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Blind 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 STAPLE CHECK HE R E STAPLE W-2 FORMS H E RE ATTACH L AB EL H E RE 2013 R Jr.,Sr.,III,etc. Jr.,Sr.,III,etc. 1. 3. 5. From Month Day 2013 To Month Day 2013 2. 4 1. 00 00 2a . b . 2 3. 00 00 Blind 3 4. 4 5. 5 00 00 00 00 00 00 6. 7. .... .... .... 00 00 6 00 00 7 8. .. .. .......... . ...... ....... . > 8 00 00 9 a . .. ............. ..... . .. . ............................. . 9a 00 00 9 b . . ...... .. . ...... . ..................... .. .......................... . 9b 1 0 . 11. 12. 13. . .... ... ... 10 - . . 11 .. ...... .................................................................. . 12 .. . ... .. ................... . ............ . 13 1 4 . ............ . . 14 1 5 . .......... . 15 16 . BALANCE . ... ... ......... . ... . 16 17. .... ....... .. 00 0 0 17 1 8 . 19 . 20 . .... 00 0 0 18 00 0 0 19 00 0 0 20 2 1 . . . ...... ............. .. . .. ... . > 21 00 00 22 . . ..... ... > 22 2 3 . .................... .... > 23 00 00 00 00 2 4 . . . ........ . 24 00 2 5 . 26. 27. 2 8 . > 00 > 00 00 28 00 Present Home Address (Number and Street) Column A is for Spouse information, Filing Status 4 only. All other filing statuses use Column B. If you elect the DELAWARE STANDARD DEDUCTION check here..... Filing Status 4 Enter $3250 in Column A and in Column B If you elect the DELAWARE ITEMIZED DEDUCTIONS check here..... Filing Statuses 1, 3 & 5 Enter $3250 in Column B; Filing Status 2 Enter $6500 in Column B; Filing Statuses 1, 2, 3 and 5, enter Itemized Deductions from reverse side, Line 48 in Column B Filing status 4 enter Itemized Deductions from reverse side, Line 48 in Columns A and B ADDITIONAL STANDARD DEDUCTIONS (Not Allowed with Itemized Deductions - see instructions) Multiply the number of boxes checked below by $2500. If you are filing a combined separate return (Filing status 4), enter the total for each appropriate column. All others enter total in Column B. Spouse Taxpayer DELAWARE INDIVIDUAL RESIDENT INCOME TAX RETURN FORM 200- 01 or Fiscal year beginning and ending Your Social Security No. Spouse’s Social Sec. No. Your Last Name Middle Initial Spouse’s First Name Apt.# City State Zip Code Form DE2210 Attached If you were a part-year resident in 2013, give the dates you resided in Delaware. FILING STATUS (MUST CHECK ONE) Single, Divorced, Widow(er) Joint or Entered into a Civil Union Married or Entered into a Civil Union & Filing Separate Forms Married or Entered into a Civil Union & Filing Combined Separate on this form Head of Household Column A Column B DELAWARE ADJUSTED GROSS INCOME. Begin Return on Page 2, Line 29, then enter amount from Line 42 here...>1 65 or over Column B - if YOU were: TOTAL DEDUCTIONS - Add Lines 2 & 3 and enter here........................................................................ TAXABLE INCOME - Subtract Line 4 from Line 1, and Compute Tax on this Amount............................... Tax Liability from Tax Rate Table/Schedule See Instructions............................................................... Column A Column B Tax on Lump Sum Distribution (Form 329) TOTAL TAX - Add Lines 6 and 7 and enter here.................................................... PERSONAL CREDITS If you are Filing Status 3, see instructions on Page 6. If you use Filing Status 4, enter the total for each appropriate column. All others enter total in Column B. Enter number of exemptions claimed on Federal return On Line 9a, enter the number of exemptions for: CHECK BOX(ES) Spouse 60 or over (ColumnA) Self 60 or over (ColumnB) Enter number of boxes checked on Line 9b. X $110. Tax imposed by State of (Must attach copy of DE ScheduleI and other state return) Volunteer Fire fighter Co.# Self (Column B) Spouse (Column A) Enter credit amount....... Other Non-Refundable Credits (see instructionson Page 7) Child Care Credit. Must attach Form 2441. (Enter 50% of Federal credit) Earned Income Tax Credit. See instructions on Page 8 for ALL required documentation Total Non-Refundable Credits. Add Lines 9a, 9b, 10, 11, 12, 13 & 14 and enter here......................... Subtract Line 15 from Line 8. If Line 15 is greater than Line 8, enter “0” (Zero).... Delaware Tax Withheld (Attach W2s/ 1099s) 2013 Estimated Tax Paid & Payments with Extensions. S Corp Payments and Refundable Business Credits.... 2013 Capital Gains Tax Payments (Attach Form 5403) TOTAL Refundable Credits. Add Lines 17, 18, 19, and 20 and enter here............... If Line 16 is greater than Line 21, subtract 21 from 16 and enter here................. OVERPAYMENT. If Line 21 is greater than Line 16, subtract 16 from 21 and enter here CONTRIBUTIONS TO SPECIAL FUNDS If electing a contribution, complete and attach DE Schedule III AMOUNT OF LINE 23 TO BE APPLIED TO 2014 ESTIMATED TAX ACCOUNT.............................. ENTER PENALTIES AND INTEREST DUE. If Line 22 is greater than $400, see estimated tax instructions.............. NET BALANCE DUE (For Filing Status 4, see instructions, page 9)..................................................... PAY IN FULL > For all other filing statuses, enter Line 22 plus Lines 24 and 26 NET REFUND (For Filing Status 4, see instructions, Page 9)................................. ZERO DUE/TO BE REFUNDED > For all other filing statuses, subtract Lines 24, 25 and 26 from Line 23 DO NOT WRITE OR STAPLE IN THIS AREA First Name Middle Initial X $ 110. BALANCE DUE. ENTER 25 27 26 Spouse’s Last Name Column A Column B Column A - if SPOUSE was: 65 or over ----------------Page (0) Break---------------- Delaware NOL Carry forward. - please see instructions on Page 10. 