Form                                                      2022  
760PY                     Virginia Part-Year Resident Income Tax Return                                                           *VA760P122888*
Page 1                                          Due May 1, 2023
 See instructions before completing line items.                                                                                                                   Dates of VA Residence  
 Enclose a complete copy of your federal tax return and all other required Virginia enclosures.                                                                          (mm-dd-yyyy)
 YOUR First Name                            MI Your Last Name     Check if deceased Suffix                               A Your Social Security Number          You - From             You - To

 SPOUSE’S First Name (filing status 2 or 4) MI Spouse’s Last Name Check if deceased Suffix                               B Spouse's Social Security Number      Spouse - From          Spouse - To

 Present Home Address (Number and Street, or Rural Route)                                                                                               VA Driver’s License Information
                                                                                                                                                                Customer ID
                                                                                                                              You               __________________________________________
 City, Town or Post Office
                                                                                                                              Spouse            __________________________________________
                                                                                                                                                           Issue Date (mm-dd-yyyy)
 State                                         ZIP Code                             Locality Code                             You               __________________________________________
                                                                                                                              Spouse            __________________________________________
                           Amended Return                            Qualifying Farmer, Fisherman or Merchant Seaman                                       Combined Social Security for You and 
 Check                     Reason Code                                                                                                                     Spouse reported as taxable income on 
 Applicable                                                       Earned Income Credit Claimed on federal return                                           Federal Return
                           Dependent on Another’s Return
 Boxes                     Overseas on Due Date                   $  ______________________.00                                                             $  ______________________.00
 I/we authorize the sharing of certain information from Form 760PY and Schedule HCI (as described in the instructions) with the Department of Medical 
 Assistance Services (DMAS) and the Department of Social Services (DSS) for purposes of identifying persons who would like to newly enroll in medical assistance.
   Filing Status Enter Filing Status Code in box below.                                                                   Exemptions Enter the number of exemptions being claimed.
                                                                                                                                                           You/
         1 = Single (Column A) - Federal head of household?         YES                                                                                  Spouse Dependents    65 or Over  Blind
         2 = Married, Filing Joint return (Column A)                                                                          A - You
         3 = Married, Filing Separate returns (Column A)                                                                  Enter the numbers for both You 
                                                                                                                           and Spouse if Filing Status 2
       { 4 = Married, Filing Separately on this combined return (Columns A and B)
 If Filing Status 3, enter spouse's SSN in the Spouse's Social Security Number                                                B - Spouse
                                                                                                                           Filing Status 4 Only
 box at top of form and, enter Spouse’s Name_______________________________
 DATE OF BIRTH
                        Your Birth Date (mm-dd-yyyy)                -         -                                                      Spouse                                       You  
                                                                                                                                     Filing Status 4                       Include Spouse if  
                        Spouse’s Birth Date (mm-dd-yyyy)            -         -                                               B         ONLY                      A        Filing Status 2

 Complete the Schedule of Income first and submit it with your Form 760PY.
       1 FEDERAL ADJUSTED GROSS INCOME from Schedule of Income, Part 1, 
         Line 7, Column 1. ............................................................................................    1                                   00                                 00
       2 Additions from Schedule 760PY ADJ, Line 3. .................................................                      2                                   00                                 00
       3 Add Lines 1 and 2. .........................................................................................      3                                   00                                 00
       4 Qualifying Age Deduction. Enter Birth Dates above. Complete Age Deduction                                         4a                                                                     00
         Worksheet in instructions. Enter Spouse's Age Deduction on Line 4b, Column 
         B when using Filing Status 4 ONLY. Otherwise, claim Your Age Deduction on 
         Line 4a, Column A and Spouse's on Line 4b, Column A. ................................                             4b                                  00                                 00
       5 Social  Security  Act  and  equivalent  Tier  1  Railroad  Retirement  Act  benefits 
         reported as taxable income on federal return and attributable to your period of 
         residence in Virginia. .......................................................................................    5                                   00                                 00
       6 State income tax refund or overpayment credit reported  as income  on your 
         federal return and received while a Virginia resident. Claim in the same column 
         you reported adjusted gross income on Line 1................................................                      6                                   00                                 00
       7 Income attributable to your period of residence outside Virginia from Schedule of 
         Income, Part 1, Line 9, Column 3. ...................................................................             7                                   00                                 00
       8 Subtractions from Schedule 760PY ADJ, Line 7. ............................................                        8                                   00                                 00
       9 Add Lines 4a, 4b, 5, 6, 7, and 8.....................................................................             9                                   00                                 00
 10      Virginia Adjusted Gross Income (VAGI). Subtract Line 9 from Line 3. .....                                         10                                  00                                 00

