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4                 State of Rhode Island Division of Taxation                                                                                                                                              4
5                 2024 Form RI-1040                                                                                                                                                                       5
6                 Resident Individual Income Tax Return                                                                     24100199990101                                                                6
7                                                                                                                                                                                                         7
8                                                                                                                                                                                                         8
9  Your social security number                         Spouse’s social security number                                                                                                                    9
10 999999999                                             999999999                                                          Reserved for 2D barcode                                                       10
11 Your first name                            MI    Last name                                    Suffix                                                                                                   11
12 XXXXXXXXXXXXXX                           X     XXXXXXXXXXXXXX                                               XXX                        x: 5.00 in                                                      12
13 Spouse’s name                              MI    Last name                                    Suffix                                                                                                   13
                                                                                                                                          y: 1.3 in 
14 XXXXXXXXXXXXXXAddress                    X     XXXXXXXXXXXXXX                                               XXX                        w: 2.75 in                                                      14
15                                                                                                                                                                                                        15
16 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                                h:1.5 in                                                        16
17 City, town or post office                                State         ZIP code                                                                                                                        17
18 XXXXXXXXXXXXXXXXXXXX                                     XX    99999                                                                                                                                   18
19 City or town of legal residence                Check each box          Primary                                 Spouse                New                            Amended                            19
                                                  that applies. Other-
20 XXXXXXXXXXXXXXXXXXX                            wise, leave blank.      deceased?                               deceased?             address?                       Return? *                          20
   ELECTORAL           If you want $5.00 ($10.00 if a joint return) to go                                      If you wish the 1st $2.00 ($4.00 if a joint return) be paid to a specific party, check the 
21 CONTRIBUTION        to this fund, check here. (See instructions. This        Yes                            box and fill in the name of the political party. Other-                                    21
22                     will not increase your tax or reduce your refund.)                                      wise, it will be paid to a nonpartisan general account. XXXXXXXXXX 22
23 FILING                                      Married filing                  Married filing                               Head of                                    Qualifying                         23
24 STATUS         Singleððððjointly                                            separately                                   household                                  widow(er) ð24
   Check one
25                                                                                                                                                                                                        25
26 INCOME,        1    Federal AGI from Federal Form 1040 or 1040-SR, line 11 ...........................................................                       1   9999999999 99                         26
   TAX AND 
27 CREDITS                                                                                                                                                                                                27
28                2    Net modifications to Federal AGI from RI Sch M, line 3. If no modifications, enter 0 on this line.                                       2   9999999999 99                         28
29  Rhode                                                                                                                                                                                                 29
    Island 
30 Standard       3    Modified Federal AGI. Combine lines 1 and 2 (add net increases or subtract net decreases).....                                           3   9999999999 99                         30
31 Deduction                                                                                                                                                                                              31
32  Single           4 RI Standard Deduction from left. If line 3 is over $ 246,450 see Standard Deduction Worksheet ...........                                4   9999999999 99                         32
   $10,550    
33  Married                                                                                                                                                                                               33
34 filing jointly 5    Subtract line 4 from line 3.  If zero or less, enter 0........................................................................           5   9999999999 99                         34
    or  
35 Qualifying                                                                                                                                                                                             35
36 widow(er)      6    Enter # of exemptions from RI Sch E, line 5 in box, multiply by $4,950 and                  99       X $4,950 =                          6   9999999999 99                         36
   $21,150             enter result on line 6. If line 3 is over $246,450, see Exemption Worksheet
37                                                                                                                                                                                                        37
     filing            RI TAXABLE INCOME. Subtract line 6 from line 5. If zero or less, enter 0...................................
