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State of Rhode Island Division of Taxation
2023 Form RI-1040
Resident Individual Income Tax Return 23100199990101

Your social security number Spouse’s social security number

Your first name MI Last name Suffix

Spouse’s name MI Last name Suffix

Address

City, town or post office State ZIP code

City or town of legal residence Check each box Primary Spouse New Amended
that applies. Other-
wise, leave blank. deceased? deceased? address? Return? *
ELECTORAL If you want $5.00 ($10.00 if a joint return) to go If you wish the 1st $2.00 ($4.00 if a joint return) be paid to a specific party, check the
CONTRIBUTION to this fund, check here. (See instructions. This Yes box and fill in the name of the political party. Other-
will not increase your tax or reduce your refund.) wise, it will be paid to a nonpartisan general account.
FILING Married filing Married filing Head of Qualifying
STATUS Singleððððjointly separately household widow(er) ð
Check one
INCOME, 1 Federal AGI from Federal Form 1040 or 1040-SR, line 11 ........................................................... 1
TAX AND
CREDITS
2 Net modifications to Federal AGI from RI Sch M, line 3. If no modifications, enter 0 on this line. 2
Rhode
Island
Standard 3 Modified Federal AGI. Combine lines 1 and 2 (add net increases or subtract net decreases)..... 3
Deduction
Single 4 RI Standard Deduction from left. If line 3 is over $ 233,750 see Standard Deduction Worksheet ........... 4
$10,000
Married
filing jointly 5 Subtract line 4 from line 3. If zero or less, enter 0........................................................................ 5
or
Qualifying
widow(er) 6 Enter # of exemptions from RI Sch E, line 5 in box, multiply by $4,700 and X $4,700 = 6
$20,050 enter result on line 6. If line 3 is over $233,750, see Exemption Worksheet
Married 7 7
filing RI TAXABLE INCOME. Subtract line 6 from line 5. If zero or less, enter 0...................................
separately
$10,025 8 RI income tax from Rhode Island Tax Table or Tax Computation Worksheet............................... 8
Head of
household 9 a RI percentage of allowable Federal credit from page 3,
$15,050 RI Sch I, line 22...................................................................... 9a
Check üto certify
b RI Credit for income taxes paid to other states from page 3, 9b use tax amount on
RI Sch II, line 29..................................................................... line 12a is accurate.

Using a c Other Rhode Island Credits from RI Schedule CR, line 9...... 9c
paper
clip, d Total RI credits. Add lines 9a, 9b and 9c................................................................................. ............. 9d
please
attach
Forms 10 a Rhode Island income tax after credits. Subtract line 9d from line 8 (not less than zero) ............. 10a
W-2 and
1099 b Recapture of Prior Year Other Rhode Island Credits from RI Schedule CR, line 12.................... 10b
here.
Contributions reduce
11 RI checkoff contributions from page 3, RI Checkoff Schedule, line 37. your refund or increase 11
your balance due
12 a USE/SALES tax due from RI Schedule U, line 4 or line 8, whichever applies.............................. 12a

b Individual Mandate Penalty (see instructions). Check ü to certify full year coverage . 12b

13 a TOTAL RI TAX AND CHECKOFF CONTRIBUTIONS. Add lines 10a, 10b, 11, 12a and 12b....... 13a

RETURN MUST BE SIGNED - SIGNATURE IS LOCATED ON PAGE 2
Mailing address: RI Division of Taxation, One Capitol Hill, Providence, RI 02908-5806
* If filing an amended return, attach the Explanation of Changes supplemental page

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State of Rhode Island Division of Taxation
2023 Form RI-1040
Resident Individual Income Tax Return - page 2 23100199990102