 11      Itemized Deductions from Virginia Schedule A         paid while a Virginia resident.                              11                                  00                                 00
         See Instructions.. .............................................................................................
 12      If you do not claim itemized deductions on Line 11, enter standard deduction                                      12                                  00                                 00
         from Standard Deductions Worksheet in instructions. .....................................
Va. Dept. of Taxation      For Local Use
2601039   Rev. 07/22
                                               LTD                $_________ 

2022 Form 760PY Page 2
Your Name                                              Your SSN
                                                                                                                               *VA760P222888*
                                                                                                                               Spouse                                  You Include Spouse if 
                                                                                                                             B Filing Status 4 ONLY                  A Filing Status 2
13  Prorated exemption amount from Schedule of Income, Part 2, Line 11.                                                   13
    See instructions ....................................................................................................                                        00                   00
14  Deductions from Schedule 760PY ADJ, Line 9. ...................................................                       14                                     00                   00
15  Add Lines 11, 12, 13 and 14. ..............................................................................           15                                     00                   00
16  Virginia Taxable Income. Subtract Line 15 from Line 10. ...............................                               16                                     00                   00
17  Tax amount from Tax Table or Tax Rate Schedule. ..............................................                        17                                     00                   00
18  Total Tax. Add Line 17, Column A and Line 17, Column B. ............................................................................                         18                   00
19a   Your Virginia income tax withheld. Enclose copies of Forms W-2, W-2G, 1099 and VK-1 ..................................                                     19a                  00
19b Spouse's Virginia income tax withheld. Enclose copies of Forms W-2, W-2G, 1099 and VK-1 ...........................                                          19b                  00
20  Combined 2022 Estimated Tax Payments. ...........................................................................................................            20                   00
21  2021 overpayment credited to 2022 estimated taxes. ..........................................................................................                21                   00
22  Extension Payment - Enter amount paid on Form 760IP. .....................................................................................                   22                   00
23  Tax Credit for Low-Income Individuals or Virginia Earned Income Credit from Schedule 760PY ADJ, Line 17. ..                                                  23                   00
24  Total credit for taxes paid to another state from Schedule OSC...........................................................................                    24                   00
25  Credits from Schedule CR, Section 5, Line 1A. ..................................................................................................             25                   00
26  Total payments and credits.  Add Lines 19a through 25. ...............................................................................                       26                   00
27  If Line 18 is larger than Line 26, enter the difference. This is the INCOME TAX YOU OWE. ..............................                                      27                   00
28  If Line 26 is larger than Line 18, enter the difference. This is the OVERPAYMENT AMOUNT. ...........................                                         28                   00
29  Amount of overpayment on Line 28 to be CREDITED TO 2023 ESTIMATED INCOME TAX. ................................                                               29                   00
30  Virginia529 and ABLE Contributions from Schedule VAC, Section I,  Line 6 .......................................................                             30                   00
31  Other Voluntary Contributions from Schedule VAC, Section II, Line 14 ...............................................................                         31                   00
32  Addition to Tax, Penalty and Interest from enclosed Schedule 760PY ADJ, Line 21.                                                                             32                   00
    See instructions. .................................. Enclose 760C or 760F and check here. ...........................................
33  Sales and Use Tax is due on Internet, mail order, and out-of-state purchases (Consumer’s Use Tax).                                                           33
    See instructions. ..................................Check here if no sales and use tax is due.........................................                                            00
34  Add Lines 29 through 33. ................................................................................................................................... 34                   00
35  If you owe tax on Line 27, add Lines 27 and 34 - OR - If Line 28 is an overpayment and Line 34 is larger than 
    Line 28, enter the difference.  Enclose payment or pay at www.tax.virginia.gov.....                                   AMOUNT YOU OWE ..                      35
          Check here if paying by credit or debit card - See instructions. ............................................................                                               00
36  If Line 28 is larger than Line 34, subtract Line 34 from Line 28. ............................................ YOUR REFUND. .....                            36
                                                                                                                                                                                      00
    If the Direct Deposit section below is not completed, your refund will be issued by check.
DIRECT BANK DEPOSIT                    Your Bank Routing Transit Number  Your Bank Account Number                                         Checking                     Savings
Domestic Accounts Only.
No International Deposits.
  I (We) authorize the Department of Taxation to discuss this return with my (our) preparer.                                   I agree to obtain my Form 1099-G at www.tax.virginia.gov.
I (We), the undersigned, declare under penalty of law that I (we) have examined this return and to the best of my (our) knowledge, it is a true, correct 
and complete return.
Your Signature                                                           Your Phone Number                                                  Date

Spouse’s Signature (If a joint return, both must sign)                   Spouse’s Phone Number                                              Date

Preparer’s Name                                                          Preparer’s Phone Number                                            Date

Firm’s Name (or Yours if Self-Employed)                                  Preparer’s PTIN                                     Vendor Code    Filing Election Code       ID Theft PIN