2021 Virginia Nonresident Income Tax Return
Due May 1, 2022
763
*VA0763121888*
Enclose a complete copy of your federal tax return and all other required Virginia enclosures.
1 Adjusted Gross Income from federal return - Not federal taxable income.............................................................. 1 00
2
Additions from Schedule 763 ADJ, Line 3. ............................................................................................................. 2 00
3
Add Lines 1 and 2. ................................................................................................................................................ 3 00
4
Age Deduction (See instructions and the Age Deduction Worksheet). ............................................................ You
Enter Birth Dates above. Enter Your Age Deduction
on Line 4a and Your Spouse's Age Deduction on Line 4b.. ........................................................................ Spouse
4a 00
4b 00
5 Social Security Act and equivalent Tier 1 Railroad Retirement Act benets reported on your federal return. .......
5 00
6 State income tax refund or overpayment credit reported as income on your federal return. ................................. 6 00
7 Subtractions from Schedule 763 ADJ, Line 7. ........................................................................................................ 7 00
8 Add Lines 4a, 4b, 5, 6, and 7................................................................................................................................ 8 00
9 Virginia Adjusted Gross Income (VAGI). Subtract Line 8 from Line 3. ............................................................ 9 00
10 Itemized Deductions from Virginia Schedule A, if applicable. See instructions. ..................................................... 10 00
11 If you do not claim itemized deductions on Line 10, enter standard deduction. See instructions. ........................ 11 00
12 Exemption amount. Enter the total amount from the Exemption Sections 1 and 2 above. .................................... 12 00
13 Deductions from Schedule 763 ADJ, Line 9. .......................................................................................................... 13 00
14 Add Lines 10, 11, 12 and 13. ................................................................................................................................ 14 00
15 Virginia Taxable Income computed as a resident. Subtract Line 14 from Line 9. ................................................... 15 00
16 Percentage from Nonresident Allocation Section on Page 2 (Enter to one decimal place only) ............................ 16 %
17 Nonresident Taxable Income. (Multiply Line 15 by percentage on Line 16). .......................................................... 17 00
18 Income Tax from Tax Table or Tax Rate Schedule .................................................................................................. 18 00
Page 1
For Local Use
Va. Dept. of Taxation
2601044 Rev. 06/21
LTD $_________
First Name MI Last Name Sux Your Social Security Number Check if
deceased
Spouse's First Name (Filing Status 2 Only) MI Last Name Sux Spouse's Social Security Number Check if
deceased
Present Home Address (Number and Street or Rural Route)
Your Birth Date
(mm-dd-yyyy)
- -
City, Town or Post Oce State ZIP Code
Spouse’s Birth Date
(mm-dd-yyyy)
- -
State of Residence Important - Name of Virginia City or County in which principal place of business, employment, or income source
is located.
City OR County
Locality Code
Check Applicable
Boxes
Amended Return
Reason Code
Name(s) or Address Dierent
than Shown on 2020 VA
Return
Overseas on Due Date
Dependent on Another’s Return Qualifying Farmer, Fisherman, or
Merchant Seaman
EIC Claimed on federal return
$___________________ .00
+ + = X $930 =
{
If Filing Status 3 or 4, enter spouse's SSN in the Spouse's Social Security Number
box at top of form and enter Spouse’s Name
___________________________________
Total Section 2
Total Section 1
DependentsYou
Exemptions Add Sections 1 and 2. Enter the sum on Line 12.
+ + + = X $800 =
Spouse 65
or over
You 65
or over
Spouse
Blind
You
Blind
Spouse if
Filing Status
2 or 3
1
Filing Status Enter Filing Status Code in box below.
1 = Single. Federal head of household?
YES
2 = Married, Filing Joint Return - both must have Virginia income
3 = Married, Spouse Has No Income From Any Source
4 = Married, Filing Separate Returns
*VA0763221888*
2021 FORM 763 Page 2
I (We), the undersigned, declare under penalty provided by law that I (we) have examined this return and to the best of my (our) knowledge, it is a true, correct, and complete return.
