2022 Virginia Nonresident Income Tax Return
763Page 1                                   Due May 1, 2023
                                                                                                *VA0763122888*
    Enclose a complete copy of your federal tax return and all other required Virginia enclosures.
 First Name                                         MI   Last Name                 Suffix     Your Social Security Number                                                              Check if 
                                                                                                                                                                                       deceased  
 Spouse's First Name (Filing Status 2 Only)         MI   Last Name                 Suffix     Spouse's Social Security Number                                                          Check if 
                                                                                                                                                                                       deceased
 Present Home Address (Number and Street or Rural Route)                           Your Birth Date
                                                                                          (mm-dd-yyyy)           -         -
 City, Town or Post Office                               State     ZIP Code        Spouse’s Birth Date
                                                                                          (mm-dd-yyyy)           -         -
 State of Residence                     Important - Name of Virginia City or County in which principal place of business, employment, or income source  Locality Code
                                        is located. 
                                                                                                                                     City  OR                                  County
                             Amended Return                         Name(s) or Address Different than                                                                     Overseas on Due Date
                                        Reason Code                 Shown on 2021 VA Return
 Check Applicable  
          Boxes              Dependent on Another’s Return           Qualifying Farmer, Fisherman, or            EIC Claimed on federal return 
                                                                    Merchant Seaman                              $___________________ .00  
    Filing Status Enter Filing Status Code in box below.                           Exemptions Add Sections 1 and 2. Enter the sum on Line 12.
                                                                                                Spouse if  
            1 = Single. Federal head of household? YES                                         Filing Status                                                                         Total Section 1
                                                                                          You                Dependents
            2 = Married, Filing Joint Return - both must have Virginia income                   2 or 3
            3 = Married, Spouse Has No Income From Any Source                             1   +          +                                                              =     X $930 = 
          { 4 = Married, Filing Separate Returns
                                                                                   You 65     Spouse 65  You    Spouse                                                                 Total Section 2
If Filing Status 3 or 4, enter spouse's SSN in the Spouse's Social Security Number or over      or over  Blind   Blind
box at top of form and enter Spouse’s Name___________________________________                 +        +       +                                                        =     X $800 = 

 1  Adjusted Gross Income from federal return - Not federal taxable income..............................................................                                   1                  00
 2  Additions from Schedule 763 ADJ, Line 3. .............................................................................................................                 2                  00
 3  Add Lines 1 and 2. ................................................................................................................................................    3                  00
 4  Age Deduction (See instructions and the Age Deduction Worksheet) .......................................................... You                                        4a                 00
    Enter Birth Dates above. Enter Your Age Deduction on Line 4a  
    and Your Spouse's Age Deduction on Line 4b.. ...................................................................................... Spouse                             4b                 00
 5  Social Security Act and equivalent Tier 1 Railroad Retirement Act benefits reported on your federal return.  .......                                                   5                  00
 6  State income tax refund or overpayment credit reported as income on your federal return. .................................                                             6                  00
 7  Subtractions from Schedule 763 ADJ, Line 7. ........................................................................................................                   7                  00
 8  Add Lines 4a, 4b, 5, 6, and 7................................................................................................................................          8                  00
 9  Virginia Adjusted Gross Income (VAGI). Subtract Line 8 from Line 3. ............................................................                                       9                  00
 10 Itemized Deductions from Virginia Schedule A, if applicable. See instructions. .....................................................                                   10                 00
 11 If you do not claim itemized deductions on Line 10, enter standard deduction.  See instructions. ........................                                              11                 00
 12 Exemption amount. Enter the total amount from the Exemption Sections 1 and 2 above. ....................................                                               12                 00
 13 Deductions from Schedule 763 ADJ, Line 9. ..........................................................................................................                   13                 00
 14 Add Lines 10, 11, 12 and 13. ................................................................................................................................          14                 00
 15 Virginia Taxable Income computed as a resident. Subtract Line 14 from Line 9. ...................................................                                      15                 00
 16 Percentage from Nonresident Allocation Section on Page 2 (Enter to one decimal place only) ............................                                                16                 %
 17 Nonresident Taxable Income. (Multiply Line 15 by percentage on Line 16). ..........................................................                                    17                 00
 18 Income Tax from Tax Table or Tax Rate Schedule ..................................................................................................                      18                 00
 19a  Your Virginia income tax withheld. Enclose Forms W-2, W-2G, 1099, and VK-1. ..................................................                                     19a
 Va. Dept. of Taxation     For Local Use
 2601044   Rev. 07/22                       LTD                $_________ 

2022 FORM 763  Page 2
Your Name                                              Your SSN                                                             *VA0763222888*

