---
type: document
title: State%20Tax%20Form
file: ../State%20Tax%20Form.pdf
tags:
  - Russell_County
  - Commissioner_of_Revenue
docDate: null
contentType: application/pdf
contentLength: 196909
sha256sum: 8c175bd56843c7ceb75f3c79204e7e588a53555777a05223b2b1088abc4344aa
sha1sum: 20ed8243727cc419e1b97de4499070336c2e8249
---

Individual Income Tax Return
by May 4, 2017 - PLEASE USE BLACK INK

2016 Virginia Resident Form 760 _ ll

~ Social Seurty Number

UNTCAO

First letters

Revoane

Your fst name TM Lastname including ufc

“Spouse's firstname (ointrelums ony) NLL Lastname ineading sfx

“Birth Date (mmdéyyyy) —Doeased Locality

‘Number and Street his is change, you must fin oval
and Sire If this isa change, you must iin oval Socal

iy, town or post offce and state

i i ‘VA Driver's License information
Fillin all ova that apply: customer
‘Name or Fling Status changed Overseas on due dato

Virginia return not fied last year Federal Schedule Cfied “fit
Dependent on another's tum Eamed Income Credit | ery
‘on federal retur {Spouse i

> Qulhing amet, herman or =
‘merchant seaman

‘Amended Return - Result of NOL?
Filing Status Enter o box (1= Single, 2= Jos, and
Ce% Federal head of household? Yi
| ____lFing Status 3, enter spouse's SSN in he Spouse's Social Security Number

box at top of form and enter Spouse's Name. =

--+Do you need to file? See Line 9 and instruct
Adjusted Gross Income from federal return - Not federal taxable income.

Aout dnt: <p =~ somone Al soa Ae ie noi
: I vor ragga opens Tot sstona

iF x $930 =

fasted Filing Separately)

Spouse ~
Bee ‘Total Section 8
+ x $800 =

‘Additions fram enclosed Schedule ADJ, Line 3,

‘Add Lines 4 and 2.

5. Social Security and equivalent Tier 4 Ratoad Retirement benefits if taxable on federal rt on

‘Slate income Tax refund or overpayment crect (reported as income on federal return}.

Subtractions from enclosed! Schedule ADJ, Lin 7 nnn

‘Add Lines 4, 5,6 and?....

Vigna Adjusted Gross Income (VAI = Subba the 8 fom Une. Erbe este hs ne,
Note: If loss than $11,950 for Fing Status 1 or 3; or $23,900 for Fling Status 2, your taxis $0.0...9

410. Itemized Deductions from federal return. a)

1. Slate and Local Income Taxes claimed on federal Schedule A.

12, Subtract Line 11 from Line 10 if claiming itemized deductions, Otherwise, enter standard deduct
Fling Status: 1 = $3,000; 2= $6,000; 3 = $3,00

1, Exemptions. Sum of foll from Exemplion Section A plus Exemption Section B...

44, Deductions from Schedule ADU, Line 9

15, Add Lines 12, 13 and 14.
16, Virginia Taxable Income - Subtract Line 15 from Line 9....uronm

L pr LTD o |





Page 2

aveeomo MAUI

7. Amount of Tax fom Tax Table or Tax Rate Schedule (round to whol

48, Spouse Tax Adjustment (STA), Fling Status 2
only, Enfer Spouse's VAG in box here
‘and STA ammount on Line 18.

49, Net Amount of Tax - Subtract Line 48 from Line 17 .

20, Virgina income tax withheld for 2016, Enclose copies of Forms W-2, W-2G, 1099 andlor VIA,
20a. Your Virginia wthholing

1200

20b. Spouse's Vegnia withoting (Fiing Status 2 oi).. sO

21, Estimated tax payments for taxable year 2016 (rom Form 760ES}, a)

22, Amount of 2018 overpayment applied toward 2016 estimated tax... 22

23, Extension Payments (om Form 7601). 23

24, Tax Credit for Low-Income Invdals or Earned Income Crd from Sch. ADJ, Line 17 oe)

25, Cred for Tax Pald to Another State from Schedule OSC, Line 21
‘You must enclose Schedule OSC and a copy of all oer stale FORUMS. youre DS

28. Credit for Political Contbutions..

27. Credits from enclosed Schedule CR, Section 5, Part 1, Line 1A...

28, Add Lines 20a through 27...

29, IfLine 28 s loss than Line 19, subiract Line 28 from Line 19, This the Tax You Owe...

20, Line 191s less than Line 28, subtract Line 19 from Line 28, This is Your Tax Overpayment uu.30
31. Amount of overpayment you want credited to next year's estimate 2X ennnnnnnne dt

32, Viginia Cologe Savings Plan Contributions from Schedule VAC, Section |, Line 6...

33, Other Voluntary Contributions from Schedule VAC, Section I, Line 14 .ncunesmnanannenninin dS

34, Addition o Tax, Penalty and Interest from enclosed Schedilo ADJ, Lin@ 21. nmsnnnnnensnnn dh

35, Sea Us Tels nn ne mal oan ont sia psec (Coneuno Uso Tx,
See instructions. Do not eave blank. Ifyou owe no sales and use tax, enter 00. ns

36. Add Lines 31 through 35. seer

57. fy owe taxon ine 29, Lies 29 and 36, OR if Lino 90 ses than Une 36, subact Line 30
ffom Line 38. Enclose payment or pay at worwtax.virginia.go....... AMOUNT YOU OWE...37

ILL OVAL FPAYNG BY CREDIT OR DEBT CARO 8 WSTRUCTINS

38, IfLine 30s greater than Line 96, subtract Line 36 fom Liné 30, ns. YOUR REFUND o.oo 38
Ith Bet Bapost scion blows ot completed, your refand wi sued by chook.

DIRECT BANK DEPOSIT

Domestic Accounts Only.

No iteration Depost.

Phone Number Fling Eleston Prepares PIN