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                                                                                                                                           FORM 1065N
                                                    Nebraska Schedule K-1N  —                                                              Schedule K-1N
                                 Partner’s Share of Income, Deductions, Modifications, and Credits
                                                                                                                                              2021
                                                                                                Partner’s Name and Mailing Address
                  Partnership’s Name and Mailing Address                             (If partner is a disregarded entity (DE), use beneficial owner information not DE’s).
 Name Doing Business As (dba)                                                        Name 

 Legal Name 

 Street or Other Mailing Address                                                     Street or Other Mailing Address

 City                               State                          Zip Code          City                                   State             Zip Code

 Check One:                                                                          Nebraska ID Number                     Federal ID Number 
      Partnership                LLC
 Nebraska ID Number                 Federal ID Number                                Social Security Number                 Spouse’s Social Security Number

     Taxable Year of Organization                                                    Check One:
                                                                                           Resident Individual      Nonresident Individual    Estate or Trust
      Beginning _________________ , 20 _____ and Ending _________________ , 20 _____       Other (describe) ___________________________________________________
  Partnership’s Nebraska          Nebraska Receipts Total Receipts                   Partner’s Share of Income Percentage   If applicable, check the appropriate box: 
  Apportionment Factor 
                         %                                                                                                % Final             Amended
                                          Part A – Partner’s Share of Income and Deductions
 1  Ordinary business income (loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 
 2  Net rental real estate income (loss)  ................................................                                               2
 3  Other net rental income (loss) .....................................................                                                 3
 4  Guaranteed payments  ..........................................................                                                      4
 5  Interest income ................................................................                                                     5
 6  Ordinary dividends .............................................................                                                     6
 7  Royalties .....................................................................                                                      7
 8  Net short-term capital gain (loss) ..................................................                                                8
 9  Net long-term capital gain (loss) ...................................................                                                9
 10  Net Section 1231 gain (loss) ......................................................                                                 10
 11   Other income (loss) (list below or attach schedule) 
           aList type: _____________________________________________                           b Amount: $ _________
            Total other income (loss). Enter total of lines 11b ....................................                                     11
 12  Contributions ..................................................................                                                    12
 13  Section 179 deduction  ..........................................................                                                   13
 14  Other deductions (list below or attach schedule)
           aList type: _____________________________________________                           b Amount: $ _________
            Total other deductions. Enter total of lines 14b ......................................                                      14
                                                    Part B – Partner’s Share of Modifications
 15  Qualified U.S. government interest deduction  ........................................                                              15
 16  State and local bond interest and dividend income  ....................................                                             16
 17  Income (loss) from non-Nebraska sources (use only if you checked the LLC box above) .......                                         17
                                                    Part C– Partner’s Share of Credits
 18  Community Development Assistance Act credit .......................................                                                 18
 19  Form 3800N credits (see instructions)
      a  Employment and Investment Growth Act ......................... 19 a  $ ___________
      b  Nebraska Advantage Act ..................................... 19 b $ ___________
      c  Nebraska Advantage Rural Development Act ..................... 19 c  $ ___________
      d  Nebraska Advantage Research and Development Act  .............. 19 d $ ___________
      e  New Markets Tax Credit ...................................... 19 e  $ ___________
      f   Nebraska Historic Tax Credit  .................................. 19 f  $ ___________
      g  ImagiNE Nebraska Act..... ..................................... 19 g  $ ___________
      h  Key Employer and Jobs Retention Act ........................... 19 h  $ ___________
      i  Urban Redevelopment Act....  .................................. 19 i  $ ___________
        Total of 19a through 19i .......................................................                                                 19
 20  Contractor income tax withholding (see instructions) ...................................                                            20
 21  Nebraska income tax withheld (see instructions) ......................................                                              21
                                    revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729 
                                                                                                                                              8-691-2021