DONATION TO THE MILITARY FAMILY ASSISTANCE FUND
6
IRA distributions, Pensions and Annuities.
7
Rental real estate, royalties, partnerships, S corporations, trusts, etc.
51
51
ADDITIONAL DONATION TO THE COASTAL PROTECTION AND RESTORATION FUND
8
Social Security benefi ts
ADDITIONAL DONATION TO LOUISIANA CHAPTER OF THE NATIONAL MULTIPLE SCLEROSIS
9
Other income
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52
SOCIETY FUND
10
Total Income – Add the income amounts on Lines 1 – 9 for each column.
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53
ADDITIONAL DONATION TO LOUISIANA FOOD BANK ASSOCIATION
11
Total Adjustments to Income
Adjusted Gross Income – Subtract Line 11 from Line 10 for each column. Enter the amount
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54
INTEREST – From the Interest Calculation Worksheet, page 29, Line 5.
in the Federal column on IT-540B, Line 7. The amount shown in the Federal column should
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agree with Federal Form 1040EZ, Line 4, OR Federal Form 1040A, Line 21, OR Federal Form
1040, Line 37.
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55
DELINQUENT FILING PENALTY – From the Delinquent Filing Penalty Calculation Worksheet, page 29, Line 7.
2011 Adjustments to Income
DELINQUENT PAYMENT PENALTY – From Delinquent Payment Penalty Calculation Worksheet, page 29,
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56
Line 7.
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Interest and dividend income from other states and their political subdivisions
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UNDERPAYMENT PENALTY – See instructions for Underpayment Penalty, page 29 and Form
Recapture of START contributions
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57
R-210NR. If you are a farmer, check the box.
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Total – Add Lines 12, 13, and 14.
BALANCE DUE LOUISIANA – Add Lines 49 through 57. Use
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PAY THIS AMOUNT.
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address 1 below. For electronic payment options, see page 2.
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Interest and Dividends on U.S. Government Obligations
DO NOT SEND CASH.
Louisiana State Employees’ Retirement Benefi ts –
17
Taxpayer date retired: ____________________ Spouse date retired: ____________________
Louisiana State Teachers’ Retirement Benefi ts –
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Taxpayer date retired: ____________________ Spouse date retired: ___________________
19
Federal Retirement Benefi ts – Date retired: Taxpayer ____________ Spouse: _____________
Other Retirement Benefi ts – Date retired: Taxpayer _____________ Spouse: _____________
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Provide name or statute: _______________________________________________________________
Annual Retirement Income Exemption for Taxpayers 65 or over –
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Provide name of pension or annuity: ___________________________________________________
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Native American Income
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START Savings Program Contribution
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Military Pay Exclusion
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Road Home
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Recreation Volunteer or Volunteer Firefi ghter
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Voluntary Retrofi t Residential Structure
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IRC 280C Expense Adjustment
Elementary and Secondary School Tuition, Educational Expenses for Home-Schooled
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Children, Educational Expenses for Quality Public Education
Enter the fi rst 4 characters of your
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Capital Gain from Sale of Louisiana Business
last name in these boxes.
FOR OFFICE USE ONLY
Other Exempt Income
31
Field
Identify: ____________________________________________________________________________
Flag
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Total Exempt Income – Add Lines 16 through 31.
LOUISIANA ADJUSTED GROSS INCOME. Subtract Line 32 from Line 15. Also, enter this
SPEC
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amount on Form IT-540B, Line 8.
CODE
6287
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