38 Married        7                                                                                                                                             7   9999999999 99                         38
39 separately                                                                                                                                                                                             39
40 $10,575        8    RI income tax from Rhode Island Tax Table or Tax Computation Worksheet...............................                                    8   9999999999 99                         40
   Head of  
41 household      9 a  RI percentage of allowable Federal credit from page 3,                                                                                                                             41
42 $15,850             RI Sch I, line 22......................................................................DRAFT9a 9999999999 99                                                                       42
43                                                                                                                                                                     Check ü to certify                 43
                  b    RI Credit for income taxes paid to other states from page 3,                            9b                                                      use tax amount on 
44                     RI Sch II, line 29.....................................................................    9999999999 99                                        line 12a is accurate.              44
45                                                                                                                                                                                                        45
46 Using a        c    Other Rhode Island Credits from RI Schedule CR, line 9......                            9c 9999999999 99                                                                           46
47  paper                                                                                                                                                                                                 47
48  clip,         d    Total RI credits. Add lines 9a, 9b and 9c................................................................................. ............. 9d  9999999999 99                         48
   please 
49  attach                                                                                                                                                                                                49
50 Forms          10 a Rhode Island income tax after credits.  Subtract line 9d from line 8 (not less than zero) .............                                  10a 9999999999 99                         50
51 W-2 and                                                                                                                                                                                                51
52  1099          b    Recapture of Prior Year Other Rhode Island Credits from RI Schedule CR, line 12....................                                      10b 9999999999 99                         52
    here.                                                        09/30/2024
53                                                                                                                 Contributions reduce                                                                   53
54                11   RI checkoff contributions from page 3, RI Checkoff Schedule, line 38.                      your refund or increase                       11  9999999999 99                         54
                                                                                                                   your balance due
55                                                                                                                                                                                                        55
56                12 a USE/SALES tax due from RI Schedule U, line 4 or line 8, whichever applies..............................                                  12a 9999999999 99                         56
57                                                                                                                                                                                                        57
58                b    Individual Mandate Penalty (see instructions). Check  ü to certify full year coverage                .                                   12b 9999999999 99                         58
59                                                                                                                                                                                                        59
60                13 a TOTAL RI TAX AND CHECKOFF CONTRIBUTIONS. Add lines 10a, 10b, 11, 12a and 12b.......                                                      13a 9999999999 99                         60
61                                                                                                                                                                                                        61
62                                          RETURN MUST BE SIGNED - SIGNATURE IS LOCATED ON PAGE 2                                                                                                        62
          1111111111222222222233333333334444444444555555555566666666667777777777888Mailing address: RI Division of Taxation, One Capitol Hill, Providence, RI 02908-5806
34567890123456789012345678901234567890123456789012345678901234567890123456789012*  If filing an amended return, attach the Explanation of Changes supplemental page



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4                                                                                   State of Rhode Island Division of Taxation                                                                                                                                          4
5                                                                                   2024 Form RI-1040                                                                                                                                                                   5
6                                                                                   Resident Individual Income Tax Return - page 2                                                                        24100199990102                                                6
7                                                                                                                                                                                                                                                                       7
8                                                                                                                                                                                                                                                                       8
                                                                               Name(s) shown on Form RI-1040 or RI-1040NR                                                                                                             Your social security number
9                                                                                                                                                                                                                                                                       9
10                                                                             XXXXXXXXXXXXXX                       XXXXXXXXXXXXXX                                                                                                    999999999                         10
11                                                                                                                                                                                                                                                                      11
12                                                                                                                                                                                                                                                                      12
13                                                                                                                                                                                                                                                                      13
14                                                                             13 b TOTAL RI TAX AND CHECKOFF CONTRIBUTIONS from line 13a...............................................................                              13b 9999999999 99                 14
15                                                                                  RI 2024 income tax withheld from RI Schedule W, line 16. You must                                                                                                                   15
16                                                                             14 a attach Sch W AND all W-2 and 1099 forms with RI withholding. ...........                             14a 9999999999 99                                                              16
17                                                                                                                                                                                                                                                                      17
18                                                                             b    2024 estimated tax payments and amount applied from 2023 return....                                  14b 9999999999 99                                                              18
19                                                                                                                                                                                                                                                                      19
20                                                                             c    Property tax relief credit from RI-1040H, line 13. Attach RI-1040H........                           14c 9999999999 99                                                              20
21                                                                                                                                                                                                                                                                      21
22                                                                             d    RI earned income credit from page 3, RI Schedule EIC, line 41............                            14d 9999999999 99                                                              22
