40083
Income Tax Supplemental Schedule
Your last name
TC-40A
Rev. 12/08 Your social security number
Part 1 - Additions to Income (write the code and amount of each addition to income, see pages 5 and 6)
Code Code Code Amount
51 Lump sum distribution
57 Municipal bond interest 60 Untaxed income of a resident trust 61 Untaxed income of a nonresident trust 69 Equitable adjustments - attach explanation
53 Medical Savings Account (MSA) addback*
54 Utah Educational Savings Plan (UESP) addback * 55 Reimbursed adoption expenses * 56 Child's income excluded from parent's return
* To the extent previously deducted from Utah Income
Total additions to income (add all additions to income and enter total here and on TC-40, line 5)
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Amount
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Part 2 - Deductions from Income (write the code and amount of each deduction from income, see pages 6 and 7)
Code Code Code
71 Interest from U. S. Government Obligations 77 Native American income Tribe Your enrollment number Code Spouse' s enrollment number
78 Railroad retirement income 79 Equitable adjustments - attach explanation 80 State tax refund included on 1040, line 10
Code
82 Nonresident active duty military pay 85 State tax refund distributed to beneficiary
Total deductions from income (add all deductions and enter total here and on TC-40, line 7)
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Code
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Amount
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Part 3 - Apportionable Nonrefundable Credits (write the code and amount of each nonrefundable credit, see pages 8 - 10)
Code
04 Capital gain transactions credit 18 Retirement tax credit (attach TC-40C) 20 Utah Educational Savings Plan (UESP) credit 22 Medical Care Savings Plan (MSA) credit
Check box if you or spouse are age 65 or older Self Spouse
Total apportionable nonrefundable credits (add all credits and enter total here and on TC-40, line 22)
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Amount
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Part 4 - Nonapportionable Nonrefundable Credits (write the code and amount of each nonrefundable credit, see pages 10 - 13)
Code Code Code
01 At-home parent credit 02 Qualified sheltered workshop credit Name 03 Carryover of 2004, 2005 or 2006 energy credit 05 Clean fuel vehicle credit 06 Historic preservation credit 07 Enterprise zone credit 08 Low-income housing credit
10 Recycling market dev. zone credit 11 Tutoring disabled dependent credit 12 Research activities credit 13 Research machinery/equipment credit 17 Tax paid to another state (attach TC-40S) 19 Live organ donation expenses credit 21 Renewable residential energy systems credit
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Total nonapportionable nonrefundable credits (add all credits and enter total here and on TC-40, line 25) Attach completed schedule to your 2008 Utah Income tax return
40084
Continued - Income Tax Supplemental Schedule
Your last name
TC-40A
(Page 2) Rev. 12/08 Your social security number
Part 5 - Refundable Credits (write the code and amount of each refundable credit, see page 15)
Code Code Code Amount
39 Renewable commercial energy systems credit 40 Targeted business tax credit 41 Special needs adoption credit
47 Agricultural off-highway gas/undyed diesel 48 Farm operation hand tools
Total refundable credits (add all refundable credits and enter total here and on TC-40, line 37) Attach completed schedule to your 2008 Utah Income tax return
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