Free 2005 Utah Income Tax Supplemental Schedule, TC-40S - Utah

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Income Tax Supplemental Schedule
Taxpayer's last name

TC-40S

Rev. 12/05 Taxpayer's social security number

Part 1 - Additions to Income (write the code and amount of each addition to income, see pages 5 and 6) Code 51 Lump sum distribution 52 State taxes allocated from estate/trust 53 Medical Savings Account (MSA) 54 Utah Educational Savings Plan (UESP) 55 Reimbursed adoption expenses Total additions to income (add all additions to income and enter total here and on TC-40, line 6) Part 2 - Other Deductions (write the code and amount of each other deduction, see pages 7 through 9) Code 71 Interest from U. S. Government Obligations 72 Medical Savings Account (MSA) 73 Utah Educational Savings Plan (UESP) 74 Health care insurance premiums 75 Long-term care insurance premiums 76 Adoption expenses 77 Native American income Primary taxpayer Secondary taxpayer Code 78 Railroad retirement income 79 Equitable adjustments - attach explanation 81 Gains on capital transactions 82 Nonresident active duty military pay 83 National Guard/Reserve military pay Enrollment number Tribe code Code Amount Code 56 Child's income excluded from parent's return 57 Municipal bond interest 60 Untaxed income of a resident trust 61 Untaxed income of a nonresident trust Code Amount

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Total other deductions (add all other deductions and enter total here and on TC-40, line 13) Part 3 - Nonrefundable Credits (write the code and amount of each nonrefundable credit, see pages 10 through 12) Code Code Code 01 At-home parent 09 Hiring disabled 02 Qualified sheltered workshop Name 03 Renewable energy systems 05 Clean fuel vehicle 06 Historic preservation 07 Enterprise zone 08 Low-income housing Total nonrefundable credits (add all nonrefundable credits and enter total here and on TC-40, line 19) Part 4 - Refundable Credits (write the code and amount of each refundable credit, see pages 14 through 15) Code 40 Targeted business tax credit 41 Special needs adoption credit 43 Nonresident shareholder's withholding FEIN Code 46 Mineral production withholding 47 Agricultural off-highway gas/undyed diesel 48 Farm operation hand tools Code Amount 10 Recycling market 11 Tutoring disabled 12 Research activities 13 Research machinery/equipment 17 Tax paid to another state (attach TC-40A) 19 Live organ donation expenses

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Amount

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Total refundable credits (add all refundable credits and enter total here and on TC-40, line 29)