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TC-40S
Rev. 12/07
40073
Income Tax Supplemental Schedule
Last name SSN
Part 1 - Additions to Income (write the code and amount of each addition to income)
Code Code
5 5 5 5 5
1 2 3 4 5
Lump sum distribution State taxes allocated from estate/trust Medical Savings Account (MSA) * Utah Educational Savings Plan (UESP) * Reimbursed adoption expenses *
* to the extent previously deducted from Utah income
5 5 6 6 6
6 7 0 1 9
Child's income excluded from parent's return Municipal bond interest Untaxed income of a resident trust Untaxed income of a nonresident trust Equitable adjustments
Total additions to income (add all additions to income and enter total here and on TC-40, line 4b)
Part 2 - Deductions from Income (write the code and amount of each other deduction)
Code Code
7 1 7 7
Interest from U.S. Government Obligations Native American income: Enrollment number & Tribe Primary Secondary
7 7 8 8
8 9 2 5
Railroad retirement income Equitable adjustments Nonresident active duty military pay State tax refund distributed to beneficiary
Total deductions from income (add all deductions from income and enter total here and on TC-40, line 5b)
Part 3 - Other Deductions from Income (write the code and amount of each other deduction)
Code Code
7 2 7 3 7 4
Medical Savings Account (MSA) Utah Educational Savings Plan (UESP) Health care insurance premiums
75 76 81
Long-term care insurance premiums Adoption expenses Gains on capital transactions
Total other deductions (add all other deductions and enter total here and on TC-40, line 9e)
Attach completed schedule to your 2007 Utah Income Tax return
Fill-in fields may not show when you open this form. If you are using Reader 7.0 or greater, checking the "Highlight field" option on your Reader will show where fields are located. Otherwise, start at "Fiscal Year" and use the tab key to move from field to field.
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TC-40S
SSN
40074
Continued - Income Tax Supplemental Schedule
Last name
Page 2
Part 4 - Nonrefundable Credits (write the code and amount of each nonrefundable credit)
Code Code
0 1 0 2 0 0 0 0 0 3 5 6 7 8
At-home parent Qualified sheltered workshop - enter name below Carryover of prior credit for energy systems Clean fuel vehicle Historic preservation Enterprise zone Low-income housing
1 1 1 1 1 1 2
0 1 2 3 7 9 1
Recycling market development zone Tutoring disabled dependents Research activities Research machinery/equipment Tax paid to another state (attach TC-40A) Live organ donation expenses Renewable residential energy systems
Total nonrefundable credits (add all nonrefundable credits and enter total here and on TC-40, line 17)
Part 5 - Refundable Credits (write the code and amount of each refundable credit)
Code Code
3 9 4 0 4 1 4 3
Renewable commercial energy systems Targeted business tax credit Special needs adoption credit Nonresident shareholder's withholding FEIN -
46 47 48
Mineral production withholding Agricultural off-highway gas/undyed diesel Farm operation hand tools
Total refundable credits (add all refundable credits and enter total here and on TC-40, line 27)
Attach completed schedule to your 2007 Utah Income Tax return