19b Spouse's Virginia income tax withheld. Enclose Forms W-2, W-2G, 1099, and VK-1. ......................................                                     19b                               00
20  2022 Estimated Tax Payments.. .........................................................................................................................      20                              00
21  2021 overpayment credited to 2022 estimated tax.............................................................................................                 21                              00
22  Extension Payment - submitted using Form 760IP. ............................................................................................                 22                              00
23  Credit for Low-Income Individuals or Virginia Earned Income Credit from Schedule 763 ADJ, Line 17. ...........                                               23                              00
24  Total credits from Schedule OSC. ......................................................................................................................      24                              00
25  Credits from Schedule CR, Section 5, Line 1A...................................................................................................              25                              00
26  Total payments and credits.  Add Lines 19a through 25. .............................................................................                         26                              00
27  If Line 18 is larger than Line 26, enter the difference. This is the INCOME TAX YOU OWE. ............................                                        27                              00
28  If Line 26 is larger than Line 18, enter the difference. This is the OVERPAYMENT AMOUNT. .........................                                           28                              00
29  Amount of overpayment on Line 28 to be CREDITED TO 2023 ESTIMATED INCOME TAX. ..............................                                                 29                              00
30  Virginia529 and ABLE Contributions from Schedule VAC, Part I, Line 6 ............................................................                            30                              00
31  Other Voluntary Contributions from Schedule VAC, Section II, Line 14 .............................................................                           31                              00
32    Addition to Tax, Penalty, and Interest from enclosed Schedule 763 ADJ, Line 21.                                                                            32                              00
      See instructions.  ................................... Enclose 760C or 760F and check here. ..........................................
33  Sales and Use Tax is due on Internet, mail order, and out-of-state purchases (Consumer’s Use Tax).                                                           33                              00
      See instructions. .................................... Check here if no sales and use tax is due. ..................................
34  Add Lines 29 through 33. .................................................................................................................................   34                              00
35  If you owe tax on Line 27, add Lines 27 and 34 - OR - If you have an overpayment on Line 28 and 
    Line 34 is larger than Line 28, enter the difference. AMOUNT YOU OWE.  Enclose payment or pay at                                                             35                              00
    www.tax.virginia.gov. ........Check here if paying by credit or debit card - See instructions. .....................
36  If Line 28 is larger than Line 34, subtract Line 34 from Line 28. This is the amount to be REFUNDED TO YOU.                                                  36                              00
If the Direct Deposit section below is not completed, your refund will be issued by check.
DIRECT BANK DEPOSIT                    Your Bank Routing Transit Number            Your Bank Account Number                                Checking                                 Savings
Domestic Accounts Only
No International Deposits  
Nonresident Allocation Percentage                                                                                           A - All Sources                         B - Virginia Sources
1. Wages, salaries, tips, etc.. .................................................................................        1                                     00                                00
2. Interest income. .................................................................................................    2                                     00                                00
3. Dividends. .......................................................................................................... 3                                     00                                00
4. Alimony received. ..............................................................................................      4                                     00                                00
5. Business income or loss. ...................................................................................          5                                     00                                00
6. Capital gain or loss/capital gain distributions.....................................................                  6                                     00                                00
7. Other gains or losses.........................................................................................        7                                     00                                00
8. Taxable pensions, annuities and IRA distributions. ...........................................                        8                                     00
9. Rents, royalties, partnerships, estates, trusts, S corporations, etc....................                              9                                     00                                00
10. Farm income or loss. .........................................................................................       10                                    00                                00
11. Other income. ....................................................................................................   11                                    00                                00
12. Interest on obligations of other states from Schedule 763 ADJ, Line 1. ............                                  12                                    00
13. Lump-sum and accumulation distributions included on Sch. 763 ADJ, Line 3. .                                          13                                    00                                00
14. TOTAL - Add Lines 1 through 13 and enter each column total here ..................                                   14                                    00                                00
15. Nonresident allocation percentage - Divide Line 14 B, by Line 14 A. Compute                                                                                                                 %
    percentage to one decimal place (e.g., 5.4%). Enter on Page 1, Line 16. ........                                     15
  I (We) authorize the Dept. of Taxation to discuss this return with my (our) preparer.                                       I agree to obtain my Form 1099-G at www.tax.virginia.gov.
I (We), the undersigned, declare under penalty provided by law that I (we) have examined this return and to the best of my (our) knowledge, it is a true, correct, and complete return.
Your Signature                                                                          Your Phone Number                                                      Date

Spouse’s Signature (If a joint return, both must sign)                                  Spouse’s Phone Number                                                  Preparer’s PTIN      Vendor Code

Preparer’s Name                            Firm’s Name (or Yours if Self-Employed)      Preparer’s Phone Number                                                Filing Election Code ID Theft PIN