04  05  06  07  08  09  10  11  12  13  14  15  16  17  18            19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42   43  44  45  46  47  48     49  50  51  52  53  54  55  56  57  58  59  60  61  62      63  64  65  66  67  68  69  70  71  72      73  74  75  76  77  78  79  80  81  82 
 03                                                                                                                                                                                                                                                                                                                                 03 
 04                                                                           DELAWARE INDIVIDUAL RESIDENT                                                                                                DO NOT WRITE OR STAPLE IN THIS AREA                                                                                       04 
 05                                               2016                                            INCOME TAX RETURN                                                                                                                                                                                                                 05 
                                                                    R                                         FORM 200-01
 06                                                                                                                                                                                                                                                                                                                                 06 
 07                                       For Fiscal year beginning                                           and ending                                                                                                                                                                                                            07 
 08                                       Your Social Security No.                                      Spouse’s Social Security No.                                                                                                                                                                                                08 
 09                                                                                                                                                                                                                                                                                                                                 09 
 10                                                                                                                                                                                                                                                                                                                                 10 
 11                                          Your Last Name                                             First Name and Middle Initial      Jr., Sr., III, etc.                                                                                                                                                                      11 
 12                                                                                                                                                                                                                                                                                                                                 12 
 13                                          Spouse’s Last Name                                         Spouse’s First Name,                              Jr., Sr., III, etc.                                                                                                                                                       13 
 14                                                                                                                                                                                                                                                                                                                                 14 
 15                                          Present Home Address (Number and Street)                                                         Apt. #                                                                                                                                                                                15 
                     ATTACH LABEL HERE
 16                                                                                                                                                                                                                                                                                                                                 16 
 17                                          City                                                            State                    Zip Code                                                                                    FILING STATUS (MUST CHECK ONE)                                                                    17 
 18                                                                                                                                                                                   1.                  Single, Divorced,  3.                       Married or Entered into a Civil                     5.              Head of   18 
                                                                                                                                                                                                          Widow(er)                                   Union & Filing Separate Forms                                       Household
 19                                              Form DE2210    If you were a part-year resident in 2016, give the dates you resided in Delaware:                                                                                                                                                                                   19 
 20                                                                                                           2016                                                        2016        2.                  Joint or Entered            4.              Married or Entered into a Civil Union & Filing                                20 
                                                                                                                                                                                                          into a Civil Union                          Combined Separate on this form
 21                                                  Attached                                                                                                                                                                                                                                                                       21 
 22                                       Column A is for Spouse information, Filing Status 4 only. All other filing statuses use Column B.                                                                                                               Column A                                        Column B                  22 
 23                                       1.      DELAWARE ADJUSTED GROSS INCOME. Begin Return on Page 2, Line 29, then enter amount from Line..                                                                                  42 1here     >                                                                                    23 
 24                                       2a.     If you elect the DELAWARE STANDARD DEDUCTION check here..............                                                                                                                                                                                                             24 
 25                                               Filing Statuses 1, 3 & 5 enter $3250 in Column B; Filing Status 2 enter $6500 in Column B;                                                                                                                                                                                        25 
                                                  Filing Status 4 enter $3250 in Column A and in Column B                                                                                                             *DF20116019999*                                                                                               26 
 26 
                                                  If you elect the DELAWARE ITEMIZED DEDUCTIONS check here...............                                                                                                                                     DF20116019999
 27                                         b.    Filing Statuses 1, 2, 3 and 5, enter itemized deductions from reverse side, Line 48 in Column B                                                                                                                                                                                   27 
 28                                               Filing Status 4 enter itemized deductions from reverse side, Line 48 in Columns A and B                                                                                              2                                                                                            28 
 29                                       3.      ADDITIONAL STANDARD DEDUCTIONS    (Not Allowed with Itemized Deductions - see instructions)                                                                                                                                                                                       29 
 30                                               Multiply the number of boxes checked below by $2500. If you are filing a combined separate return (Filing status                                                                                                                                                                  30 
                                                  4), enter the total for each appropriate column. All others enter total in Column B.
