Hawaii Individual Income Tax Return (Resident Short Form) OBSOLETE

Individual Income Tax Return (Resident Short Form) OBSOLETE
Form N-13, Rev. 2015, Individual Income Tax Return, Short Form
Clear Form
				

THIS SPACE FOR DATE RECEIVED STAMP

	FORM	
STATE OF HAWAII
DEPARTMENT OF TAXATION
	N-13
	
(Rev. 2015)
	
Individual Income Tax Return
		
RESIDENT	

2015

JDF151

(FOR USE BY TAXPAYERS WHO HAVE LESS THAN
$100,000 TAXABLE INCOME, DO NOT ITEMIZE
DEDUCTIONS, AND DO NOT CLAIM
ADJUSTMENTS TO INCOME)

• ATTACH CHECK OR MONEY ORDER AND FORM N-200V HERE • ATTACH COPY B OF FORM HW-2 HERE •
USE STATE LABEL
FILING
INCOME
EXEMPTIONS
STATUS
OTHERWISE PRINT OR TYPE

  AMENDED Return     First Time Filer     Address or Name Change
Your first name	

M.I.	

Last name	

Your social security number

If a joint return, spouse’s first name	

M.I.	

Last name	

Spouse’s social security number

Present mailing or home address (Number and street, including apartment number or rural route)

 IMPORTANT 
You must enter your SSN(s).
Your occupation / Spouse’s occupation

City, town or post office, State and Postal/ZIP code. If you have a foreign address, see Instructions.	



Note:  Checking “Yes” will
HAWAII ELECTION		
Do you want $3 to go to the Hawaii Election Campaign Fund?.................. 	Yes	
No
not increase your tax or
CAMPAIGN FUND	
	If
joint
return,
does
your
spouse
want
$3
to
go
to
the
fund?.......................
	Yes	
No
reduce your refund.
(See page 8 of the Instructions)
(Check only ONE box)
	 1	
	Single	
	 4	
	 Head of household (with qualifying person). If the qualifying
person is a child but not your dependent, enter this child’s name
	 2	
	 Married filing joint return (even if only one had income).
here. ä	
 
	 3	
	 Married filing separate return. Enter spouse’s SSN above and
	 5	
	 Qualifying widow(er) with dependent child (Year spouse died _______).
full name here. ________________________________
Caution: If you can be claimed as a dependent on another person’s tax return (such as your parents’), do not check box 6a, but be sure to check the box below line 11.

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6a	
	Yourself............................
	 Age 65 or over...............................................................................
6b	
	Spouse............................
	 Age 65 or over...............................................................................	
		 If you checked box 3 and 6b above, see the Instructions on page 9 and if your spouse meets the qualifications, check here
  6c Dependents:	
If more than 6		
2. Dependent’s social
	
dependents, use		
security number	
3. Relationship
  and 1. First and last name	
attachment
  6d

 

}

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6e	 Total number of exemptions claimed......................................................................................................	

Enter number of
boxes checked 	
on 6a and 6b

ç

Enter number
of your children
listed	

6c

Enter number
of  other
dependents	

6d  

Add numbers
entered in
boxes above	

6e  

ç
ç
ç

ROUND TO THE NEAREST DOLLAR
00
	7	 Wages, salaries, tips, etc. (attach Form(s) W-2; if unavailable, see item 5 on page 12 of Instructions).................................. 	 7
00
	8	 Interest income (complete Part I on page 2 if over $1,500)............................................................................... 	 8
00
	9	 Ordinary dividends (complete Part II on page 2 if over $1,500)......................................................................... 	 9
00
	10	 Unemployment compensation (insurance)......................................................................................................... 	 10
00
	11	 Add lines 7, 8, 9 and 10.......................................................................................Adjusted Gross Income ä	11
Caution:	 	 If you can be claimed as a dependent on another person’s return,
			 see page 12 of the Instructions and check here............................................... ä 
		
	 If you are married filing separately and your spouse itemizes deductions,
			 see page 8 of the Instructions.
	12	 Standard deduction.		
1 or 3, enter $2,200
		 If you checked filing status box:		
2 or 5, enter $4,400
00
			
	 4, enter $3,212................................................Standard Deduction ä	12
00
	
13	 Line 11 minus line 12. (This line MUST be filled in)..................................................................................... ä	13
	
14	 Multiply $1,144 by the total number of exemptions claimed on line 6e. If you and/or your spouse are blind, deaf,
00
		 or disabled, check applicable box(es)  
  Yourself  
Spouse, and see page 13 of Instructions..	 14
00
	15	 Line 13 minus line 14. Enter the result (but not less than zero). ..................................... Taxable Income ä	15

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{

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Continue on other side		
Continue on other side

					

FORM N-13

Form N-13		
Page 2
(Rev. 2015)
Name(s) as shown on return	

JDF152

PART I
Interest Income
If you received more than $1,500 in interest, list the names of the payers
and the amounts of interest on the lines below. See page 12 of the
Instructions for what interest to report.
Name of Payer	

Social Security Number(s)

PART II
Ordinary Dividends
If you received more than $1,500 in ordinary dividends, list the names
of the payers and the amounts of the dividends on the lines below. See
page 12 of the Instructions for a definition of ordinary dividends.