Name(s) shown on Form RI-1040 or RI-1040NR Your social security number

13 b TOTAL RI TAX AND CHECKOFF CONTRIBUTIONS from line 13a............................................................... 13b
RI 2023 income tax withheld from RI Schedule W, line 16. You must
14 a attach Sch W AND all W-2 and 1099 forms with RI withholding. ........... 14a
b 2023 estimated tax payments and amount applied from 2022 return.... 14b

c Property tax relief credit from RI-1040H, line 13. Attach RI-1040H........ 14c

d RI earned income credit from page 3, RI Schedule EIC, line 40............ 14d

e RI Residential Lead Paint Credit from RI-6238, line 7. Attach RI-6238.. 14e

f Other payments...................................................................................... 14f

g TOTAL PAYMENTS AND CREDITS. Add lines 14a, 14b, 14c, 14d, 14e and 14f......................................... 14g

h Previously issued overpayments (if filing an amended return)..................................................................... 14h
PAYMENTS AND PROPERTY TAX RELIEF CREDIT
i NET PAYMENTS. Subtract line 14h from line 14g........................................................................................ 14i

15 a AMOUNT DUE. If line 13b is LARGER than line 14i, subtract line 14i from line 13b.................................... 15a

b Enter the amount of underestimating interest due from Form RI-2210 or RI-2210A. (attach form) 15b
This amount should be added to line 15a or subtracted from line 16, whichever applies.............................
c TOTAL AMOUNT DUE. Add lines 15a and 15b. Complete RI-1040V and send in with your payment 15c
L
16 AMOUNT OVERPAID. If line 14i is LARGER than line 13b, subtract line 13b from line 14i. If there 16
is an amount due for underestimating interest on line 15b, subtract line 15b from line 16.................. J
17 Amount of overpayment to be refunded........................................................................................................ 17

18 Amount of overpayment to be applied to 2024 estimated tax................ 18

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature Your driver’s license number and state Date Telephone number

Spouse’s signature Spouse’s driver’s license number and state Date Telephone number

Paid preparer signature Print name Date Telephone number

Paid preparer address City, town or post office State ZIP code PTIN

May the Division of Taxation contact your preparer? YES

Revised
11/2023

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State of Rhode Island Division of Taxation
2023 Form RI-1040
Resident Individual Income Tax Return - page 3 23100199990103

Name(s) shown on Form RI-1040 or RI-1040NR Your social security number

RI SCHEDULE I - ALLOWABLE FEDERAL CREDIT

19 RI income tax from page 1, line 8 ................................................................................................................... 19

20 Credit for child and dependent care expenses from Federal Form 1040 or 1040-SR, Schedule 3, line 2........... 20

21 Tentative allowable federal credit. Multiply line 20 by 25% (0.2500).............................................................. 21

22 MAXIMUM CREDIT. Line 19 or 21, whichever is SMALLER. Enter here and on page 1, line 9a................. 22

RI SCHEDULE II - CREDIT FOR INCOME TAX PAID TO ANOTHER STATE
(ATTACH COPY OF OTHER STATE(S) RETURN)
23 RI income tax from RI-1040, page 1, line 8 less allowable federal credit from RI-1040, page 3, line 22 ....... 23

24 Income derived from other state. If more than one state, see instructions.................................................... 24

25 Modified federal AGI from page 1, line 3......................................................................................................... 25

26 Divide line 24 by line 25 ........................................................................................................................................ 26
_ . _ _ _ _
27 Tentative credit. Multiply line 23 by line 26............................................................................................................. 27

28 Tax due and paid to other state (see specific instructions). Insert abbreviation for state paid 28

29 MAXIMUM TAX CREDIT. Line 23, 27 or 28, whichever is the SMALLEST. Enter here and on pg 1, line 9b 29

RI CHECKOFF CONTRIBUTIONS SCHEDULE
$1.00 $5.00 $10.00 Other
30 Drug program account RIGL §44-30-2.4 ............ 30

31 Olympic Contribution RIGL §44-30-2.1 ....... Yes $1.00 contribution ($2.00 if a joint return) 31

32 RI Organ Transplant FundRIGL §44-30-2.5 ...... 32

33 RI Council onRIGLthe Arts §42-75.1-1 ............. 33

34 RI Nongame Wildlife Fund RIGL §44-30-2.2 ..... 34
Childhood Disease Victim’s FundRIGL §44-30-2.3
35 and Substance Use and Mental Health Leadership 35
CouncilRIGLof RI §44-30-2.11...............................
36 RI Military Family Relief FundRIGL §44-30-2.9 .... 36

