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State of Rhode Island Division of Taxation
2023 Form RI-1040NR
Nonresident Individual Income Tax Return 23100499990101

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 6 Enter # of exemptions from RI Sch E, line 5 in box, multiply by $4,700 and 6
widow(er) enter result on line 6. If line 3 is over $233,750, see Exemption Worksheet X $4,700=
$20,050
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
$15,050 9 RI percentage of allowable Federal credit from page 3, RI Sch I, line 25..................................... 9

10 Rhode Island tax after allowable Federal credit - before allocation. Subtract line 9 from line 8 ... 10
RI allocated All income is Nonresident with in- Part-year resident with
11 income tax. from RI, enter come from outside RI, income from outside RI, 11
Using a Check only amount from line complete Sch II and complete Sch III and
paper one box. 10 on this line. enter result on this line. enter result on this line.
clip, 12 Other Rhode Island Credits from RI Schedule CR, line 9............................................................. 12
please
attach
Forms 13 a Rhode Island income tax after credits. Subtract line 12 from line 11 (not less than zero) ........... 13a
W-2 and
1099 b Recapture of Prior Year Other Rhode Island Credits from RI Schedule CR, line 12.................... 13b
here.
Contributions reduce
14 RI checkoff contributions from page 3, RI Checkoff Schedule, line 33. your refund or increase 14
your balance due
15 a USE/SALES tax due from RI Schedule U, line 4 or line 8, whichever applies 15a
Check ü to certify use tax amount on line 15a is accurate.
b Individual Mandate Penalty (see instructions). Check ü to certify full year coverage. 15b

16 a TOTAL RI TAX AND CHECKOFF CONTRIBUTIONS. Add lines 13a, 13b, 14, 15a and 15b....... 16a

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-1040NR
Nonresident Individual Income Tax Return - page 2 23100499990102

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

16 b TOTAL RI TAX AND CHECKOFF CONTRIBUTIONS from line 16a............................................................... 16b
RI 2023 income tax withheld from RI Schedule W, line 16. You must
17 a attach Sch W AND all W-2 and 1099 forms with RI withholding. ........... 17a
b 2023 estimated tax payments and amount applied from 2022 return.... 17b

c Nonresident withholding on real estate sales in 2023............................ 17c

d RI earned income credit from page 3, RI Schedule EIC, line 38............ 17d

e Other payments...................................................................................... 17e

f TOTAL PAYMENTS AND CREDITS. Add lines 17a, 17b, 17c, 17d and 17e................................................ 17f

g Previously issued overpayments (if filing an amended return)...................................................................... 17g

h NET PAYMENTS. Subtract line 17g from line 17f........................................................................................ 17h

18 a AMOUNT DUE. If line 16b is LARGER than line 17h, subtract line 17h from line 16b................................. 18a

b Enter the amount of underestimating interest due from Form RI-2210 or RI-2210A. (attach form) 18b
This amount should be added to line 18a or subtracted from line 19, whichever applies.............................
c TOTAL AMOUNT DUE. Add lines 18a and 18b. Complete RI-1040V and send in with your payment 18c
L
19 AMOUNT OVERPAID. If line 17h is LARGER than line 16b, subtract line 16b from line 17h. If there 19
is an amount due for underestimating interest on line 18b, subtract line 18b from line 19.................. J
20 Amount of overpayment to be refunded........................................................................................................ 20

21 Amount of overpayment to be applied to 2024 estimated tax................ 21

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-1040NR
Nonresident Individual Income Tax Return - page 3 23100499990103

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

RI SCHEDULE I - ALLOWABLE FEDERAL CREDIT

22 RI income tax from page 1, line 8 ................................................................................................................... 22

23 Credit for child and dependent care expenses from Federal Form 1040 or 1040-SR, Schedule 3, line 2........... 23

24 Tentative allowable federal credit. Multiply line 23 by 25% (0.2500).............................................................. 24

25 MAXIMUM CREDIT. Line 22 or 24, whichever is SMALLER. Enter here and on page 1, line 9......................... 25

RI SCHEDULE II AND III - ALLOCATION AND MODIFICATION FOR NONRESIDENTS
Schedule II should be completed by NONRESIDENTS with income from outside Rhode Island.
RI Schedule II is located on page 13.
Schedule III should be completed by PART-YEAR RESIDENTS with income from outside Rhode Island.
RI Schedule III is located on page 15.
NONRESIDENTS and PART-YEAR RESIDENTS with all income from Rhode Island sources do not need
to complete either schedule II or III.

RI CHECKOFF CONTRIBUTIONS SCHEDULE
$1.00 $5.00 $10.00 Other
26 Drug program account RIGL §44-30-2.4 ............ 26

27 Olympic Contribution RIGL §44-30-2.1 ....... Yes $1.00 contribution ($2.00 if a joint return) 27

28 RI Organ Transplant FundRIGL §44-30-2.5 ...... 28

29 RI Council onRIGLthe Arts §42-75.1-1 ............. 29

30 RI Nongame Wildlife Fund RIGL §44-30-2.2 ..... 30
Childhood Disease Victim’s FundRIGL §44-30-2.3
31 and Substance Use and Mental Health Leadership 31
CouncilRIGLof RI §44-30-2.11...............................
32 RI Military Family Relief FundRIGL §44-30-2.9 .... 32

33 TOTAL CONTRIBUTIONS. Add lines 26 through 32. Enter here and on RI-1040NR, page 1, line 14............... 33

RI SCHEDULE EIC - RHODE ISLAND EARNED INCOME CREDIT

34 Federal earned income credit from Federal Form 1040 or 1040-SR, line 27.................................................. 34

35 Rhode Island percentage................................................................................................................................ 35 15%

36 RI EARNED INCOME CREDIT. Multiply line 34 by line 35 ............................................................................ 36

37 Rhode Island allocation from RI-1040NR, page 11, Schedule II, line 13 or RI-1040NR, page 13, Schedule 37
III, line 14. If all income is from RI, enter 1.0000.............................................................................................
38 TOTAL RI EARNED INCOME CREDIT. Multiply line 36 by line 37. Enter here and on RI-1040NR, pg 2, 38
line 17d...........................................................................................................................................................

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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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