19a Your Virginia income tax withheld. Enclose Forms W-2, W-2G, 1099, and VK-1. ............................................. 19a 00
19b Spouse's Virginia income tax withheld. Enclose Forms W-2, W-2G, 1099, and VK-1. ...................................... 19b 00
20 2021 Estimated Tax Payments.. ......................................................................................................................... 20 00
21 2020 overpayment credited to 2021 estimated tax............................................................................................. 21 00
22 Extension Payment - submitted using Form 760IP. ............................................................................................ 22 00
23 Credit for Low-Income Individuals or Virginia Earned Income Credit from Schedule 763 ADJ, Line 17. ........... 23 00
24 Total credits from Schedule OSC. ...................................................................................................................... 24 00
25
Credits from Schedule CR, Section 5, Line 1A................................................................................................... 25 00
26 Total payments and credits. Add Lines 19a through 25. ............................................................................. 26 00
27 If Line 18 is larger than Line 26, enter the dierence. This is the INCOME TAX YOU OWE. ............................ 27 00
28 If Line 26 is larger than Line 18, enter the dierence. This is the OVERPAYMENT AMOUNT. ......................... 28 00
29 Amount of overpayment on Line 28 to be CREDITED TO 2022 ESTIMATED INCOME TAX. .............................. 29 00
30 Virginia529 and ABLE Contributions from Schedule VAC, Part I, Line 6 ............................................................ 30 00
31 Other Voluntary Contributions from Schedule VAC, Section II, Line 14 ............................................................. 31 00
32 Addition to Tax, Penalty, and Interest from enclosed Schedule 763 ADJ, Line 21. .......................................... 32 00
33
Sales and Use Tax is due on Internet, mail order, and out-of-state purchases (Consumer’s Use Tax).
See instructions. .................................... Check here if no sales and use tax is due. ...................................
33 00
34 Add Lines 29 through 33. ................................................................................................................................. 34 00
35 If you owe tax on Line 27, add Lines 27 and 34 - OR - If you have an overpayment on Line 28 and
Line 34 is larger than Line 28, enter the dierence. AMOUNT YOU OWE. Enclose payment or pay at
www.tax.virginia.gov. ........Check here if paying by credit or debit card - See instructions. ......................
35 00
36 If Line 28 is larger than Line 34, subtract Line 34 from Line 28. This is the amount to be REFUNDED TO YOU. 36 00
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.
Your Bank Routing Transit Number
Your Bank Account Number
Checking
Savings
If the Direct Deposit section below is not completed, your refund will be issued by check.
DIRECT BANK DEPOSIT
Domestic Accounts Only
No International Deposits
Your Name Your SSN
Nonresident Allocation Percentage
A - All Sources B - Virginia Sources
1. Wages, salaries, tips, etc.. ................................................................................. 1 00 00
2. Interest income. ................................................................................................. 2 00 00
3. Dividends. .......................................................................................................... 3 00 00
4. Alimony received. .............................................................................................. 4 00 00
5. Business income or loss. ................................................................................... 5 00 00
6. Capital gain or loss/capital gain distributions..................................................... 6 00 00
7. Other gains or losses......................................................................................... 7 00 00
8. Taxable pensions, annuities and IRA distributions. ........................................... 8 00
9. Rents, royalties, partnerships, estates, trusts, S corporations, etc.................... 9 00 00
10. Farm income or loss. ......................................................................................... 10 00 00
11. Other income. .................................................................................................... 11 00 00
12. Interest on obligations of other states from Schedule 763 ADJ, Line 1. ............ 12 00
13. Lump-sum and accumulation distributions included on Sch. 763 ADJ, Line 3. . 13 00 00
14. TOTAL - Add Lines 1 through 13 and enter each column total here .................. 14 00 00
15. Nonresident allocation percentage - Divide Line 14 B, by Line 14 A. Compute
percentage to one decimal place (e.g., 5.4%). Enter on Page 1, Line 16. ........ 15
%
Your Signature
Your Phone Number Date
Spouse’s Signature (If a joint return, both must sign) Spouse’s Phone Number Preparer’s PTIN Vendor Code
Preparer’s Name Firm’s Name (or Yours if Self-Employed) Preparer’s Phone Number Filing Election Code ID Theft PIN