2010 Louisiana Resident - 2D

Transcription

1 Name Change Decedent Filing Decedent Address Change Amended Return IT--2D (Page 1 of ) Louisiana Resident - 2D First Name MI Last Name First Name MI Last Name Mailing Address City ST ZIP CODE Taxpayer SSN SSN Telephone DEV ID FILING STATUS: Print the appropriate number in the filing status box. It must agree with your federal return. Print a 1 in box if single. Print a 2 in box if married filing jointly. Print a in box if married filing separately. Print a in box if head of household. X Print a in box if qualifying widow(er). A B EXEMPTIONS: X Yourself or older or older Blind Blind Qualifying Widow(er) Total of A & B X If the qualifying person is not your dependent, print name here. C dependents Print dependent information below. If you have more than dependents, attach a statement to your return with the required information. Print the total number from Federal Form 0A, Line c, or Federal Form 0, Line c in the boxes here. C 2 2 Dependent First and Last Name SSN Relationship to you Birth Date (mm/dd/yyyy) D Total exemptions Total of A, B, and C D If you are not required to file a federal return, indicate wages here. Mark this box and enter zero 0 on Line 1. 0 FEDERAL ADJUSTED GROSS INCOME If your Federal Adjusted Gross Income is less than zero, print 0. From Louisiana Schedule E, attached 0 2 If you did not itemize your deductions on your federal return, leave Lines A, B and C blank and go to Line 9. 2 A FEDERAL ITEMIZED DEDUCTIONS A B FEDERAL STANDARD DEDUCTION B C EXCESS FEDERAL ITEMIZED DEDUCTIONS Subtract Line B from Line A and print the result. C 9 FEDERAL INCOME TAX If your federal income tax has been decreased by a federal disaster credit allowed by IRS, mark the box. 9 YOUR LOUISIANA TAX TABLE INCOME Subtract Lines C and 9 from Line. If less than zero, print YOUR LOUISIANA INCOME TAX

2 IT--2D (Page 2 of ) Nonrefundable Tax Credits A Federal Child Care Credit A B Louisiana Nonrefundable Child Care Credit B C Amount of louisiana nonrefundable child care credit carried forward from 0 THROUGH 09 C 1 D LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT 1 D E AMOUNT OF LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT CARRIED FORWARD FROM 0 THROUGH 09 E 1 1 Education Credit Multiply the number of qualified dependents by $2 and print the result. 1 1 Other Nonrefundable tax Credits From Schedule G, Line TOTAL Nonrefundable TAX credits Add Lines B through 1 and print the result ADJUSTED LOUISIANA INCOME TAX Subtract Line 1 from Line 11 and print the result. If the result is less than zero, or you are not required to file a federal return, print zero CONSUMER USE TAX No use tax due. Amount from the Consumer Use Tax Worksheet TOTAL INCOME TAX AND CONSUMER USE TAX - Add Lines 1 and 1 and print the result. Refundable Tax Credits 1 19 LOUISIANA REFUNDABLE Child Care 19 19A Print the qualified expense amount from the Refundable Child Care Credit Worksheet. 19A 19B Print the amount from the Refundable Child Care Credit Worksheet. 19B LOUISIANA REFUNDABLE SCHOOL READINESS CREDIT Earned Income Credit 21 Louisiana Citizens Insurance Credit 2 OTHER refundable Tax credits From Schedule F, Line 2 Payments 2 AMOUNT OF LOUISIANA TAX WITHHELD for Attach Forms W-2 and Amount OF CREDIT carried forward from AMOUNT PAID ON YOUR BEHALF BY A COMPOSITE PARTNERSHIP filing Enter name of partnership. 2 2 AMOUNT OF estimated payments MADE for 2 2 AMOUNT paid with extension request

3 IT--2D (Page of ) 29 TOTAL REFUNDABLE Tax CREDITS AND PAYMENTS Add Lines 19, through 2 and print the result. 29 OVERPAYMENT UNDERPAYMENT PENALTY If you are a farmer check the box. ADJUSTED Overpayment If Line is greater than Line 1, subtract Line 1 from Line and print the result. If Line 1 is greater than Line, print zero 0 here, subtract Line from Line 1, and print the balance on Line Donations of Line 1 The Military Family Assistance Fund Coastal Protection and Restoration Fund 2 The Start Program Wildlife Habitat and Natural Heritage Trust Fund 2 Louisiana Prostate Cancer Trust Fund Louisiana Animal Welfare Commission 9 Community - Based Primary Health Care Fund National Lung Cancer Partnership Louisiana Chapter of the National Multiple Sclerosis Society Fund Total Donations Add Lines through 1 and print the result. 2 Refund Due Subtotal Subtract Line 2 from Line and print the result. AMOUNT TO BE CREDITED TO 11 INCOME TAX credit AMOUNT TO BE REFUNDED Subtract Line from Line and print the result. REFUND

