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4 State of Rhode Island Division of Taxation 4
5 2023 Form RI-1040NR 5
6 Nonresident Individual Income Tax Return 23100499990101 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 6 Enter # of exemptions from RI Sch E, line 5 in box, multiply by $4,700 and 6 35
36 widow(er) enter result on line 6. If line 3 is over $233,750, see Exemption Worksheet 99 X $4,700= 9999999999 99 36
37 $20,050 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 41
42 $15,050 9 RI percentage of allowable Federal credit from page 3, RI Sch I, line 25.....................................DRAFT 9 9999999999 99 42
43 43
44 10 Rhode Island tax after allowable Federal credit - before allocation. Subtract line 9 from line 8 ... 10 9999999999 99 44
45 RI allocated All income is Nonresident with in- Part-year resident with 45
46 11 income tax. from RI, enter come from outside RI, income from outside RI, 11 9999999999 99 46
Using a Check only amount from line complete Sch II and complete Sch III and
47 paper one box. 10 on this line. enter result on this line. enter result on this line. 47
48 clip, 12 Other Rhode Island Credits from RI Schedule CR, line 9............................................................. 12 9999999999 99 48
please
49 attach 49
50 Forms 13 a Rhode Island income tax after credits. Subtract line 12 from line 11 (not less than zero) ........... 13a 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.................... 13b 9999999999 99 52
here. 09/01/2023
53 Contributions reduce 53
14 RI checkoff contributions from page 3, RI Checkoff Schedule, line 33. your refund or increase 14
54 your balance due 9999999999 99 54
55 55
56 15 a USE/SALES tax due from RI Schedule U, line 4 or line 8, whichever applies 15a 9999999999 99 56
Check üto certify use tax amount on line 15a is accurate.
57 57
58 b Individual Mandate Penalty (see instructions). Check ü to certify full year coverage. 15b 9999999999 99 58
59 59
60 16 a TOTAL RI TAX AND CHECKOFF CONTRIBUTIONS. Add lines 13a, 13b, 14, 15a and 15b....... 16a 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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