R-210R (1/17)
                               Underpayment of Individual Income Tax Penalty                                   2016
                                          Computation 2016  Taxable Year
                                                     Resident Filers

                                                                                                  PLEASE PRINT OR TYPE.
              Name as shown in the order on tax return                                 Social Security Number
Yours                                                                     Yours 

Spouse’s                                                                  Spouse’s 

Section 1 – Required Annual Payment Computation
1  2016 tax liability - See instructions.                                                                          00
2  2015 tax liability - See instructions.                                                                          00
3  Enter the smaller of Line 1 or Line 2                                                                           00
4  Number of payments required for year
Section 2 – Underpayment Computation                        04/15/16      06/15/16        09/15/16        01/15/17
   Required payment -From Section 1, divide amount 
5                                                                    00                00          00              00
   on Line 3 by amount on Line 4 . See instructions.
6  Amount paid for each period  - See instructions.                  00                00          00              00

   Carryforward - Overpayment or underpayment from 
   previous period shown on Line 9 of each column. 
   Carryforward amounts from the previous period can 
7                                                                                      00          00              00
   be a positive number or a negative number. 
   Note: No carryforward amount can be shown for 
   the first period. See instructions.

8  Amount available for period. Add Lines 6 and 7.                   00                00          00              00
   Underpayment or overpayment - Subtract Line 
   5 from Line 8. A positive number indicates an 
9  overpayment. A negative number indicates an                       00                00          00              00
   underpayment. Move the number on this line to  
   Line 7 in next column.
Section 3 – Exceptions
   Exception 1 – See worksheet on page 3. If you meet this exception, you do not owe an underpayment penalty.  
10
   STOP – You do not need to file this form.
11 Exception 2 – Prior Year’s Tax Liability                          00                00          00              00
12 Exception 3 – Prior Year’s Income.                                00                00          00              00
13 Exception 4 – Annualized Income                                   00                00          00     no exception  
                                                                                                          available
14 Exception 5 – Installment Period Income                           00                00          00              00
Section 4 – Penalty  Computation
15 Amount of underpayment (from Line 9 above)                        00                00          00              00
16 Date of Payment – See instructions.
17 Number of days from due date of installment
18 Penalty – See instructions.                                       00                00          00              00
   Add amounts on Line 18. Enter total here and on Form IT-540, Line 35 if you have an overpayment. Enter 
19                                                                                                                 00
   the total here and on Form IT-540, Line 48 if you have a balance due.