23                                                                                                                                                                                                                                                                      23
24                                                                             e    RI Residential Lead Paint Credit from RI-6238, line 7. Attach RI-6238..                              14e 9999999999 99                                                              24
25                                                                                                                                                                                                                                                                      25
26                                                                                f Other payments...................................................................................... 14f 9999999999 99                                                              26
27                                                                                                                                                                                                                                                                      27
                                                                               g    TOTAL PAYMENTS AND CREDITS. Add lines 14a, 14b, 14c, 14d, 14e and 14f.........................................                                    14g
28                                                                                                                                                                                                                                        9999999999 99                 28
29                                                                                                                                                                                                                                                                      29
30                                                                             h    Previously issued overpayments (if filing an amended return).....................................................................                 14h 9999999999 99                 30
                                       PAYMENTS AND PROPERTY TAX RELIEF CREDIT
31                                                                                                                                                                                                                                                                      31
32                                                                                i NET PAYMENTS. Subtract line 14h from line 14g........................................................................................             14i 9999999999 99                 32
33                                                                                                                                                                                                                                                                      33
34                                                                             15 a AMOUNT DUE. If line 13b is LARGER than line 14i, subtract line 14i from line 13b....................................                              15a 9999999999 99                 34
35                                                                                                                                                                                                                                                                      35
                                                                                    This amount should be added to line 15a or subtracted from line 16, whichever applies.............................
36                                                                             b    Enter the amount of underestimating interest due from Form RI-2210 or RI-2210A. (attach form)                                                     15b 9999999999 99                 36
37                                                                                                                                                                                                                                                                      37
38                                                                             c    TOTAL AMOUNT DUE. Add lines 15a and 15b. Complete RI-1040V and send in with your payment                                                          15c 9999999999 99                 38
                                                                                                                                                                                                                L
39                                                                             16   AMOUNT OVERPAID. If line 14i is LARGER than line 13b, subtract line 13b from line 14i. If there                                                   16                                39
40                                                                                  is an amount due for underestimating interest on line 15b, subtract line 15b from line 16..................                 J                         9999999999 99                 40
41                                                                                                                                                                                                                                                                      41
42                                                                             17   Amount of overpayment to be refunded........................................................................................................DRAFT 17  9999999999 99                 42
43                                                                                                                                                                                                                                                                      43
44                                                                             18   Amount of overpayment to be applied to 2025 estimated tax................                            18  9999999999 99                                                              44
45                                                                                                                                                                                                                                                                      45
46                                                                                                                                                                                                                                                                      46
47                                                                                                                                                                                                                                                                      47
48                                                                                                                                                                                                                                                                      48
49                                                                             Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and                                    49
                                                                               belief, it is true, accurate and complete.  Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
50                                                                                                                                                                                                                                                                      50
                                                                               Your signature                        Your driver’s license number     and    state                                             Date                        Telephone number
51                                                                                                                                                                                                                                                                      51
52                                                                                                                  999999999                                                                XX           09/28/20                        (999) 999-9999 52
                                                                               Spouse’s signature                    Spouse’s driver’s license number and state                Date09/30/2024       Telephone number
53                                                                                                                                                                                                                                                                      53
54                                                                                                                  999999999                                                                XX           09/28/20                        (999) 999-9999 54
55                                                                             Paid preparer signature                       Print name                                                                           Date                           Telephone number       55
56                                                                                                                                                                                                                                                                      56
                                                                               Paid preparer address                XXXXXXXXXXXXXXXXXXXXXX    City, town or post office                             State 09/28/20  ZIP code              (999)  PTIN999-9999
57                                                                                                                                                                                                                                                                      57
58                                                                            XXXXXXXXXXXXXXXXXXXXXX                XXXXXXXXXXXXXXXXX                                                        XX           99999                           P99999999                     58
59                                                                                                                                                                                                                                                                      59
