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 04                                                                                       DELAWARE INDIVIDUAL NON-RESIDENT                                                                                            DO NOT WRITE OR STAPLE IN THIS AREA                                                                                             04 
 05                                      2016 NR                                              INCOME TAX RETURN - FORM 200-02                                                                                                                                                                                                                         05 
 06                           For Fiscal year beginning                                                               and ending                                                                                                                                                                                                                      06 
 07                           Your Social Security No.                                                          Spouse’s Social Security No.                                                                                                                                                                                                          07 
 08                                                                                                                                                                                                                                                                                                                                                   08 
 09                                                                                                                                                                                                                                                                                                                                                   09 
 10                              Your Last Name                                                                 First Name and Middle Initial      Jr., Sr., III, etc.                                                                                                                                                                                10 
 11                                                                                                                                                                                                                                                                                                                                                   11 
 12                              Spouse’s Last Name                                                             Spouse’s First Name,                                  Jr., Sr., III, etc.                                                                                                                                                             12 
 13                                                                                                                                                                                                                                                                                                                                                   13 
 14     ATTACH LABEL HERE        Present Home Address (Number and Street)                                                                             Apt. #                                                                                                                                                                                          14 
 15                                                                                                                                                                                                                                                                                                                                                   15 
 16                              City                                                                                State                    Zip Code                                                    Check if                                                FILING STATUS (MUST CHECK ONE)                                                      16 
 17                                                                                                                                                                                                       FULL-YEAR                       1.              Single, Divorced,                   3.              Married or Entered into a Civil         17 
                                                                                                                                                                                                          non-resident                                    Widow(er)                                           Union & Filing Separate Forms
 18                           Form DE2210          If you were a part-year resident in 2016, give the dates you resided in                                                                                    in 2016                                                                                                                                 18 
                                                   Delaware.                                                                                                                                                                              2.              Joint or Entered                    5.              Head of Household                       19 
 19                                                            From                                                   2016   to                                                       2016                                                                into a Civil Union
 20                               Attached                                        Month      Day                                                  Month      Day                                                                                                                                                                                      20 
 21                           37.     DELAWARE ADJUSTED GROSS INCOME (Begin return on Page 2, Line 1, then enter the amount from Line 30B, Column 1 here ............... >                                                                                                                                                                            21 
 22                           38.     (a) If you elect the STANDARD DEDUCTION check here ..................................................................................          a.                                                                                                                                                               22 
 23                                   Filing Statuses 1, 3, & 5 - $3250           Filing Status 2 - $6500                                                                                                                                                                                                                                             23 
 24                                   (b) If you elect to ITEMIZE DEDUCTIONS check here and enter amount from reverse side Line 36.................          b.                                                                                                                                                                                       24 
 25                           39.     ADDITIONAL STANDARD DEDUCTIONS         (Not allowed with Itemized Deductions - see instructions)                                                                                                                                                                                                                25 
 26                                   CHECK BOX(ES)  If SPOUSE was 65 or over            and/or blind                                                                                     If YOU were 65 or over              and/or blind                                                                                                            26 
 27                           40.     TOTAL DEDUCTIONS - Add Lines 38 & 39 and enter here ...........................................................................................................................                                                                                                                                 27 
 28                           41.     TAXABLE INCOME - Subtract Line 40 from Line 37, and compute tax on this amount ..................................................................................                                                                                                                                               28 
 29                           42.     Tax Liability Computation                                                           Proration Decimal                                           Tax Liability from Tax Rate                                                                                                                                     29 
 30                                   A  Line 30 A                                                                (See instructions, Page 10 )                                            Table/Schedule Amount                                                                                                                                       30 
 31                                   B  Line 30 B                                                                            = .                                             x                                                                                                                                                                       31 
 32                                                                                                                                                                                                                                                                                                                                                   32 
                              43.     PERSONAL CREDITS    (If Filing Status 3, see instructions on page 10)
 33                                      Enter number of exemptions claimed on Federal return                                                                         X $110 =                                                                                                                                                                        33 
 34                                      Multiply this amount by the proration decimal on Line 42 (X                                                                                      ) and enter total here .................................................................                                                                    34 
 35                           43b     CHECK BOX(ES)                                   Spouse 60 or over (if filing status 2)                                                          Self 60 or over                                                                                                                                                 35 