4 IT--2D (Page of ) Amounts due louisiana Amount you owe If Line 1 is greater than Line 29, subtract Line 29 from Line 1 and print the result. If you entered an amount here from Line, complete Lines,, 9 and and print zero 0 on Lines through. ADDITIONAL DONATION TO THE MILITARY FAMILY ASSISTANCE FUND 1 1 ADDITIONAL DONATION TO THE COASTAL PROTECTION AND RESTORATION FUND ADDITIONAL DONATION TO Louisiana Chapter of the National Multiple Sclerosis Society Fund 9 1 INTEREST 2 1 DELINQUENT FILING PENALTY DELINQUENT PAYMENT PENALTY 2 UNDERPAYMENT PENALTY If you are a farmer, check the box. Balance Due Louisiana Add Lines through and print the result. PAY THIS AMOUNT. DO NOT SEND CASH D Barcode Area 0 2 Status Contribution and Donation I declare that I have examined this return, and to the best of my knowledge, it is true and complete. Declaration of paid preparer is based on all available information. If I made a contribution to the START Savings Program, I consent that my may be given to the Louisiana Office of Student Financial Assistance in order to properly identify the START Savings Program account holder. If married filing jointly, both s may be submitted. Your Signature Date Signature of paid preparer other than taxpayer s Signature (If filing jointly, both must sign.) Date Telephone number of paid preparer Date Name Address Individual Income Tax Return Calendar year return due /1/11 Field Flag Mail to: FOR OFFICE USE ONLY Department of Revenue, PTIN, or FEIN of paid preparer SPEC CODE

5 SCHEDULE E ADJUSTMENTS TO INCOME 1 2 2A FEDERAL ADJUSTED GROSS INCOME Print the amount from your Federal Form 0EZ, Line, OR Federal Form 0A, Line 21, OR Federal Form 0, Line. If less than zero, print 0. INTEREST AND DIVIDEND INCOME FROM OTHER STATES AND THEIR POLITICAL SUBDIVISIONS Print the amount of any tax-exempt interest and dividend income reported on your federal return that is taxable to Louisiana. RECAPTURE OF START CONTRIBUTIONS TOTAL Add Lines 1, 2, and 2A and print the result. EXEMPT INCOME Print on Lines A through H the amount of exempted income included in Line 1 above. Enter description and associated code, along with the dollar amount. Exempt Income Amount 1 2 2A A A 1 B B c C 2 D D 2 2 E E 2 2 F F 2 G G H H I EXEMPT INCOME BEFORE APPLICABLE FEDERAL TAX Add lines A through H and print the result. I J Federal Tax applicable to Exempt income Use Option 1 or Option 2, J K Exempt Income Subtract Line J from Line I and print the result. K 0 A Louisiana Adjusted Gross Income before IRC (C) WAGE EXPENSE adjustment Subtract Line K from Line and print the result. A 0 2 B IRC (C) WAGE EXPENSE ADJUSTMENT Print the amount of your IRC (C) wage expense adjustment. B 2 C Louisiana Adjusted Gross Income Subtract Line B from Line A. Print the result here and on Form IT--2D, Line. C 0 Interest and Dividends on US Government Obligations... 01E Louisiana State Employees Retirement Benefits (Date Retired)... 02E Taxpayer Louisiana State Teachers Retirement Benefits (Date Retired)... 0E Taxpayer Federal Retirement Benefits (Date Retired)... 0E Taxpayer Other Retirement Benefits (Date Retired)... 0E Provide name or statute: Taxpayer Annual Retirement Income Exemption for Taxpayers or over... 0E Provide name of pension or annuity: Taxable Amount of Social Security.... 0E Native American Income.... 0E Start Savings Program Contribution... Military Pay Exclusion... Road Home... Recreation Volunteer... Volunteer Firefighter... Voluntary Retrofit Residential Structure... Elementary and Secondary School Tuition... Educational Expenses for Home-Schooled Children... Educational Expenses for Quality Public Education... Capital Gain from Sale of Louisiana Business... Other Identify: 09E E 11E 1E 1E 1E 1E 1E 19E E 9E