2013 R COLUMNS: (Reconcile your Federal CO L UM N A CO L UM N B 29 . ............ .... ..................... . . .... 29 00 00 30 . ....................... ............................... .. ................... ...... .. 30 31 . .. .................... . .. . .................... . .. 31 32 . ............................................................................................. . ... .............. .. ........ . 32 0 0 00 0 0 00 0 0 00 33 . . . ................................... 0 0 0 0 33 34 . . .. .... .. ... ........ . 34 35 . ..... 35 3 6 . .............................................................. . ..... . .. 36 37 . ....... 37 38 . ........................................................................... .. . ... 38 00 00 0 0 00 00 00 0 0 00 0 0 00 39 . . . ..................... 00 0 0 39 40 . .... ................................. . ... . 40 41 . TOTAL - ...................................................................................................... . .... .. ... .... . ... . 41 4 2. ..... . .. 42 0 0 00 0 0 00 00 00 43 . . ... ... ................. ... ..................... . .. . 43 44 . ....................................................... ... ................. . .. ...... . 44 45 . . ..... .... ................ .. .... . . 45 46 . ........................................................ . .......... ........... .... . . . 46 47a . ................. ... ................ .. ......... . 47a 47 b . .. .................. ... ....................... . . 47b 48 . . .. . ....... ... . 48 0 0 00 0 0 00 00 00 00 00 00 00 00 00 00 00 a. b . Savings c . d. No NOTE: Date Date Date Address 2013 DELAWARE RESIDENT FORM 200-01, PAGE 2 Page 2 totals to the appropriate individual. See Page 9 worksheet.) Taxpayers using filing statuses 1, 2, 3, or 5 are to complete Column B only. Column A is reserved for the spouse of those couples choosing filing status 4. MODIFICATIONS TOFEDERAL ADJUSTED GROSS INCOME Filing Status 4 ONLY All other filings statuses Spouse Information You or You plus Spouse SECTION A - ADDITIONS (+) Interest on State & Local obligations other than Delaware .... ... ........................................................... Fiduciary adjustment, oil depletion Add Lines 30 and 31 TOTAL - Subtotal. Add Lines 29 and 32 SECTION B - SUBTRACTIONS (-) . .. ....................................................................................... Interest received on U.S. Obligations Pension/Retirement Exclusions (For a definition of eligible income, see instructions on Page10) Delaware State tax refund, fiduciary adjustment, work opportunity tax credit, Taxable Soc Sec/RR Retirement Benefits/Higher Educ. Excl/Certain Lump Sum Dist. (See instr. on Pg 11) SUBTOTAL. Add Lines 34, 35, 36 and 37 and enter here Subtotal. Subtract Line 38 from Line 33 Enter total Itemized Deductions from Schedule A, Federal Form, Line 29.......... Enter Foreign Taxes Paid (See instructions on Page 11) . .. ................................ Enter Charitable Mileage Deduction (See instructions on Page 11) SUBTOTAL. - Add Lines 43, 44, and 45 and enter here Enter State Income Tax included in Line 43 above (See instructions on Page 11) ................. Enter Form 700 Tax Credit Adjustment (See instructions on Page 11) TOTAL - Subtract Line 47a and 47b from Line 46. Enter here and on Front, Line 2 (See instructions) SECTION D - DIRECT DEPOSIT INFORMATION If you would like your refund deposited directly to your checking or savings account, complete boxes a, b, c and d below. See instructions for details. Routing Number Account Number Type: Checking Is this refund going to or through an account that is located outside of the United States? Yes If your refund is adjusted by$100.00 or more, a paper check will be issued and mailed to the address on your return. BE SURE TOSIGN YOUR RETURN BELOW AND KEEP A COPY FOR YOUR RECORDS Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and be lieve it is true, correct and complete. Your Signature Signature of Paid Preparer Spouse's Signature (if filing joint or combined return) Home Phone Business Phone State Zip E-Mail Address City EIN, SSN OR PTIN Business Phone E - Mail Address NET BALANCE DUE (LINE 27): DELAWARE DIVISION OF REVENUE P.O. BOX 508 WILMINGTON, DE19899-0508 NET REFUND (LINE 28): DELAWARE DIVISION OF REVENUE P.O. BOX 8765 WILMINGTON, DE19899-8765 ZERO (LINE 28): DELAWARE DIVISION OF REVENUE P.O.BOX8711 WILMINGTON, DE19899-8711 MAKE CHECK PAYABLE TO : DELAWARE DIVISION OF REVENUE PLEASE REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN (Rev 1 0 /31/13) allocate deductions between spouses, you must prorate in accordance with income. DELAWARE ADJUSTED GROSS INCOME. Subtract line 41 from Line 33. Enter here and on Front, Line1 Add Lines 38 and 40 Exclusion for certain persons 60 and over or disabled (See instructions on Page 11). Enter Federal AGI amount from Federal 1040, Line 37; 1040A, Line 21; or 1040EZ, Line 4 SECTION C - ITEMIZED DEDUCTIONS (MUST ATTACH FEDERAL SCHEDULE A) If Columns A and B are used and you are unable to specifically ----------------Page (1) Break----------------