 36                                        Enter number of boxes checked on Line 43b                                                                  X $110 =                                                                                                                                                                                        36 
 37                                        Multiply this amount by the proration decimal on Line 42 (X                                                                                ) and enter total here ..................................................................                                                                       37 
 38                           44.     Tax imposed by state of                                         (Must attach copy of DE Sch I and other state return)                                                                                                                                                                                           38 
 39     STAPLE W-2 FORMS HERE         (Part-Year Residents Only. See instructions, page 11) .....................................................................       44                                                                                                                    00                                                      39 
 40                           45.     Other Non-Refundable Credits (see instructions, page 11) ..........................................................................................                                                     45                                              00                                                      40 
 41                           46.     Total Non-Refundable Credits. Add Lines 43a, 43b, 44 and 45 ............................................................................................................................                                                                                                                        41 
 42                           47.     BALANCE. Subtract Line 46 from Line 42. If Line 46 is greater than Line 42, enter “0” (Zero) ............................................................................                                                                                                                                       42 
 43                           48.     Delaware Tax Withheld (Attach W-2s/1099s) .............................................................................................................        48                                                                                                                                               43 
 44                           49.     2016 Estimated Tax Paid & Payments with Extensions ...............................................................................................        49                                                                                                                                                    44 
 45                           50.     S Corp Payments and Refundable Business Credits  (See Instructions, Page 12) ...............................................        50                                                                                                                                                                          45 
 46                           51.     2016 Capital Gains Tax Payments (Attach Form 5403) ...........................................................................................        51                                                                                                                                                        46 
 47                           52.     TOTAL REFUNDABLE CREDITS.  Add Lines 48, 49, 50 and 51 ..........................................................................................................................................                                                                                                               47 
 48                           53.     If Line 47 is greater than Line 52, subtract 52 from 47 and enter here ...................................................................    AMOUNT YOU OWE       >                                                                                                                                            48 
 49                           54.     If Line 52 is greater than Line 47, subtract 47 from 52 and enter here ...................................................................    OVERPAYMENT              >                                                                                                                                        49 
 50                           55.     CONTRIBUTIONS TO SPECIAL FUNDS                                                                                                                                                                                                                                                                                  50 
 51                                   If electing a contribution, complete and attach DE Schedule III ..................................................................................................                                                                  TOTAL      >                                                                51 
 52                           56.     AMOUNT OF LINE 54 TO BE APPLIED TO 2017 ESTIMATED TAX ACCOUNT .......................................................................    ENTER     >                                                                                                                                                            52 
 53                           57.     PENALTIES AND INTEREST DUE.  If Line 53 is greater than $400, see estimated tax instructions ‘........................................    ENTER     >                                                                                                                                                           53 
 54                           58.     NET BALANCE DUE.  Enter the amount due (Line 53 plus Lines 55 and 57) and pay in full ............................................  PAY IN FULL    >                                                                                                                                                            54 
 55                           59.     NET REFUND.  Subtract Lines 55, 56, and 57 from Line 54 ..........................................................  ZERO DUE/TO BE REFUNDED    >                                                                                                                                                                55 
 56                           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.                                                                                                                                                 56 
 57                            Your Signature                                                                                         Date                                                   Spouse’s Signature (if filing joint)                                                                                 Date                                57 
 58                             X                                                                                                                                                            X                                                                                                                                                        58 
 59                            Home Phone:                                                                                              Business Phone:                                                                                               Email Address:                                                                                  59 
 60     STAPLE CHECK HERE      Signature of Paid Preparer                                                                               Date                                                 Address of Paid Preparer                                                                                                                                 60 
 61                             X                                                                                                                                                                                                                                                                                                                     61 
 62                                     Business Phone                                                                          Email Address                                                                                                                                                                                                         62 
 63                                     EIN, SSN, or PTIN                                                                                                                                                                                 *DF20316019999*                                                                                             63 
 64                                                                                                                                                                                                                                                                                   DF20316019999                                                   64 
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 03                                                                                                                                                                                                                                                                                                                                                   03 
 04                                                                                                       2016 DELAWARE NON-RESIDENT FORM 200-02                                                                                                      , PAGE 2                                                                                        04 
 05                             2016 NR                                                                                                                                                                                                                                                               Page 2                                          05 
 06                                                                                                                           *DF20316029999*                                                                                                                                 Federal                                        Delaware Source          06 
                                                                                                                                                                          DF20316029999                                                                                   COLUMN 1                                           Income/Loss 
 07     SECTION A - INCOME AND ADJUSTMENTS FROM FEDERAL RETURN                                                                                                                                                                                                                                                               COLUMN 2                 07 