6 SCHEDULE F REFUNDABLE TAX CREDITS 1 Credit for amounts paid by certain military servicemembers for obtaining Louisiana Hunting and Fishing Licenses. See instructions, page 2. 1A Yourself Date of Birth (MM/DD/YYYY) Driver s License number State of issue or State Identification State of issue 1B Date of Birth (MM/DD/YYYY) Driver s License number State of issue or State Identification State of issue 1C Dependents: List dependent names Dependent name Dependent name Dependent name Date of Birth (MM/DD/YYYY) Date of Birth (MM/DD/YYYY) Date of Birth (MM/DD/YYYY) 1 1 Dependent name Date of Birth (MM/DD/YYYY) 2 1D Print the total amount of fees paid for Louisiana hunting and fishing licenses purchased for the listed individuals. Additional Refundable Credits Enter description and associated code, along with the dollar amount. 1D 2 2 Credit amount of Credit Claimed OTHER REFUNDABLE TAX CREDITS Add Lines 1D, 2 through and print here and on Form IT--2D, Line SCHEDULE H MODIFIED FEDERAL INCOME TAX DEDUCTION 1 Print the amount of your federal income tax liability found on Federal Form 0, Line. 1 2 Print the amount of federal disaster credits allowed by IRS. 2 Add Lines 1 and 2 and print the result here and on Form IT--2D, Line

7 SCHEDULE G NONREFUNDABLE TAX CREDITS 1 CREDIT FOR TAX LIABILITIES PAID TO OTHER STATES Complete this part only if you paid income tax liabilities to other states and you were a resident of Louisiana. See instructions, page 2. A copy of the return filed with the other states must be submitted with this schedule. Print the amount of the income tax liability paid to other states. Round to the nearest dollar. 1 2 CREDIT FOR CERTAIN DISABILITIES - Mark an X in the appropriate boxes. Only one credit is allowed per person. 1 2A Yourself Deaf Loss of Limb Mentally incapacitated Blind 2D Print the total number of qualifying individuals. Only one credit is allowed per person. 2D B 2C Dependent X 2E Multiply Line 2D by $0 and print the result. 2E 1 1 X List dependent names here. CREDIT FOR CONTRIBUTIONS TO EDUCATIONAL INSTITUTIONS 2 A Print the value of computer or other technological equipment donated. Attach Form R-0. A 2 2 B Multiply Line A by 0 percent and print the result. Round to the nearest dollar. CREDIT FOR CERTAIN FEDERAL TAX CREDITS B 2 2 A Print the amount of eligible federal credits. A 2 B Multiply Line A by percent. Print the result or $2, whichever is less. This credit is limited to $2. B 0 2 Additional Nonrefundable Credits Enter credit description and associated code, along with the dollar amount of credit claimed. Credit Credit Amount of Credit Claimed 9 11 OTHER NONREFUNDABLE TAX CREDITS Add Lines 1, 2E, B, B, and through. Print the result here and enter on Form IT--2D, Line

8 CREDIT CODES DO NOT MAIL THIS PAGE (INFORMATION ONLY) Schedule F Credit s Inventory Tax...F Ad Valorem Natural Gas...1F Ad Valorem Offshore Vessels...F Telephone Company Property...F Prison Industry Enhancement...F Urban Revitalization...F Mentor-Protégé....F Milk Producers...F Technology Commercialization...9F Historic Residential....0F Angel Investor...1F Schedule F Credit s Musical and Theatrical Productions...2F Wind and Solar Energy Systems...F School Readiness Child Care Provider...F School Readiness Child Care Directors and Staff...F School Readiness Business-Supported Child Care....F School Readiness Fees and Grants to Resource and Referral Agencies....F Sugarcane Trailer Conversion or Acquisition....9F Retention and Modernization...0F Conversion of Vehicle to Alternative Fuel...1F Research and Development....2F (Reserved for future credits. Do not use unless specifically directed to do so by LDR.)...0F Schedule G Credit s Premium Tax...0 Commercial Fishing... Family Responsibility...1 Small Town Doctor/Dentist Bone Marrow...1 Law Enforcement Education... First Time Drug Offenders...1 Bulletproof Vest...1 Nonviolent Offenders...10 Qualified Playgrounds...1 Debt Issuance...1 Donations of Materials, Equipment, Advisors, Instructors... 1 (Reserved for future credits. Do not use unless specifically directed to do so by LDR.) Atchafalaya Trace...0 Organ Donation...2 Household Expense for Physically and Mentally Incapable Persons... Previously Unemployed... Recycling Credit...2 Basic Skills Training...2 Dedicated Research....2 New Jobs Credit.... Refunds by Utilities.... Schedule G Credit s Eligible Re-entrants... Neighborhood Assistance...2 Cane River Heritage....2 LA Community Economic Development Apprenticeship...2 Ports of Louisiana Investor....2 Ports of Louisiana Import Export Cargo.... Motion Picture Investment...21 Research and Development....2 Historic Structures...2 Digital Interactive Media....2 Motion Picture Employment of Resident...2 Capital Company...2 LA Community Development Financial Institution (LCDFI)... 2 New Markets...29 Brownfields Investor Credit... Motion Picture Infrastructure...21 (Reserved for future credits. Do not use unless specifically directed to do so by LDR.) Biomed/University Research...0 Tax Equalization.... Manufacturing Establishments... Enterprise Zone...1 (Reserved for future credits. Do not use unless specifically directed to do so by LDR.)...99

