|
3083810521 Legal Aid of Nebraska GI 02:41:05 p.m. 10-05-2018 5/5
<br /> NEB A-51474- Worksheet A—Part I FORM 458
<br /> Good Life.Great Service. Line 8,Other Income or Adjustments Schedule I
<br /> Worksheet A
<br /> A Net business income including rental,or farm income,or(loss) A 0
<br /> B Capital gain or(loss) B 0
<br /> C Other gain or(loss)
<br /> C O
<br /> D Unemployment compensation D
<br /> E Any other income or(adjustments reducing income.) Explain: E
<br /> F Penalty on early withdrawal of savings F c O
<br /> G Total of lines A through E,minus line F(enter this amount here and on Part I, line 8) G 0
<br /> Retain a copy for your records.
<br /> Instructions
<br /> Who Must File.This Form 458 Schedule I must be filed by persons applying fora homestead exemption,who are not filing
<br /> as a veteran drawing compensation from the Department of Veteran's Affairs(DVA)or as a paraplegic veteran or multiple
<br /> amputee whose home was substantially contributed to by the DVA.This form is to be attached to and filed with the Nebraska
<br /> Homestead Exemption Application or Certification of Status,Form 458.(See Form 458 Instructions).If you filed,or would
<br /> have filed as married for Nebraska individual income tax purposes for 2017,you must include income for both you and your
<br /> spouse,even if you filed as"married,filing separately."Each additional owner who occupied the homestead during any part
<br /> of 2017 must also report their income on a separate schedule.
<br /> When and Where to File. Schedule I must be attached to the Form 458 and filed with your county assessor, after
<br /> February 1,2018 and by July 2,2018.
<br /> Specific Instructions
<br /> Note—Do NOT include the following on the income statement:
<br /> • Department of Veterans Affairs disability compensation;
<br /> • Supplemental Security Income(SSI);
<br /> • Worker's Compensation Act payments;
<br /> • Child support payments;
<br /> • Aid to Dependent Children(ADC);and
<br /> • Nebraska Department of Health and Human Services aid.
<br /> Exclude Social Security payments based on disability for applicants and spouses under their full retirement age(generally
<br /> age 66) EXCEPT for any portion of the benefits included in federal adjusted gross income (AGI). Disability benefits
<br /> automatically convert to retirement benefits at full retirement age and must be reported.See aLLEINi Publication No.05-10035.
<br /> Part I
<br /> Line 1,Wages and Salaries.Include any wages,salaries,fees,commissions,tips,bonuses,etc.received in 2017,even
<br /> if you do not have a Federal Form W-2.If you have a Federal Form W-2, this information is shown in Box 1.
<br /> Line 2, Social Security Retirement Income. Report net benefits received in 2017, as shown in Box 5, Federal
<br /> Form SSA-1099.Do NOT subtract Medicare premiums or any other adjustments from the amount in Box 5.
<br /> Line 3,Tier I Railroad Retirement Income. Include Tier I net Social Security equivalent benefit received in 2017,as
<br /> shown in Box 5,Federal Form RRB-1099.
<br /> Line 4a and 4b,Total Pensions and Annuities.On line 4a,include total payments from retirement plans,life insurance
<br /> annuity contracts,profit-sharing plans,and employee savings plans.Include any gross distribution reported for 2017,as shown
<br /> in Box 1,Federal Form 1099-R.Include Tier II,contributory amount paid,vested dual benefits,and supplemental annuities
<br /> as shown in Box 7, Federal Form RRB-1099-R. On line 4b,report the taxable amount from Box 2(a), Form 1099-R. See
<br /> Federal Form 1099-R and IRS Publication 575.
<br /> Line 5a and 5b, IRA Distributions.On line 5a,report the total payments received in 2017 from your IRA as shown in
<br /> Box 1,Federal Form 1099-R.On fine 5b,report the taxable amount from Box 2(a),Form 1099-R.Do not report any amount
<br /> from a qualified IRA rollover.See Federal Form 1099-R and IRS Publication 590.
<br /> Line 6,Tax Exempt Interest and Dividends.Report the total interest received in 2017 on tax exempt obligations.State
<br /> and local bond income from both Nebraska and out-of-state obligations must be included. Include any exempt interest from
<br /> a mutual fund or other regulated investment company. Do not include interest earned on your IRA,or excludable interest on
<br /> series EE bonds.See Federal Form 8815.
<br />
|