 08     1.          Wages, salaries, tips, etc. .............................................................................................................................................................                                         1                                           00                                         00       08 
 09     2.          Interest ..............................................................................................................................................................................................                           2                                           00                                         00       09 
 10     3.          Dividends ..........................................................................................................................................................................................                              3                                           00                                         00       10 
 11     4.          State refunds, credits or offsets of state & local income taxes ..............................................................................................                                                                    4                                           00                                         00       11 
 12     5.          Alimony received .............................................................................................................................................................................                                    5                                           00                                         00       12 
 13     6.          Business income or (loss) (See instructions on page 6) ........................................................................................................                                                                   6                                           00                                         00       13 
 14     7a.         Capital gain or (loss) ......................................................................................................................................................................                                 7a                                              00                                         00       14 
 15     7b.         Other gains or (losses) ..................................................................................................................................................................                                    7b                                              00                                         00       15 
 16     8.          IRA distributions ..............................................................................................................................................................................                                  8                                           00                                         00       16 
 17     9.          Taxable pensions and annuities ..................................................................................................................................................                                                 9                                           00                                         00       17 
 18     10.         Rents, royalties, partnerships, S corps, estates, trusts, etc. .................................................................................................                                                              10                                              00                                         00       18 
 19     11.         Farm income or (loss) ...................................................................................................................................................................                                     11                                              00                                         00       19 
 20     12.         Unemployment compensation (insurance) ...............................................................................................................................                                                         12                                              00                                         00       20 
 21     13.         Taxable Social Security benefits .................................................................................................................................................                                            13                                              00                                         00       21 
 22     14.         Other income (state nature and source)                                                                                                                                                                                        14                                              00                                         00       22 
 23     15.         Total income. Add Lines 1 through 14 .......................................................................................................................................                                                  15                                              00                                         00       23 
 24     16.         Total Federal Adjustments (see instructions on Page 6) .......................................................................................................                                                                16                                              00                                         00       24 
 25     17.         Federal Adjusted Gross Income for Delaware purposes. Subract Line 16 from 15 ........................................................                                                                                         17                                              00                                         00       25 
 26     SECTION B - DELAWARE MODIFICATIONS AND ADJUSTMENTS - ADDITIONS (+)                                                                                                                                                                                                COLUMN 1                                           COLUMN 2                 26 
 27     18.         Interest received on obligations of any state other than Delaware .....................................................................................                                                                       18                                              00                                         00       27 
 28     19.         Fiduciary adjustment, oil depletion ............................................................................................................................................                                              19                                              00                                         00       28 
 29     20.         TOTAL - Add Lines 18 & 19 .........................................................................................................................................................                                           20                                              00                                         00       29 
 30     21.         Add Lines 17 & 20 .........................................................................................................................................................................                                   21                                              00                                         00       30 
 31     SECTION C - DELAWARE MODIFICATIONS AND ADJUSTMENTS - SUBTRACTIONS (-)                                                                                                                                                                                             COLUMN 1                                           COLUMN 2                 31 
 32     22.         Interest received on U.S. obligations ..........................................................................................................................................                                              22                                              00                                         00       32 
 33     23.         Pension/Retirement Exclusions  (For a definition of eligible income, see instructions on Page 7)...............                                                                                                               23                                              00                                         00       33 
 34     24.         Delaware State tax refund ............................................................................................................................................................                                        24                                              00                                         00       34 
 35     25.         Fiduciary Adjustment,  Work Opportunity Credit, Delaware NOL Carryforward ................................................................                                                                                    25                                              00                                         00       35 
 36     26.         Taxable Social Security Benefits/Railroad Retirement Benefits/Higher Education Exclusion .........................................                                                                                            26                                              00                                         00       36 
 37     27.         TOTAL - Add lines 22 through 26 ................................................................................................................................................                                              27                                              00                                         00       37 
 38     28.         Subtract Line 27 from Line 21 and enter here ..........................................................................................................................                                                       28                                              00                                         00       38 
 39     29.         Exclusion for certain persons 60 and over or disabled (see instructions on Page 8) .......................................................                                                                                    29                                              00                                         00       39 
 40                                                                                                                                                                                                                                                                                                                                                   40 
 41     30A         Column 2. Subtract Line 29 from Line 28. This is your modified Delaware Source Income......................................                                                                                                                                                   30A                                        00       41 
                    Enter on front side Line 42, Box A ..........................................................................................................................................