9 Attach to return if completed. Louisiana School Expense Deduction Worksheet Your Name Your I. This worksheet should be used to calculate the three School Expense Deductions listed below. Refer to Revenue Information Bulletin on LDR s website. 1. Elementary and Secondary School Tuition R.S. :29. provides a deduction for amounts paid during the tax year for tuition and fees required for your dependent child s enrollment in a nonpublic elementary or secondary school that complies with the criteria set forth in Brumfield v. Dodd and Section 1(c)() of the Internal Revenue or to any public elementary or secondary laboratory school that is operated by a public college or university. The school can verify that it complies with the criteria. The deduction is equal to percent of the actual amount of tuition and fees paid per dependent, limited to $,000. The tuition and fees that can be deducted include amounts paid for tuition, fees, uniforms, textbooks and other supplies required by the school. 2. Educational Expenses for Home-Schooled Children R.S. :29.11 provides a deduction for educational expenses paid during the tax year for home-schooling your dependent child. In order to qualify for the deduction, you must be approved by the State Board of Elementary and Secondary Education (BESE) for home-schooling. The deduction is equal to percent of the actual qualified educational expenses paid for the home-schooling per dependent, limited to $,000. Qualified educational expenses include amounts paid for the purchase of textbooks and curricula necessary for home-schooling.. Educational Expenses for a Quality Public Education R.S. :29. provides a deduction for the fees or other amounts paid during the tax year for a quality education of a dependent child enrolled in a public elementary or secondary school, including Louisiana Department of Education approved charter schools. The deduction is equal to percent of the amounts paid per dependent, limited to $,000. The amounts that can be deducted include amounts paid for uniforms, textbooks and other supplies required by the school. II. On the chart below, list the name of each qualifying dependent and the name of the school the student attends. If the student is home-schooled, print home-schooled. Print an X in the box in column 1 if your dependent qualifies for the Elementary and Secondary School Tuition deduction, column 2 for Educational Expenses for Home-Schooled Children deduction, or column for Quality Public Education deduction. If you have more than six qualifying dependents, attach a statement to your return with the required information. Student Name of Qualifying Dependent Name of School A Deduction as described in Section I 1 2 B C D E F III. Using the letters that correspond to each qualifying dependent listed in Section II, list the amount paid per student for each qualifying expense. For students attending a qualifying school, the expense must be for an item required by the school. Refer to the information in Section I to determine which expenses qualify for the deduction. Retain copies of cancelled checks, receipts and other documentation in order to support the amount of qualifying expenses. Tuition and Fees Qualifying Expense List the amount paid for each student as listed in Section II. A B C D E F School Uniforms Textbooks, or Other Instructional Materials Supplies Total (add amounts in each column) Multiply by % % % % % % Deduction per Student Print the result or $,000 whichever is less. IV. Total the Deduction per Student in Section III, based on the deduction for which the students qualified as marked in boxes 1, 2, or in Section II. Print the Elementary and Secondary School Tuition Deduction here and on IT-, Schedule E, code 1E. $ Print the Educational Expenses for Home-Schooled Children Deduction here and on IT-, Schedule E, code 1E. $ Print the Educational Expenses for a Quality Public Education Deduction here and on IT-, Schedule E, code 19E. $ 19