37 TOTAL CONTRIBUTIONS. Add lines 30 through 36. Enter here and on RI-1040, page 1, line 11 .................... 37

RI SCHEDULE EIC - RHODE ISLAND EARNED INCOME CREDIT

38 Federal earned income credit from Federal Form 1040 or 1040-SR, line 27.................................................. 38

39 Rhode Island percentage................................................................................................................................ 39 15%
40 RI EARNED INCOME CREDIT. Multiply line 38 by line 39. Enter here 40
and on RI-1040, page 2, line 14d ............................................................

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   State of Rhode Island Division of Taxation 
   2023 RI Schedule W 
   Rhode Island Withholding Information - Page 4                              23101099990101

Name(s) shown on Form RI-1040 or RI-1040NR                                             Your social security number

Complete this Schedule listing all of your and, if applicable, your spouse’s W-2s, 1099s, etc. showing Rhode Island Income 
Tax withheld.  W-2s, 1099s, etc. showing Rhode Island Income Tax withheld must still be attached to the front of your return.   
   Failure to do so may delay the processing of your return.        ATTACH THIS SCHEDULE W TO YOUR RETURN
   Column A    Column B                    Column C                           Column D                                                                                   Column E
   Enter “S”   Enter letter                                           Employer’s state ID # from                                                                       Rhode Island Income Tax 
                               Employer’s Name from Box C of your W-
   if Spouse’s code from                                              box 15 of your W-2 or Payer’s                                                                    Withheld (SEE BELOW 
                               2 or Payer’s Name from your other forms
   W-2, 1099, etc. chart below                                        Federal ID # from other forms FOR BOX REFERENCES)
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15
16 Total RI Income Tax Withheld.  Add lines 1 through 15, Col. E.  Enter total here and on RI-1040, line 14a or  
   RI-1040NR, line 17a.................................................................................................................................................
17 Total number of W-2s and 1099s showing Rhode Island Income Tax Withheld ......................................................

                                           Schedule W Reference Chart
   Form Type   Letter Code  Withholding    Form Type Letter Code  Withholding Form Type                          Letter Code  Withholding 
               for Column B    Box                   for Column B     Box                                        for Column B                                            Box 
   W-2                         17          1099-G    G                11      1099-OID                                                                                 O 14
   W-2G        W               15          1099-INT  I                17      1099-R                                                                                   R 14
   1042-S      S               17a         1099-K    K                8       RI-1099E                                                                                 E 11
   1099-B      B               16          1099-MISC M                16      RI K-1                                                                                   P Sect. IV, line 2
   1099-DIV    D               16          1099-NEC  N                5

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State of Rhode Island Division of Taxation
2023 RI Schedule E
Exemption Schedule for RI-1040 and RI-1040NR 23105999990101

Name(s) shown on Form RI-1040 or RI-1040NR Your social security number

EXEMPTIONS

Complete this Schedule listing all individuals you can claim as a dependent.
ATTACH THIS EXEMPTION SCHEDULE TO YOUR RETURN Failure to do so may delay the processing of your return.

1a Yourself

b Spouse

(A) Name of Dependent (B) Social Security Number (C) Date of Birth (D) Relationship

Exemption Number Summary

3 Enter the number of boxes checked on lines 1a and 1b ........................................................ 3

4a Enter the number of children from lines 2a through 2m who lived with you ........................... 4a

b Enter the number of children from lines 2a through 2m who did not live with you due to 4b
divorce or separation ................................... ..........................................................................
c Enter the number of other dependents from lines 2a through 2m not included on lines 4a or 4b. 4c

5 Add the numbers from lines 3 through 4c. Enter here and in the box on RI-1040/NR, pg 1, line 6 . 5

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