 42     30B         Column 1. Subtract Line 29 from Line 28. This is your Delaware Adjusted Gross Income............................................                                                                                                                                                                                                  42 
 43                 Enter on front side Line 37 and Line 42, Box B ..................................................................................................................                                                         30B                                                 00                                                  43 
 44     SECTION D - ITEMIZED DEDUCTIONS (ATTACH FEDERAL SCHEDULE A, FORM 1040)                                                                                                                                                                                            COLUMN 1                                                                    44 
 45     31.         Enter total Itemized Deductions (If Filing Status 3, See instructions on Page 8) ........................................................                                                                                     31                                              00                                                  45 
 46     32.         Enter Foreign Taxes Paid (See instructions on Page 8) ........................................................................................................                                                                32                                              00                                                  46 
 47     33.         Enter Charitable Mileage Deduction (See instructions on Page 8) ......................................................................................                                                                        33                                              00                                                  47 
 48     34.         TOTAL - Add Lines 31, 32, and 33 ..............................................................................................................................................                                               34                                              00                                                  48 
 49     35a         Enter State Income Tax included in Line 31 above (see Instructions on Page 8) ..............................................................................                                                              35a                                                 00                                                  49 
 50     35b         Enter Form 700 Tax Credit Adjustment (See instructions on Page 9) .................................................................................                                                                       35b                                                 00                                                  50 
 51     36.         Subtract Line 35a and 35b from Line 34. Enter here and on front, Line 38 .......................................................................                                                                              36                                              00                                                  51 
 52     SECTION E - DIRECT DEPOSIT INFORMATION                                                                                                                                                                                                                                                                                                        52 
 53     If you would like your refund deposited directly to your checking or savings account, complete boxes a, b, c, and d below. See instructions for details.                                                                                                                                                                                      53 
 54                 a. Routing Number                                                                                                                                                                                                                     b. Type:           Checking                                        Savings                  54 
 55                                                                                                                                                                                                                                                                                                                                                   55 
 56                                                                                                                                                                                                                                                       d. Is this refund going to or through an account that                                       56 
 57                 c. Account Number                                                                                                                                                                                                                     is located outside of the United states?                                                    57 
 58                                                                                                                                                                                                                                                                                               Yes                        No                       58 
 59                                                                                                                                                                                                                                                                                                                                                   59 
 60         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.                                                                                                                                                                                                              60 
 61         BALANCE DUE W/PAYMENT ENCLOSED (LINE 58):                                                                                                 REFUND (LINE 59):                                                                                   ALL OTHER RETURNS:                                                                          61 
 62         DELAWARE DIVISION OF REVENUE                                                                                                              DELAWARE DIVISION OF REVENUE                                                                        DELAWARE DIVISION OF REVENUE                                                                62 
            P.O. BOX 508, WILMINGTON, DE 19899-0508                                                                                                   P.O. BOX 8710, WILMINGTON, DE 19899-8710                                                            P.O. BOX 8711, WILMINGTON, DE 19899-8711
 63                                                                                                                                                                                                                                                                                                                                                   63 
                    MAKE CHECK PAYABLE TO: DELAWARE DIVISION OF REVENUE. REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING  
 64                                 (Rev 11/2016)                                                 YOUR RETURN, AND KEEP A COPY OF THE RETURN FOR YOUR RECORDS                                                                                                                                                                                         64 
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