Form Mo Nri – Fill Out and Use This PDF

PART A — RESIDENT/NONRESIDENT STATUS — Check your status in the appropriate box below.

NAME (YOURSELF)		NAME (SPOUSE)
ADDRESS		ADDRESS
CITY, STATE, ZIP CODE	SOCIAL SECURITY NUMBER	CITY, STATE, ZIP CODE	SOCIAL SECURITY NUMBER

		1. NONRESIDENT OF MISSOURI What was your state of residence during 2011?							1. NONRESIDENT OF MISSOURI What was your state of residence during 2011?
		2. PART‑YEAR MISSOURI RESIDENT							2. PART‑YEAR MISSOURI RESIDENT
			a. Indicate the date you were a Missouri resident in 2011.	Date From:	Date To:				a. Indicate the date you were a Missouri resident in 2011.	Date From:	Date To:
			b. Indicate other state of residence and date you resided there.	Date From:	Date To:				b. Indicate other state of residence and date you resided there.	Date From:	Date To:

Based on the Military Spouse’s Residency Relief Act, if you are the spouse of a military servicemember residing outside of Missouri solely because your spouse is there on military orders, and Missouri is your state of residence, any income you earn is taxable to Missouri.

Do not complete Form MO-NRI. You must report 100% on Line 27 of MO-1040.

PART B — WORKSHEET FOR MISSOURI SOURCE INCOME

	ADJUSTED GROSS INCOME	FEDERAL		FEDERAL		YOURSELF OR			SPOUSE (ON A
		FORM		FORM		ONE INCOME FILER			COMBINED RETURN)
	COMPUTATIONS	1040A		1040
		LINE		LINE		MISSOURI SOURCES			MISSOURI SOURCES
		NO.		NO.
A.	Wages, salaries, tips, etc	7		7	A		00	A	00
B.	Taxable interest income	8a		8a	B		00	B	00
C.	Dividend income	9a		9a	C		00	C	00
D.	State and local income tax refunds	none		10	D		00	D	00
E.	Alimony received	none		11	E		00	E	00
F.	Business income or (loss)	none		12	F		00	F	00
G.	Capital gain or (loss)	10		13	G		00	G	00
H.	Other gains or (losses)	none		14	H		00	H	00
I.	Taxable IRA distributions	11b		15b	I		00	I	00
J.	Taxable pensions and annuities	12b		16b	J		00	J	00
K.	Rents, royalties, partnerships, S corporations, trusts, etc	none		17	K		00	K	00
L.	Farm income or (loss)	none		18	L		00	L	00
M.	Unemployment compensation	13		19	M		00	M	00
N.	Taxable social security benefits	14b		20b	N		00	N	00
O.	Other income	none		21	O		00	O	00
P.	Total — Add Lines A through O	15		22	P		00	P	00
Q.	Less: federal adjustments to income	20		36	Q		00	Q	00
R.	SUBTOTAL (Line P – Line Q) If no modifications to income,						00		00
	STOP and ENTER this amount on reverse side, Part C, Line 1	21		37	R			R
S.	Missouri modifications — additions to federal adjusted gross income						00		00
	(Missouri source from Form MO‑1040, Line 2)				S			S
T. Missouri modifications — subtractions from federal adjusted gross income							00		00
	(Missouri source from Form MO‑1040, Line 4)				T			T
U.	MISSOURI INCOME (Missouri sources). Line R plus Line S,						00		00
	minus Line T. Enter this amount on reverse side, Part C, Line 1				U			U

For Privacy Notice, see instructions.

MO 860-1096 (12-2011)

PART C — MISSOURI INCOME PERCENTAGE

INSTRUCTIONS

PART A, LINE 1: NONRESIDENTS OF MISSOURI — If you are a Missouri nonresident and had Missouri source income, complete Part A, Line 1, Part B, and Part C. Attach a copy of your federal return and this form to your Missouri return.

PART A, LINE 2: PART‑YEAR RESIDENT — If you were a Missouri part‑year resident with Missouri source income and income from another state; you may use Form MO‑NRI or Form MO‑CR, whichever is to your benefit. When using Form MO‑NRI, complete Part A, Line 2, Part B, and Part C. Missouri source income includes any income (pensions, annuities, etc.) that you received while living in Missouri. Attach a copy of your federal return and this form to your Missouri return.

PART A, LINE 3: MILITARY NONRESIDENT TAX STATUS —

MISSOURI HOME OF RECORD — If you have a Missouri home of record and you:

a)Did not have any Missouri income other than military income, were not in Missouri for more than 30 days, did not maintain a home in Missouri during the year, but did maintain living quarters elsewhere, you qualify as a nonresident for tax purposes. Complete Part A, Line 3 and enter “0” on Part C, Line 1.

b)Did have Missouri income other than military income, were in Missouri for more than 30 days or maintained a home in Missouri during the year, you cannot use this form. You must file Form MO‑1040 because 100 percent of your income is taxable, including your military income. Do not complete this form.

c)Did not have Missouri income other than military income but spent more than 30 days in Missouri or maintained a home in Missouri during the year, you must file Form MO‑1040 because 100 percent of your income is taxable, including your military income. Do not complete this form.

d)Are married to a Missouri resident, who is not in the military, but lives with you outside of Missouri on military orders, you may use Form MO‑NRI to calculate your Missouri income percentage. However, any income earned by your spouse is taxable to Missouri. Your spouse is not eligible to complete Form MO‑NRI.

MILITARY NONRESIDENT STATIONED IN MISSOURI — If you are a military nonresident, stationed in Missouri and you:

a)Earned non-military income while in Missouri, you must file Form MO‑1040. Complete Part A, Line 3, Part B and Part C. The nonresident military pay should be subtracted from your federal adjusted gross income using Form MO‑A, Part 1, Line 9, as a “Military (nonresident) Subtraction”.

b)Only had military income while in Missouri, you may complete a No Return Required-Military Online Form at the following address: http://dor.mo.gov/personal/individual/.

NOTE: IF YOU FILE A JOINT FEDERAL RETURN, YOU MUST FILE A COMBINED MISSOURI RETURN (REGARDLESS OF WHOM EARNED THE INCOME). COMPLETE EACH COLUMN OF PART B AND PART C OF THIS FORM. DO NOT COMBINE INCOMES FOR YOU AND YOUR SPOUSE.

Use this diagram to determine if you or your spouse are a RESIDENT OR NONRESIDENT

You are a	YES	NO
Nonresident
(for tax
purposes).

You are a Resident.

*Domicile (Home of Record) — The place an individual intends to be his/her permanent home; a place that he/she intends to return whenever absent. A domicile, once estab‑ lished, continues until the individual moves to a new location with the true intention of making his/her permanent home there. An individual can only have one domicile at a time.

Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which he/she has any knowledge. As provided in Chapter 143, RSMo, a penalty of up to $500 shall be imposed on any individual who files a frivolous return.

This form is available upon request in alternative accessible format(s).

MO 860-1096 (12-2011)