Page 1Revision: 20200117
DF22419019995V1
Attach this form to your Delaware State tax return.
NAME
(
S
)
SOCIAL SECURITY NO.
18. If you elect to itemize deductions even though they are less than your
standard deduction, check here.
b. If ling status 4, allocate itemized deductions here and enter in the
appropriate columns on Form 200-01, Line 43 (see instructions).
(A) (B)
1. Medical and dental expenses
TOTAL
ITEMIZED
DEDUCTIONS
OTHER
ITEMIZED
DEDUCTIONS
MEDICAL
AND DENTAL
EXPENSES
GIFTS TO
CHARITY
If you made a
gift and got a
benet for it, see
Federal Schedule
A instructions.
CASUALTY
AND THEFT
LOSSES
INTEREST
YOU PAID
Caution:
Your mortgage
interest deduction
may be limited.
TAXES
YOU PAID
2. Enter amount from Federal Form 1040, Line 8b
4. Subtract Line 3 from Line 1. If Line 3 is more than Line 1, enter 0.
13. Carryover from prior year
14. Add Line 11 through Line 13
12. Gifts other than by cash or check. If any gift of $250 or more, see instructions.
You must attach Federal Form 8283 if over $500.
11. Gifts by cash or check. If you made any gift of $250 or more, see instructions.
15. Casualty and theft loss(es) from a federally declared disaster (other than net
qualied disaster losses). (Attach Federal Form 4684 and enter the amount
from Line 18 of Federal Form 4684.)
a. Home mortgage interest and points reported to you on Federal Form 1098
b. Home mortgage interest not reported to you on Federal Form 1098
(If paid to the person from whom you bought the home, show that
person’s name, identifying no., and address.)
8. Home mortgage interest and points. (If you didn’t use all of your home
mortgage loan(s) to buy, build, or improve your home, check this box.)
c. Points not reported to you on Federal Form 1098
d. STATE and LOCAL personal property taxes
f. Enter the smaller of Line 5e or $10,000 ($5,000 if married ling separately)
6. Other taxes. List type and amount:
a. STATE and LOCAL income taxes not claimed as a credit on Form 200-01
(see instructions)
5. STATE and LOCAL taxes
7. Add Line 5f and Line 6
c. STATE and LOCAL real estate taxes
b. STATE and LOCAL general sales taxes (you may include either income taxes
or sales taxes, but not both). If you elect to include general sales taxes instead of
income taxes, check this box
e. Add Line 5a through Line 5d
16. Other deductions. See list in Federal Schedule A instructions. List type and amount:
17. a. Add Line 4, Line 7, Line 10, Line 14, Line 15, and Line 16. (If ling status
1, 2, 3, or 5, enter this amount on Form 200-01, Line 43, Column B.)
3. Multiply Line 2 by 7.5% (0.075)
d. Mortgage insurance premiums
e. Add Line 8a through Line 8d
10. Add Line 8e and Line 9
9. Investment interest. Attach Federal Form 4952.
PIT-RSA
RESIDENT SCHEDULE A - ITEMIZED DEDUCTIONS