60                                                                                                                                                                                                                                                                      60
61                                                                                                                                                                                                                                                                      61
62                                                                                                                                                                                                                                                                      62
                                                                                                                    May the Division of Taxation contact your preparer?   YES
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34567890123456789012345678901234567890123456789012345678901234567890123456789012Revised 
                                                                                                                                                                                                                                                                 09/2024



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4     State of Rhode Island Division of Taxation                                                                                                                                                      4
5     2024 Form RI-1040                                                                                                                                                                               5
6     Resident Individual Income Tax Return - page 3                                                               24100199990103                                                                     6
7                                                                                                                                                                                                     7
   Name(s) shown on Form RI-1040 or RI-1040NR                                                                                                                              Your social security number
8                                                                                                                                                                                                     8
9  XXXXXXXXXXXXXX                                             XXXXXXXXXXXXXX                                                                                               999999999                  9
10 RI SCHEDULE I - ALLOWABLE FEDERAL CREDIT                                                                                                                                                           10
11                                                                                                                                                                                                    11
12 19 RI income tax from page 1, line 8 ...................................................................................................................                19 9999999999 99           12
13                                                                                                                                                                                                    13
14 20 Credit for child and dependent care expenses from Federal Form 1040 or 1040-SR, Schedule 3, line 2...........                                                        20 9999999999 99           14
15                                                                                                                                                                                                    15
16 21 Tentative allowable federal credit.  Multiply line 20 by 25% (0.2500)..............................................................                                  21 9999999999 99           16
17                                                                                                                                                                                                    17
18 22 MAXIMUM CREDIT.  Line 19 or 21, whichever is SMALLER.  Enter here and on page 1, line 9a.................                                                            22 9999999999 99           18
19                                                                                                                                                                                                    19
20 RI SCHEDULE II - CREDIT FOR INCOME TAX PAID TO ANOTHER STATE                                                                                                                                       20
         (ATTACH COPY OF OTHER STATE(S) RETURN)
21                                                                                                                                                                                                    21
22 23 RI income tax from RI-1040, page 1, line 8 less allowable federal credit from RI-1040, page 3, line 22 .......                                                       23 9999999999 99           22
23                                                                                                                                                                                                    23
24 24 Income derived from other state.  If more than one state, see instructions....................................................                                       24 9999999999 99           24
25                                                                                                                                                                                                    25
26 25 Modified federal AGI from page 1, line 3.........................................................................................................                    25 9999999999 99           26
27                                                                                                                                                                                                    27
28 26 Divide line 24 by line 25   ........................................................................................................................................ 26 0.9999                  28
                                                                                                                                                                              _  .  _  _  _  _
29                                                                                                                                                                                                    29
30 27 Tentative credit.  Multiply line 23 by line 26.............................................................................................................          27 9999999999 99           30
31                                                                                                                                                                                                    31
32 28 Tax due and paid to other state (see specific instructions). Insert abbreviation for state paid              XX                                                      28 9999999999 99           32
33                                                                                                                                                                                                    33
34 29 MAXIMUM TAX CREDIT. Line 23, 27 or 28, whichever is the SMALLEST. Enter here and on pg 1, line 9b                                                                    29 9999999999 99           34
35                                                                                                                                                                                                    35
36 RI CHECKOFF CONTRIBUTIONS SCHEDULE                                                                                                                                                                 36
                                                                       $1.00    $5.00    $10.00   Other
37                                                                                                                                                                                                    37
   30 Drug program account RIGL §44-30-2.4                      ............                                                                                               30
38                                                                                                                                                                            9999999999 99           38
39                                                                                                                                                                                                    39
   31 Olympic Contribution RIGL §44-30-2.1                      ....... Yes         $1.00 contribution ($2.00 if a joint return)                                           31
40                                                                                                                                                                            9999999999 99           40
41                                                                                                                                                                                                    41
   32 RI Organ TransplantRIGL Fund                            §44-30-2.5 ......                                                                                            32
42                                                            DRAFT                                                                                                           9999999999 99           42
43                                                                                                                                                                                                    43
   33 RI Council onRIGLthe Arts    §42-75.1-1 .............                                                                                                                33
44                                                                                                                                                                            9999999999 99           44
45                                                                                                                                                                                                    45
   34 RI Nongame Wildlife Fund  RIGL §44-30-2.2                 .....                                                                                                      34
46                                                                                                                                                                            9999999999 99           46