10 Attach to return if completed. Louisiana Refundable Child Care Credit Worksheet Your Name Your Federal Adjusted Gross Income must be $2,000 or less in order to complete this form. See instructions on page Care Provider Information Schedule Complete columns A through D for each person or organization that provided care to your child. You may use Federal Form W-, supplied by your provider, to obtain the information. If your care provider does not provide a Federal Form W-, complete those parts of the Care Provider Information Schedule for which you have the information. You must follow the same rules of Due Diligence as the IRS requires if you do not have all of the care provider information. See IRS Publication for information on Due Diligence. If additional lines are required for Lines 1 or 2, attach a schedule. Falsification of any information provided on this form constitutes fraud and can result in criminal penalties. Care Provider Information Schedule A B C D Care provider s name Address (number, street, apartment number, city, state, and ZIP) Identifying number (SSN or EIN) Amount paid (See instructions.) 2. For each child under age 1, print their name in column E, their in column F, and the amount of Qualified Expenses you incurred and paid in in column G. See the definitions on page 2 for information on Qualified Expenses. E F G First Qualifying person s name Last Qualifying person s Qualified expenses you incurred and paid in for the person listed in column (E) Add the amounts in column G, Line 2. Do not enter more than $,000 for one qualifying person or $,000 for two or more persons. Print this amount here and on Form IT-, Line 19A. Print your earned income. See the definitions on page 2. If married filing jointly, print your spouse s earned income (if your spouse was a student or was disabled, see IRS Publication ). All other filing statuses, print the amount from Line. Print the smallest of Lines,, or. Print this amount on Form IT-, Line 19B. Print your Federal Adjusted Gross Income from Form IT-, Line, or Schedule E, Line 1 if filed. Print on Line the decimal amount shown below that applies to the amount on Line. If Line is: over but not over decimal amount $0 $1,000. $1,000 $1,000. $1,000 $19,000. $19,000 $21,000. $21,000 $2,000.1 $2,000 $2,000. X. 9 Multiply Line by the decimal amount on Line and print the result. 9 Multiply Line 9 by percent and print this amount on Line 11. X. 11 Print this amount on Form IT-, Line

11 ATTACH THIS WORKSHEET TO YOUR RETURN Your Name Louisiana Refundable School Readiness Credit Worksheet R.S. : provides a School Readiness Credit in addition to the credit for child care expenses as provided under R.S. :29.. To qualify for this credit, the taxpayer must have Federal Adjusted Gross Income of $2,000 or less and must have incurred child care expenses for a qualified dependent under age six who attended a child care facility that is participating in the Quality Start Rating program administered by the Louisiana Department of Children and Family Services. The qualifying child care facility must have provided the taxpayer with Form R-1 which verifies the facility s name, the state license number, the LA Revenue Account number, the Star Rating, and the rating award date. Complete this worksheet only if you claimed a Louisiana Refundable Child Care Credit on Form IT, Line Print the amount of Louisiana Refundable Child Care Credit on the Louisiana Refundable Child Care Credit Worksheet, page 1, Line Using the Star Rating of the child care facility that your qualified dependent attended during, shown on Form R-1, determine the applicable percentage for the School Readiness Credit from the chart shown below: A Quality Rating B Percentages for Star Rating Five Star 0% (2.0) Four Star 1% (1.) Three Star 0% (1.0) Two Star % (.) One Star 0% () 2. Print the number of your qualified dependents under age six who attended a: Five Star Facility and multiply the number by (i). Four Star Facility and multiply the number by (ii). Three Star Facility and multiply the number by (iii). Two Star Facility and multiply the number by (iv). Add lines (i) through (iv) and print the result. Be sure to include the decimal Multiply Line 1 by the total on Line. If the number results in a decimal, round to the nearest dollar and print the result here and on Form IT-, Line On Form IT-, Line print in the boxes designated for,,, or 2 the number of your qualified dependents as shown on Line 2 above for the associated star rated facility. Louisiana Earned Income Credit Worksheet R.S. :29. allows a refundable credit for resident individuals who claimed and received a Federal Earned Income Credit (EIC). The Federal EIC is available for certain individuals who work, have a valid, and have a qualifying child, or are between ages 2 and. These individuals cannot be a qualifying child or dependent of another person. Complete only if you claimed a Federal Earned Income Credit (EIC) 1 Federal Earned Income Credit Print the amount from Federal Form 0EZ, Line 9a, OR Federal Form 0A, Line 1a, OR Federal Form 0, Line a Multiply Line 1 above by. percent, round to the nearest dollar, and print the result on Line X.0 Print this amount on Form IT-, Line