*VA0760215888*
Page 2
2015 Form 760
Your SSN
DIRECT BANK DEPOSIT
Domestic Accounts Only.
No International Deposits.
Bank Routing Transit Number
Checking
Savings
Bank Account Number
If the Direct Deposit section below is not completed, your refund will be issued by check.
17. Amount of Tax from Tax Table or Tax Rate Schedule (round to whole dollars) ...................................17
18. Spouse Tax Adjustment (STA). Filing Status 2
only. Enter Spouse’s VAGI in box here
and STA amount on Line 18. 18
19. Net Amount of Tax - Subtract Line 18 from Line 17 .......................................................................19
20. Virginia income tax withheld for 2015. Enclose copies of Forms W-2, W-2G, 1099 and/or VK-1.
20a. Your Virginia withholding ..........................................................................................................20a
20b. Spouse’s Virginia withholding (Filing Status 2 only) .................................................................20b
21. Estimated tax payments for taxable year 2015 (from Form 760ES) ....................................................21
22. Amount of 2014 overpayment applied toward 2015 estimated tax ......................................................22
23. Extension Payments (from Form 760IP) .............................................................................................23
24.
Tax Credit for Low-Income Individuals or Earned Income Credit from Sch. ADJ, Line 17
.........................24
25. Credit for Tax Paid to Another State from Schedule OSC, Line 21.
You must enclose Schedule OSC and a copy of all other state returns. .............................................25
26. Credit for Political Contributions ..........................................................................................................26
27. Credits from enclosed Schedule CR, Section 5, Part 1, Line 1A ....................................................27
28. Add Lines 20a through 27 .................................................................................................................28
29. If Line 28 is less than Line 19, subtract Line 28 from Line 19. This is the Tax You Owe ....................29
30. If Line 19 is less than Line 28, subtract Line 19 from Line 28. This is Your Tax Overpayment ...........30
31. Amount of overpayment you want credited to next year’s estimated tax ............................................31
32. Virginia College Savings Plan Contributions from Schedule VAC, Section I, Line 6 ..........................32
33. Other Voluntary Contributions from Schedule VAC, Section II, Line 14 ..............................................33
34. Addition to Tax, Penalty and Interest from enclosed Schedule ADJ, Line 21. .....................................34
35. Consumer’s Use Tax. You may be liable if sales tax was not paid on Internet or other
purchases. See instructions.. ..............................................................................................................35
36. Add Lines 31 through 35 ...................................................................................................................36
37. If you owe tax on Line 29, add Lines 29 and 36. OR If Line 30 is less than Line 36, subtract Line 30
from Line 36. Enclose payment or pay at www.tax.virginia.gov. ......... AMOUNT YOU OWE ......37
fill in oval if paying by credit or debit card - see instructions
38. If Line 30 is greater than Line 36, subtract Line 36 from Line 30. ............ YOUR REFUND ..............38
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Preparer’s PTIN
Firm Name
Your Signature Date
Spouse’s Signature
Date
I (We), the undersigned, declare under penalty of law that I (we) have examined this return and to the best of my (our) knowledge, it is a true, correct and complete return.
Preparer’s Name
Filing Election
Phone Number
Your
Phone
Spouse‘s
Phone
I (We) authorize the Dept. of Taxation to discuss this return with my (our) preparer.
I agree to obtain my Form 1099-G at www.tax.virginia.gov.
Office
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