 31                                               Column A - if SPOUSE was:        65 or over              Blind                              Column B - if YOU were: 65 or over               Blind                                  3                                                                                             31 
 32                                       4.      TOTAL DEDUCTIONS - Add line 2 & 3 and enter here......................................................................................................                              4                                                                                             32 
 33                                       5.      TAXABLE INCOME - Subtract Line 4 from Line 1, and Compute Tax on this amount................................................                                                        5                                                                                             33 
 34                                       6.      Tax Liability from Tax Rate Table/Schedule                                               Column A                                               Column B                            6                                                                                             34 
 35                                                                                                                                                                                                                                                                                                                                 35 
                                                  See Instructions..........................................................                                                                                                          7
 36                                       7.      Tax on Lump Sum Distribution (Form 329).................                                                                                                                                                                                                                          36 
 37                                       8.      TOTAL TAX - Add Lines 6 and 7 and enter here......................................................................................................>                                 8                                                                                             37 
 38                                       9a.     PERSONAL CREDITS   If you are Filing Status 3, see instructions on Page 6.                                                                                                                                                                                                        38 
 39                                               If you use Filing Status 4, enter the total for each appropriate column. All others enter total in Column B.                                                                                                                                                                      39 
                                                  Enter number of exemptions claimed on Federal return ____________ x $110....................................................                                                        9a
 40                                               On Line 9a, enter the number of exemptions for:                                             Column A                 Column B                                                                                                                                                     40 
                     STAPLE W-2 FORMS HERE
 41                                       9b.     CHECK BOX(ES)                       Spouse 60 or over (Column A)                                                Self 60 or over (Column B)                                                                                                                                        41 
 42                                               Enter number of boxes checked on Line 9b __________ x $110...........................................................................                                               9b                                                                                            42 
 43                                       10.     Tax imposed by State of ______. (Must attach copy of DE Schedule I and other state return.) .....................                                                                   10                                                                                            43 
 44                                       11.     Volunteer Firefighter Co.# - Spouse (Column A) ______ Self (Column B) ______.  Enter credit amount..............                                                                    11                                                                                            44 
 45                                       12.     Other Non-Refundable Credits (see instructions on Page 7) .................................................................................                                         12                                                                                            45 
 46                                       13.     Child Care Credit.  Must attach Form 2441. (Enter 50% of Federal credit) .......................................................                                                    13                                                                                            46 
 47                                       14.     Earned Income Tax Credit. See instructions on Page 8 for ALL required documentation.............................                                                                    14                                                                                            47 
 48                                       15.     Total Non-Refundable Credits. Add Lines 9a, 9b, 10, 11, 12, 13 & 14 and enter here ...........................................                                                      15                                                                                            48 
 49                                       16.     BALANCE.  Subtract Line 15 from Line 8.  If Line 15 is greater than Line 8, enter “0” (Zero)................................                                                        16                                                                                            49 
 50                                       17.     Delaware Tax Withheld (Attach W2s/1099s)...................                                                                                                                         17                                                                                            50 
 51                                       18.     2016 Estimated Tax Paid & Payments with Extensions...                                                                                                                               18                                                                                            51 
 52                                       19.     S Corp Payments and Refundable Business Credits.......                                                                                                                              19                                                                                            52 
 53                                       20.     2016 Capital Gains Tax Payments (Attach Form 5403)..                                                                                                                                20                                                                                            53 
 54                                       21.     TOTAL Refundable Credits.  Add Lines 17, 18, 19, and 20 and enter here.............................................................>                                                21                                                                                            54 
 55                                       22.     BALANCE DUE. If Line 16 is greater than Line 21, subtract 21 from 16 and enter here........................................>                                                        22                                                                                            55 
 56                                       23.     OVERPAYMENT. If Line 21 is greater than Line 16, subtract 16 from 21 and enter here.......................................>                                                         23                                                                                            56 
 57                                       24.     CONTRIBUTIONS TO SPECIAL FUNDS  If electing a contribution, complete and attach DE Schedule III................................................                                                         24                                                                        57 
 58                                       25.     AMOUNT OF LINE 23 TO BE APPLIED TO 2017 ESTIMATED TAX ACCOUNT.................................................................................ENTER >                                                   25                                                                        58 
 59                                       26.     PENALTIES AND INTEREST DUE.  If Line 22 is greater than $400, see estimated tax instructions....................................................ENTER >                                                 26                                                                        59 
 60                  STAPLE CHECK HERE    27.     NET BALANCE DUE (For Filing Status 4, see instructions, page 9)............................................................................................PAY IN FULL >                                27                                                                        60 
                                                  For all other filing statuses, enter Line 22 plus Lines 24 and 26
 61                                       28.     NET REFUND  (For Filing Status 4, see instructions, page 9) ......................................................................ZERO DUE/TO BE REFUNDED >                                             28                                                                        61 
 62                                               For all other filing statuses, subtract Lines 24, 25, and 26 from Line 23                                                                                                                                                                                                         62 
