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Attach Form W-2, Wage and Tax Statement(s) and Payment Here—Staple to Top Page Only

740-NP						KENTUCKY INCOM E TAX RETURN
42A740-S9						NONRESIDENT OR PART-YEAR RESIDENT
Departm ent of Revenue							¸ Check if Amended Return
							¸ Check if Amended Return													2004
				For calendar year or other taxable year beginning _______________ , 2004, and ending _______________ , 2005 .																2004
			Nam e—Last, First, M iddle Initial (Joint return, give both nam es and initials.)											Your Social Security Num ber
Use	➤											B.
	➤
	L
Kentucky	L
Kentucky	A		M ailing Address (Num ber and Street Including Apartm ent Num ber or P.O. Box)										Spouse's Social Security Num ber
label if	A												Spouse's Social Security Num ber
label if
correct.	B											A.


Otherw ise	E
print or	L		City, Tow n or Post Office							State	ZIP Code			POLITICAL PARTY FUND
type.	L		City, Tow n or Post Office							State	ZIP Code

	➤
	➤											Designating $2 w ill not change your refund
												Designating $2 w ill not change your refund
															or tax due.
	1			Single
			✔
			✔
FILING	2			M arried, filing joint return.											A. Spouse					B. Yourself


STATUS

	3			M arried, filing separate returns. Enter spouse's Social Security								Democratic				(1)					(4)
(see	3											Democratic				(1)					(4)
				num ber above and full nam e here.								Republican				(2)					(5)

instructions)
												No Designation				(3)					(6)
																		✔				✔
																		✔				✔

CREDITS	COM PLETE PAGE 2 OF THIS FORM BEFORE COM PLETING LINES 4 THROUGH 31.																	OFFICIAL USE ONLY
CREDITS
	4		Enter total tax credits claim ed on page 2, line 35									➤						1	2	3	4	5
																		1	2	3	4	5

	5		Enter am ount from page 2, line 62, Colum n A. This is your federal Adjusted Gross Income													5						00
	6		Enter am ount from page 2, line 62, Colum n B. This is your Kentucky Adjusted Gross Income													6						00
TAXABLE	7		Nonitemizers: Enter $1,870. Skip lines 8(a) and 8(b) (do not prorate)													7						00
INCOM E	8		(a)	Itemizers: Enter item ized deductions from Kentucky Schedule A,
INCOM E				Form 740-NP								8(a)				00
				Form 740-NP								8(a)				00
			(b)	M ultiply line 8(a) by the percentage (				%)
																00
				from page 2, line 63								8(b)				00
	9		Subtract line 7 or line 8(b) from line 6. This is your Taxable Income													9						00
TAX	10		Enter tax from Form 740-NP Tax Table													10						00
TAX	11		M ultiply $20 by num ber of tax credits claim ed (from line 4)									11				00
	11											11				00
	12		M ultiply line 11 by the percentage (						%) from page 2, line 63			12				00
	13		Other tax credits (see instructions)									13				00
	14		Subtract lines 12 and 13 from line 10													14						00
	15		Enter Low Income Credit from w orksheet in the instructions													15						00
	16		Subtract line 15 from line 14													16						00
	17		Enter Child and Dependent Care Credit from w orksheet in the instructions													17						00
	18		Subtract line 17 from line 16. This is your Income Tax Liability													18						00
	19		Enter KENTUCKY USE TAX from w orksheet in the instructions													➤ 19						00
	20		Add lines 18 and 19. This is your Total Tax Liability													20						00
	21		(a)	Enter Kentucky income tax w ithheld as show n
				on attached 2004 Form W-2, Wage and Tax Statem ent(s)								21(a)				00
			(b)	Enter 2004 Kentucky estim ated tax paym ents								21(b)				00
	22		Add lines 21(a) and 21(b)													22						00
	23		.................................If line 22 is larger than line 20, enter AM OUNT OVERPAID (see instructions)													23						00
See	24 Nature and Wildlife Fund Contribution
See		¸ $2			¸ $5	¸ $10 ¸ Other			Enter am ount checked			24				00
instruc-		¸ $2			¸ $5	¸ $10 ¸ Other			Enter am ount checked			24				00
tions for a	25		Child Victims’ Trust Fund Contribution
detailed		¸ $2			¸ $4	¸ Other		Enter am ount checked				25				00
description		¸ $2			¸ $4	¸ Other		Enter am ount checked				25				00
description	26		Bluegrass State Games and U.S. Olympic Committee Fund Contribution									26				00
of funds.	26											26				00
	27		Veterans’ Program Trust Fund Contribution					........................................................				27				00
	28		Add lines 24 through 27														28					00
	29		..............Am ount of line 23 to be CREDITED to your 2005 estim ated tax									ESTIM ATED TAX					29					00

	30		Subtract lines 28 and 29 from line 23. Am ount to be REFUNDED TO YOU									..............		REFUND			30					00

31If line 20 is larger than line 22, enter AM OUNT YOU OWE. Attach check for full am ount payable to Kentucky State Treasurer. Write your Social Security num ber and "KY Incom e

Tax—2004" on the check. Place on TOP of w age and tax statem ents	OWE 31	00
Check ¸ if Form 2210-K is attached (see instructions)
Official
Use Only	EST CF NT P B F	R

FORM 740-NP (2004)

<www.revenue.ky.gov

Page 2

A copy of pages 1 and 2 of your federal income tax return and all supporting schedules must be attached to Kentucky Form 740-NP.


