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4 State of Rhode Island Division of Taxation 4
5 2023 Form RI-1040 5
6 Resident Individual Income Tax Return 23100199990101 6
7 7
8 8
9 Your social security number Spouse’s social security number 9
10 999999999 999999999 Reserved for 2D barcode 10
11 Your first name MI Last name Suffix 11
12 XXXXXXXXXXXXXX X XXXXXXXXXXXXXX XXX x: 5.00 in 12
13 Spouse’s name MI Last name Suffix 13
y: 1.3 in
14 XXXXXXXXXXXXXXAddress X XXXXXXXXXXXXXX XXX w: 2.75 in 14
15 15
16 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX h:1.5 in 16
17 City, town or post office State ZIP code 17
18 XXXXXXXXXXXXXXXXXXXX XX 99999 18
19 City or town of legal residence Check each box Primary Spouse New Amended 19
that applies. Other-
20 XXXXXXXXXXXXXXXXXXX wise, leave blank. deceased? deceased? address? Return? * 20
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
21 CONTRIBUTION to this fund, check here. (See instructions. This Yes box and fill in the name of the political party. Other- 21
22 will not increase your tax or reduce your refund.) wise, it will be paid to a nonpartisan general account. XXXXXXXXXX 22
23 FILING Married filing Married filing Head of Qualifying 23
24 STATUS Singleððððjointly separately household widow(er) ð24
Check one
25 25
26 INCOME, 1 Federal AGI from Federal Form 1040 or 1040-SR, line 11 ........................................................... 1 9999999999 99 26
TAX AND
27 CREDITS 27
28 2 Net modifications to Federal AGI from RI Sch M, line 3. If no modifications, enter 0 on this line. 2 9999999999 99 28
29 Rhode 29
Island
30 Standard 3 Modified Federal AGI. Combine lines 1 and 2 (add net increases or subtract net decreases)..... 3 9999999999 99 30
31 Deduction 31
32 Single 4 RI Standard Deduction from left. If line 3 is over $ 233,750 see Standard Deduction Worksheet ........... 4 9999999999 99 32
$10,000
33 Married 33
34 filing jointly 5 Subtract line 4 from line 3. If zero or less, enter 0........................................................................ 5 9999999999 99 34
or
35 Qualifying 35
36 widow(er) 6 Enter # of exemptions from RI Sch E, line 5 in box, multiply by $4,700 and 99 X $4,700 = 6 9999999999 99 36
$20,050 enter result on line 6. If line 3 is over $233,750, see Exemption Worksheet
37 37
filing RI TAXABLE INCOME. Subtract line 6 from line 5. If zero or less, enter 0...................................
38 Married 7 7 9999999999 99 38
39 separately 39
40 $10,025 8 RI income tax from Rhode Island Tax Table or Tax Computation Worksheet............................... 8 9999999999 99 40
Head of
41 household 9 a RI percentage of allowable Federal credit from page 3, 41
42 $15,050 RI Sch I, line 22......................................................................DRAFT9a 9999999999 99 42
43 Check ü to certify 43
b RI Credit for income taxes paid to other states from page 3, 9b use tax amount on
44 RI Sch II, line 29..................................................................... 9999999999 99 line 12a is accurate. 44
45 45
46 Using a c Other Rhode Island Credits from RI Schedule CR, line 9...... 9c 9999999999 99 46
47 paper 47
48 clip, d Total RI credits. Add lines 9a, 9b and 9c................................................................................. ............. 9d 9999999999 99 48
please
49 attach 49
50 Forms 10 a Rhode Island income tax after credits. Subtract line 9d from line 8 (not less than zero) ............. 10a 9999999999 99 50
51 W-2 and 51
52 1099 b Recapture of Prior Year Other Rhode Island Credits from RI Schedule CR, line 12.................... 10b 9999999999 99 52
here. 09/01/2023
53 Contributions reduce 53
54 11 RI checkoff contributions from page 3, RI Checkoff Schedule, line 37. your refund or increase 11 9999999999 99 54
your balance due
55 55
56 12 a USE/SALES tax due from RI Schedule U, line 4 or line 8, whichever applies.............................. 12a 9999999999 99 56
57 57
58 b Individual Mandate Penalty (see instructions). Check ü to certify full year coverage . 12b 9999999999 99 58
59 59
60 13 a TOTAL RI TAX AND CHECKOFF CONTRIBUTIONS. Add lines 10a, 10b, 11, 12a and 12b....... 13a 9999999999 99 60
61 61
62 RETURN MUST BE SIGNED - SIGNATURE IS LOCATED ON PAGE 2 62
1111111111222222222233333333334444444444555555555566666666667777777777888Mailing address: RI Division of Taxation, One Capitol Hill, Providence, RI 02908-5806
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