Income Tax Supplemental Schedule TC-40A Pg. 1
40104 SSN Last name 2021
USTC ORIGINAL FORM
Part 1 - Additions to Income (enter the code and amount of each addition to income) Code Amount
See instructions or incometax.utah.gov for codes. • .00
• .00
• .00
• .00
• .00
Total (add.00 all additions to income and enter total here and on TC-40, line 5) additions incometo
Part 2 - Subtractions from Income (enter the code and amount of each subtraction from income) Code Amount
See instructions or incometax.utah.gov for codes. • .00
If using subtraction 77 (Native American Income), enter your enrollment • .00
number and tribal code: Tribe
Enrollment Number Code • .00
You •
Spouse • • .00
• .00
Total subtractions from income (add all subtractions from income and enter total here and on TC-40, line 8) .00
Part 3 - Apportionable Nonrefundable Credits (enter the code and amount of each credit) Code Amount
See instructions or incometax.utah.gov for codes. • .00
• .00
If you are using credit 18 (Retirement Credit), enter your birth date(s):
You • / / Spouse • / / • .00
mm/dd/yy mm/dd/yy
• .00
• .00
Total apportionable nonrefundable credits (add all Part 3 credits and enter total here and on TC-40, line 24) .00
Part 4 - Nonapportionable Nonrefundable Credits (enter the code and amount of each credit) Code Amount
See instructions or incometax.utah.gov for codes. • .00
• .00
If • .00 you are using credit 02 (Qualified Sheltered Workshop),
enter the sheltered workshop’s name:
• .00
• .00
Total nonapportionable nonrefundable credits (add all Part 4 credits and enter total here and on TC-40, line 26) .00
Submit page ONLY if data entered.
Attach completed schedule to your Utah Income Tax Return.