RESIDENCY	¸	Full-year nonresident. I did not live in Kentucky during the year. Enter state of residence as of Decem ber 31, 2004																									.
	✔
		Part-year resident. Com plete appropriate line(s) below .

STATUS	¸

(check		M oved into Kentucky			/			/		04			. State m oved from										.

		M oved out of Kentucky			/			/		04			. State m oved to											.
one box)		M oved out of Kentucky			/			/		04			. State m oved to											.
one box)		Full-year resident of a reciprocal state. Attach a copy of the 2004 return
	¸																	➤		IL		IN			M I		OH				VA			WV				WI
	¸
		filed w ith your state of residence and circle the state of residence.

CREDITS	32		(a)	Credits for yourself:		¸	Regular		¸		¸	Check both if 65 or over				¸		¸	Check both if blind									Enter num ber of
CREDITS																			Check both if blind									Enter num ber of
							Regular		¸		¸	Check both if 65 or over				¸		¸
			(b)	Credits for spouse:		¸	Regular		¸		¸	Check both if 65 or over				¸		¸										boxes checked								32

	33		Nam es of dependent children: (a)											(b)	(c)								(d)										Total			33
	34		Tax credits for other dependents																																	34
	35		Add the total num ber of tax credits claim ed on lines 32, 33 and 34 above																																	35
INCOM E																				A. Total from Attached												B. Kentucky
	36		Enter all w ages, salaries, tips, etc. (attach w age and tax statem ents)																		Federal Return											B. Kentucky
	36																				Federal Return
			Do not include m oving expense reim bursem ents															36								00											00
	37		M oving expense reim bursem ent (attach Schedule M E)															37								00											00
	38		Interest and dividends															38								00											00
	39		Business incom e or (loss) (attach Schedule C or C-EZ)															39								00											00
	40		Capital gain or (loss) (attach Schedule D)															40								00											00
	41		Other gains or (losses) (attach Form 4797)															41								00											00
	42		(a)	Federally taxable IRA distributions, pensions and annuities														42(a)								00											00
			(b)	Pension incom e exclusion (attach Schedule P if m ore than $40,200) ...														42(b)												(							00 )
	43		Rents, royalties, partnerships, estates, trusts, etc. (attach federal Schedule E) ...															43								00											00
	44		Farm incom e or (loss) (attach Schedule F)															44								00											00
	45		Other incom e (list type and am ount)
																		45								00											00
	46		Com bine lines 36 through 45. This is your Total Income															46								00											00
ADJUST-	47		Educator expenses															47								00
M ENTS	48		Certain business expenses of reservists, perform ing artists and
TO			fee-basis governm ent officials (attach federal Form 2106 or 2106-EZ)															48								00											00
INCOM E	49		IRA deduction															49								00											00
	49		IRA deduction															49								00											00
	50		Student loan interest deduction															50								00											00
	51		Tuition and fees deduction															51								00											00
	52		Health savings account deduction (attach federal Form 8889)															52								00
	53		M oving expenses (attach Schedule M E)						................................................................									53								00											00
	54		Deduction for one-half of self-em ploym ent tax															54								00											00
	55		Self-em ployed health insurance deduction															55								00
	56		Self-em ployed SEP, SIM PLE and qualified plans deduction															56								00											00
	57		Penalty on early w ithdraw al of savings															57								00											00
	58		Alim ony paid (recipient's nam e and Social Security num ber)
																		58								00											00
	59		Long-term care insurance prem ium s (see instructions)															59																			00
	60		Health insurance prem ium s (see instructions)															60																			00
	61		Add lines 47 through 60. Total adjustm ents to incom e															61								00											00
	62		Subtract line 61 from line 46. This is your Adjusted Gross Income															62								00											00
	63		Divide line 62, Colum n B, by line 62, Colum n A. If am ount is equal to or
			greater than 100%, enter 100%. This is your Percentage of Kentucky
																	63												.						%
			Adjusted Gross Income to Federal Adjusted Gross Income														63												.						%

I, the undersigned, declare under penalties of perjury that I have exam ined this return, including all accom panying schedules and statem ents, and to the best of m y know ledge and belief, it is true, correct and com plete. I also understand and agree that our election to file a joint return under the provisions of Regulation 103 KAR 17:020 w ill result in refunds being m ade payable to us jointly and in each of us being jointly and severally liable for all taxes accruing under this return.

➤	➤	*
Your Signature (If joint return, both m ust sign.)	Spouse's Signature	Telephone Number (daytime)	Date Signed

Typed or Printed Nam e of Preparer Other than Taxpayer	I.D. Num ber of Preparer		Date
➤ M ail refund returns to Kentucky Department of Revenue, Frankfort, KY 40618-0006.		➤ M ake check payable to
M ail returns w ith payment to Kentucky Department of Revenue, Frankfort, KY 40619-0008.		Kentucky State Treasurer.

Question	Answer
Form Name	Kentucky Form 740 Np
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	42a740np itemizers enter itemized deductions from kentucky schedule a form 740 np

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