47                                                                                                                                                                                                    47
   35 Childhood Disease Victim’s FundRIGL §44-30-2.3                                                                                                                       35
48                                                                                                                                                                            9999999999 99           48
49 36 RI Military Family Relief FundRIGL §44-30-2.9 ....                                                                                                                   36                         49
50                                                                                                                                                                            9999999999 99           50
51    Behavioral health education, training, and                                                                                                                           37                         51
52 37 coordination fundRIGL §44-30-2.12......................                                                                                                                 9999999999 99           52
                                                                09/30/2024
53                                                                                                                                                                                                    53
54 38 TOTAL CONTRIBUTIONS.  Add lines 30 through 37.  Enter here and on RI-1040, page 1, line 11 ....................                                                      38 9999999999 99           54
55                                                                                                                                                                                                    55
56 RI SCHEDULE EIC - RHODE ISLAND EARNED INCOME CREDIT                                                                                                                                                56
57                                                                                                                                                                                                    57
58 39 Federal earned income credit from Federal Form 1040 or 1040-SR, line 27..................................................                                            39 9999999999 99           58
59                                                                                                                                                                                                    59
60 40 Rhode Island percentage................................................................................................................................              40 16%                     60
61 41 RI EARNED INCOME CREDIT.  Multiply line 39 by line 40.             Enter here                 41                                                                                                61
62    and on RI-1040, page 2, line 14d ............................................................    9999999999 99                                                                                  62
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4     State of Rhode Island Division of Taxation                                                                                                                                                   4
5     2024 RI Schedule W                                                                                                                                                                           5
6     Rhode Island Withholding Information - Page 4                              24101099990101                                                                                                    6
7                                                                                                                                                                                                  7
8                                                                                                                                                                                                  8
   Name(s) shown on Form RI-1040 or RI-1040NR                                             Your social security number
9                                                                                                                                                                                                  9
10 XXXXXXXXXXXXXX                     XXXXXXXXXXXXXX                                      999999999                                                                                                10
11 Complete this Schedule listing all of your and, if applicable, your spouse’s W-2s, 1099s, etc. showing Rhode Island Income                                                                      11
12 Tax withheld.  W-2s, 1099s, etc. showing Rhode Island Income Tax withheld must still be attached to the front of your return.   12
13    Failure to do so may delay the processing of your return.        ATTACH THIS SCHEDULE W TO YOUR RETURN                                                                                       13
14    Column A    Column B                    Column C                           Column D                                                                                    Column E              14
15                                                                                                                                                                                                 15
      Enter “S”   Enter letter                                           Employer’s state ID # from                                                                        Rhode Island Income Tax 
                                  Employer’s Name from Box C of your W-
16    if Spouse’s code from                                              box 15 of your W-2 or Payer’s                                                                     Withheld (SEE BELOW     16
                                  2 or Payer’s Name from your other forms
17    W-2, 1099, etc. chart below                                        Federal ID # from other forms FOR BOX REFERENCES)                                                                         17
18                                                                                                                                                                                                 18
19 1  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           19
20                                                                                                                                                                                                 20
21 2  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           21
22                                                                                                                                                                                                 22
23 3  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           23
24                                                                                                                                                                                                 24
25 4  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           25
26                                                                                                                                                                                                 26
27 5  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           27
28                                                                                                                                                                                                 28
29 6  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           29
30                                                                                                                                                                                                 30
31 7  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           31
32                                                                                                                                                                                                 32
33 8  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           33
34                                                                                                                                                                                                 34
35 9  X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           35
36                                                                                                                                                                                                 36
37 10 X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           37
38                                                                                                                                                                                                 38
39 11 X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           39
40                                                                                                                                                                                                 40
41 12 X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           41
42                                         DRAFT                                                                                                                                                   42
43 13 X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           43
44                                                                                                                                                                                                 44
45 14 X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           45
46                                                                                                                                                                                                 46
47 15 X             X             XXXXXXXXXXXXXXXXXXXXX                  999999999                                                                                         9999999999 99           47
48 16 Total RI Income Tax Withheld.  Add lines 1 through 15, Col. E.  Enter total here and on RI-1040, line 14a or                                                                                 48
49    RI-1040NR, line 17a................................................................................................................................................. 9999999999 99           49