 63                                                                                                                                                                                                                                                                                                                                 63 
 64                                                                                                                                                                                                                                                                                                                                 64 
 04   05  06  07  08  09  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60  61  62  63  64  65  66  67  68  69  70  71  72  73  74  75  76  77  78  79  80  81  82 

 04  05  06  07  08  09  10  11  12  13  14  15  16  17  18        19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42       43  44  45  46  47  48     49  50  51  52  53  54  55  56  57  58  59  60  61  62      63  64  65  66  67  68  69  70  71  72      73  74  75  76  77  78  79  80  81  82 
 03                                                                                                                                                                                                                                                                                                                                03 
 04                                                                                                       2016 DELAWARE RESIDENT FORM 200-01, PAGE 2                                                                                                                                                                               04 
 05                         2016                                                                                                                                                                                                                                                  Page 2                                           05 
 06                                               COLUMNS:R                           Column A is reserved for the spouse of those couples choosing(Reconcilefilingyour Federalstatus 4.                                                                                                                                           06 
                                    totals to the appropriate individual. See Page 9 worksheet.) Taxpayers using filing statuses 1, 2, 3, or 5 are to complete Column B only.
 07                                                                                                                                                                                                                                                                                                                                07 
 08                                                                                                                                                                                                                                               Filing Status 4 ONLY                            All other filing statuses        08 
                                                                                                                                                                                                                                                  Spouse Information                          You or You plus Spouse 
 09     MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME                                                                                                                                                                                                    COLUMN A                                        COLUMN B                 09 
 10     SECTION A - ADDITIONS (+)                                                                                                                                                                                                                                                                                                  10 
 11     29.         Enter Federal AGI amount from Federal 1040, 1040A or 1040EZ ..............................................................................                                                                        29                                                                                           11 
 12                                                                                                                                                                                                                                                                                                                                12 
 13     30.         Interest on State & Local obligations other than Delaware .........................................................................................                                                               30                                                                                           13 
 14     31.         Fiduciary adjustment, oil depletion .............................................................................................................................                                                 31                                                                                           14 
 15     32.         TOTAL - Add Lines 30 and 31 ....................................................................................................................................                                                  32                                                                                           15 
 16     33.         Subtotal. Add Lines 29 and 32 ...........................................                                                                                                                                         33                                                                                           16 
 17     SECTION B - SUBTRACTIONS (-)                                                                                                                                                                                                                                                                                               17 
 18     34.         Interest received on U.S. Obligations .........................................................................................................................                                                   34                                                                                           18 
 19     35.         Pension/Retirement Exclusions (For a definition of eligible income, see instructions on Page 10)............                                                                                                      35                                                                                           19 
 20     36.         Delaware State tax refund, fiduciary adjustment, work opportunity tax credit, Delaware NOL carry forward -                                                                                                                                                                                                     20 
 21                 please see instructions on Page 10 ............................................................................................................................                                                   36                                                                                           21 
 22     37.         Taxable Soc Sec/RR Retirement Benefits/Higher Educ. Excl/Certain Lump Sum Dist. (See instr. on Page 11) ........                                                                                                  37                                                                                           22 
 23     38.         SUBTOTAL.  Add Lines 34, 35, 36 and 37, and enter here ........................................................................................                                                                   38                                                                                           23 
 24     39.         Subtotal. Subtract Line 38 from Line 33 ............................                                                                                                                                              39                                                                                           24 
 25     40.         Exclusion for certain persons 60 and over or disabled (See instructions on Page 11) ...............................................                                                                               40                                                                                           25 
 26     41.         TOTAL - Add Lines 38 and 40 .....................................................................................................................................                                                 41                                                                                           26 
 27     42.         DELAWARE ADJUSTED GROSS INCOME. Subtract line 41 from Line 33. Enter here and on Front, Line 1 ...........                                                                                                        42                                                                                           27 
 28     SECTION C - ITEMIZED DEDUCTIONS (MUST ATTACH FEDERAL SCHEDULE A) If columns A and B are used and you are unable to specifically                                                                                                                                                                                            28 
 29     allocate deductions between spouses, you must prorate in accordance with income.                                                                                                                                                                                                                                           29 
 30     43.         Enter total Itemized Deduction from Schedule A, Federal Form, Line 29 ...................................................................                                                                         43                                                                                           30 
 31     44.         Enter Foreign Taxes Paid (See instructions on Page 11) ...........................................................................................                                                                44                                                                                           31 