Amount

Name of Payer	

1

Amount

1

2	 Total interest income. Enter here and on
	 Form N-13, line 8 (Whole dollars only).................

TAX PAYMENTS AND CREDITS

2	 Total ordinary dividends. Enter here and on
	 Form N-13, line 9 (Whole dollars only).................

	 16	 Tax from Tax Table.......................................................................................................................................... Tax ä	16
	17	 Refundable Renewable Energy Technologies Income Tax Credit (attach Form N-342)
		
Check type of energy system: 
  Solar  
  Wind.......................................... 	
17
00
	 18	 Refundable Food/Excise Tax Credit (attach Schedule X)
		
DHS, etc. exemptions             Federal AGI           .. 	
18
00
	19	 Credit for Low-Income Household Renters (attach Schedule X)............................. 	
19
00
	20	 Credit for Child and Dependent Care Expenses (attach Schedule X)..................... 	20
00
	21	 Credit for Child Passenger Restraint System(s) (attach a copy of the invoice)........ 	
21
00
	22	 Add lines 17 through 21............................................................................................... Total Refundable Credits ä	
22
	 23	 Line 16 minus line 22. If line 23 is zero or less, see Instructions............................................................................ ä	
23
	 24	 Carryover of the Nonrefundable Renewable Energy Technologies Income Tax Credit (For Systems
		 Installed and Placed in Service Before July 1, 2009) (attach Form N-323)............................................ 	
24
00
	 25	 Nonrefundable Renewable Energy Technologies Income Tax Credit (attach Form N-342)
		
Check type of energy system: 
  Solar  
  Wind........................................ 	
25
00
	 26	 Add lines 24 and 25................................................................................................Total Nonrefundable Credits ä	26
	27	 Line 23 minus line 26................................................................................................................................Balance ä	27
	 28	 Total Hawaii income tax withheld (attach W-2s) (see page 15 of the Instructions for other attachments)... 	
28
00
	29	 Amount paid with extension..................................................................................... 	
29
00
	30	
Add lines 28 and 29..................................................................................................................... Total Payments ä	
30
	 31	 If line 30 is larger than line 27, enter the amount OVERPAID (line 30 minus line 27) (see page 15 of the Instructions)........... 	
31

•

REFUND OR AMOUNT
YOU OWE

00

•

•

	32	 Contributions to (See page 15 of the Instructions):.......  Yourself	 Spouse
	 32a	  Hawaii Schools Repairs and Maintenance Fund.......... 
$2	

$2
	 32b	  Hawaii Public Libraries Fund......................................... 
$2	

$2
	 32c	 Domestic and Sexual Violence / Child Abuse and Neglect Funds.. 
$5	

$5
	 33	 Add the amounts of the checked boxes on lines 32a through 32c and enter the total here....................................... 	
	 34a	 Line 31 minus line 33. This is the amount to be REFUNDED TO YOU. If filing late, see page 15 of Instructions....... 	
		
 
  Check here if this refund will ultimately be deposited to a foreign (non-U.S.) bank. Do not complete lines 34b, 34c, or 34d.
	 34b	 Routing number	                
34c Type:  
 Checking  
 Savings
	 34d	 Account number	                             
	35	 If line 27 is larger than line 30, enter the AMOUNT YOU OWE (line 27 minus line 30). Send Form N-200V
		 with your payment. Make check or money order payable to the “Hawaii State Tax Collector”..................................... 	
	36	 Estimated tax penalty. (See page 16 of Instructions) Do not include on line 31 or 35.
		 Check box if Form N-210 is attached ä
.......................................................... 	
36
00
	 37	 AMENDED RETURN ONLY – Amount paid (overpaid) on original return. (See Instructions) (Attach Sch. AMD).... 	
	 38	 AMENDED RETURN ONLY – Balance due (refund) with amended return. (See Instructions) (Attach Sch. AMD).. 	

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00
00

00
00
00
00

33
34a

00
00

35

00

37
38

00
00

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DESIGNEE

RETURN

00

•

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AMENDED

00

	
If designating another person to discuss this return with the Hawaii Department of Taxation, complete the following. This is not a full power of attorney. See page 17 of the Instructions.
	
Designee’s name ä	
Phone no. ä	
Identification number ä
DECLARATION — I declare, under the penalties set forth in section 231-36, HRS, that this return (including accompanying schedules or statements)
has been examined by me and, to the best of my knowledge and belief, is a true, correct, and complete return, made in good faith, for the taxable year
stated, pursuant to the Hawaii Income Tax Law, Chapter 235, HRS.

PLEASE
SIGN HERE

ä	

ä

Your signature	
Date	
Spouse’s signature (if filing jointly, BOTH must sign)	
Date
Preparer’s Signature	
Preparer’s identification number
Check if
and date
	
Paid
		
self-employed ä
Print Preparer’s Name			
Preparer’s
Firm’s name (or yours		
Federal
E.I.
No.
ä
Information
if self-employed),
Phone No. ä
Address, and ZIP Code		

ä

ä

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