50                                                                                                                                                                                                 50
51 17 Total number of W-2s and 1099s showing Rhode Island Income Tax Withheld ......................................................                                       9999999                 51
52                                                                                                                                                                                                 52
                                              09/30/2024
53                                                                                                                                                                                                 53
                                              Schedule W Reference Chart
54                                                                                                                                                                                                 54
55    Form Type   Letter Code  Withholding    Form Type Letter Code  Withholding Form Type                          Letter Code  Withholding                                                       55
56                for Column B    Box                   for Column B     Box                                        for Column B                                             Box                   56
57    W-2                         17          1099-G    G                11      1099-OID                                                                                  O 14                    57
58    W-2G        W               15          1099-INT  I                17      1099-R                                                                                    R 14                    58
59    1042-S      S               17a         1099-K    K                8       RI K-1 - PTE                                                                              E Sect. VI, line 2      59
60    1099-B      B               16          1099-MISC M                16      RI K-1 - PTW                                                                              P Sect. IV, line 2      60
61                                                                                                                                                                                                 61
62    1099-DIV    D               16          1099-NEC  N                5                                                                                                                         62
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4     State of Rhode Island Division of Taxation                                                                                                              4
5     2024 RI Schedule E                                                                                                                                      5
6     Exemption Schedule for RI-1040 and RI-1040NR                            24105999990101                                                                  6
7                                                                                                                                                             7
8                                                                                                                                                             8
   Name(s) shown on Form RI-1040 or RI-1040NR                                                  Your social security number
9                                                                                                                                                             9
10 XXXXXXXXXXXXXX                       XXXXXXXXXXXXXX                                         999999999                                                      10
11                                                                                                                                                            11
   EXEMPTIONS
12                                                                                                                                                            12
13                                                                                                                                                            13
                       Complete this Schedule listing all individuals you can claim as a dependent.  
14 ATTACH THIS EXEMPTION SCHEDULE TO YOUR RETURN               Failure to do so may delay the processing of your return.       14
15                                                                                                                                                            15
16                                                                                                                                                            16
17 1a       Yourself                                                                                                                                          17
18                                                                                                                                                            18
19  b       Spouse                                                                                                                                            19
20                                                                                                                                                            20
21              (A) Name of Dependent           (B) Social Security Number    (C) Date of Birth                                              (D) Relationship 21
22                                                                                                                                                            22
23 2a XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           23
24                                                                                                                                                            24
25  b XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           25
26                                                                                                                                                            26
27  c XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           27
28                                                                                                                                                            28
29  d XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           29
30                                                                                                                                                            30
31  e XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           31
32                                                                                                                                                            32
33  f XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           33
34                                                                                                                                                            34
35  g XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           35
36                                                                                                                                                            36
37  h XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           37
38                                                                                                                                                            38
39  i XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           39
40                                                                                                                                                            40
41  j XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           41
42                                 DRAFT                                                                                                                      42
43  k XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           43
44                                                                                                                                                            44
45  l XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           45
46                                                                                                                                                            46
47  m XXXXXXXXXXXXXXXXXXXXXXXXXXX                       999999999             09282020                                                    XXXXXXXXX           47
48                                                                                                                                                            48
49                                 Exemption Number Summary                                                                                                   49
50                                                                                                                                                            50
51 3   Enter the number of boxes checked on lines 1a and 1b ........................................................                      3  9999999999       51
52                                                                                                                                                            52
   4a Enter the number of children from lines09/30/20242a through 2m who lived with you ...........................                       4a
53                                                                                                                                           9999999999       53
54                                                                                                                                                            54
55  b Enter the number of children from lines 2a through 2m who did not live with you due to                                              4b 9999999999       55
      divorce or separation ................................... ..........................................................................
56                                                                                                                                                            56
57  c  Enter the number of other dependents from lines 2a through 2m not included on lines 4a or 4b.                                      4c 9999999999       57
58                                                                                                                                                            58
59 5    Add the numbers from lines 3 through 4c. Enter here and in the box on RI-1040/NR, pg 1, line 6 .                                  5  9999999999       59
60                                                                                                                                                            60
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(Plugin #1/10.13/13.0)