 32     45.         Enter Charitable Mileage Deduction (See instructions on Page 11) ...........................................................................                                                                      45                                                                                           32 
 33     46.         SUBTOTAL - Add Lines 43, 44, and 45 and enter here ..............................................................................................                                                                 46                                                                                           33 
 34     47a.        Enter State Income Tax included in Line 43 above (See instructions on Page 11) .....................................................                                                                              47a                                                                                          34 
 35     47b.        Enter Form 700 Tax Credit Adjustment (See instructions on Page 11) .......................................................................                                                                        47b                                                                                          35 
 36     48.         TOTAL - Subtract Line 47a and 47b from Line 46. Enter here and on Front, Line 2 (See instructions) ......................                                                                                         48                                                                                           36 
 37                                                                                                                                                                                                                                                                                                                                37 
 38     SECTION D - DIRECT DEPOSIT INFORMATION    If you would like your refund deposited directly to your                                                                                                                                                                                                                         38 
 39     checking or savings account, complete boxes a, b, c and d below. See instructions for details.                                                                                                                                                                                                                             39 
 40         a. Routing Number                                                                                                                                                                                                         b. Type:          Checking                      Savings                                      40 
 41                                                                                                                                                                                                                                                                                                                                41 
 42         c. Account Number                                                                                                                                                                                                         d. Is this refund going to or through an account that                                        42 
 43                                                                                                                                                                                                                                   is located outside of the United States?                                                     43 
 44                                                                                                                                                                                                                                                                   Yes                               No                         44 
 45                         NOTE: If your refund is adjusted by $100.00 or more, a paper check will be issued and mailed to the address on your return.                                                                                                                                                                            45 
 46                                                           BE SURE TO SIGN YOUR RETURN BELOW AND KEEP A COPY FOR YOUR RECORDS                                                                                                                                                                                                   46 
 47 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and believe it is true, correct and complete.                                                                                                                                                         47 
 48     Your Signature                                                                                     Date                                                   Signature of Paid Preparer                                                                                                  Date                                 48 
 49                                                                                                                                                                                                                                                                                                                                49 
 50     Spouse’s Signature (if filing joint or combined return)                                            Date                                                   Address                                                                                                                                                          50 
 51                                                                                                                                                                                                                                                                                                                                51 
 52     Home Phone                                                                                              Business Phone                                    City                                                                                                        State               Zip                              52 
 53                                                                                                                                                                                                                                                                                                                                53 
 54     E-Mail Address                                                                                                                                            EIN, SSN or PTIN                             Business Phone                                                      E-Mail Address                                  54 
 55                                                                                                                                                                                                                                                                                                                                55 
 56                                                                                                                                                                                                                                                                                                                                56 
 57     BALANCE DUE W/PAYMENT ENCLOSED (LINE 27)                                                                                                                       REFUND (LINE 28):                                                                          ALL OTHER RETURNS:                                               57 
 58                                 DELAWARE DIVISION OF REVENUE                                                                                          DELAWARE DIVISION OF REVENUE                                                                    DELAWARE DIVISION OF REVENUE                                             58 
                                                              P.O. BOX 508                                                                                                        P.O. BOX 8710                                                                                   P.O. BOX 8711
 59                                         WILMINGTON, DE 19899-0508                                                                                             WILMINGTON, DE 19899-8710                                                                       WILMINGTON, DE 19899-8711                                        59 
 60                                                                                                                                                                                                                                                                                                                                60 
 61                                                                                           MAKE CHECK PAYABLE TO: DELAWARE DIVISION OF REVENUE                                                                                                                                                                                  61 
                                              PLEASE REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN
 62                                                                                                                                                                                                                                                                                                                                62 
 63                             (Rev 11/2016)                                                                                                                                                             *DF20116029999*                                                                                                          63 
 64                                                                                                                                                                                                                                                   DF20116029999                                                                64 
 04   05  06  07  08  09  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60  61  62  63  64  65  66  67  68  69  70  71  72  73  74  75  76  77  78  79  80  81  82