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F                          IDAHO SUPPLEMENTAL SCHEDULE  
O
 EFO0008739NR                                                                                                                                              2009
R09-21-09                 For Form 43, Nonresident and Part-Year Resident Returns Only 
M

Name(s) as shown on return                                                                                                        Social Security Number

                                                                                                                                   Column A - Total       Column B - Idaho
A.  Additions.  See instructions, page 26.
  1.   Non-Idaho state and local bond interest and dividends    ......................................                        1   00. . . .                               00
  2.  Idaho college savings account withdrawal    ..........................................................                  2   00                                      00
  3.   Other additions.  Attach explanation   ...................................................................             3   00                                      00
  4.   Total additions.  Add lines 1 through 3.  Enter on line 31, Form 43   ....................                             4   00                                      00
B.  Subtractions. See instructions, page 26.
   1.  Idaho net operating loss carryover                           . . 
       Idaho net operating loss carryback                               Enter total here    ................                  1   00                                      00
   2.  State income tax refund included in line 30, Column A, Form 43  .......................                                2   00                                       
   3.  Interest from U.S. Government obligations   ........................................................                   3   00. .                                   00
   4.  Child/dependent care.  Attach federal Form 2441   ...............................................                      4   00                                      00
   5.  Social security and railroad beneits included in line 30, Column A, Form 43    ....                                    5   00                                       
   6.  Idaho capital gains deduction.  Attach Form CG   ................................................                      6   00. .                                   00
   7.  Idaho resident - Active duty military pay earned outside of Idaho   ......................                        .    7   00                                      00
   8.  Idaho medical savings account - contributions and interest
       Financial institution _______________   Account number ________________                                                8   00. . . . . . . . . . . .               00
   9.  Idaho college savings program   ..........................................................................             9   00                                      00
 10.  Adoption expenses    .............................................................................................      10  00                                      00
 11.  Maintaining a home for the aged and/or developmentally disabled   ...................                                   11  00                                      00
 12.  Idaho lottery winnings, less than $600 per prize   ................................................                     12  00                                      00
 13.  Income earned on a reservation by an  American Indian   ...................................                             13                                          00
 14.  Worker's compensation insurance  ......................................................................                 14  00                                      00
 15.  Partner's and shareholder's pass-through subtractions   .....................................                           15  00                                      00
 16.  Insulation of Idaho residence   .............................................................................           16  00                                      00
 17.  Technological equipment donation   .....................................................................                17  00                                      00
 18.  Health insurance premiums  ................................................................................             18  00                                      00
 19.  Long-term care insurance   ..................................................................................           19  00                                      00
 20.  Alternative energy device deduction                                                                                         00
              Year                                                                                                                00
            Acquired         Type of Device            Total Cost                    Percent
       a.  2009                                      $                              X  40%  =                                 20a 00                                      00
       b.  2008                                      $                              X  20%  =                                 20b 00                                      00
       c.  2007                                      $                              X  20%  =                                 20c 00                                      00
       d.  2006                                      $                              X20%    =                                 20d 00                                      00
       e.  Add lines 20a through 20d    .............................................................................         20e 00                                      00
                                                                                                                                    .
 21.  Add lines 1 through 19 and 20e   .........................................................................              21  00                                      00
 22.  Retirement beneits deduction                                                                                                                                        00
       a. If single enter $27,876, if married iling jointly enter $41,814    .........................
                                                                                                                         . . .22a 00   See instructions, 
       b. Federal Railroad Retirement received   ...........................................................                  22b 00   page 30, for 
       c. Social Security beneits received   ...................................................................              22c 00   qualiied retirement 
       d. Balance. Line 22a minus lines 22b and 22c. If less than zero, enter zero    .....                                   22d 00   beneits to be 
                                                                                                                                       included on lines 
       e. Qualiied retirement beneits included in federal gross income   .....................                           .    22e 00   22e and 22g.
        f. Column A beneits. Smaller of line 22d or line 22e   ........................................                       22f 00
       g. Qualiied retirement beneits included in Idaho gross income   .......................                                22g   .                                     00
       h. Divide line 22g by line 22e   .............................................................................         22h                          %
        i.  Column B beneits deduction. Multiply line 22f by line 22h   ...........................                      
                                                                                                                              22i   .                                     00
  23.  Nonresident military pay included in line 30, Column A, Form 43   ......................                          .    23                                           
                                                                                                                                  00
 24.  Bonus depreciation.  Attach computations   .........................................................                    24  00. .                                   00
 25.  Other subtractions.  Attach explanation  ..............................................................
                                                                                                                              25  00                                      00
 26.  Total subtractions.  Column A, add lines 21, 22f, 23, 24, and 25.
        Column B, add lines 21, 22i, 24, and 25.  Enter on line 32, Form 43    .................                              26  00.                                     00

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Form 39NR - 2009
EFO00087p2
09-21-09 Page 2
Name(s) as shown on return Social Security Number

C. Credit for Income Tax Paid to Other States by Part-Year Residents. See instructions, page 31.
Nonresidents cannot claim this credit. Idaho residents on active military duty, complete Part D below.
This credit is being claimed for taxes paid to: .__________________________________ (State name)
1. Idaho adjusted income from line 33, Column B, Form 43 ........................ 1 00
Attach a copy of the
2. Other state's adjusted income .................................................................. 2 00 income tax return and
3. Amount of income taxed by Idaho, and also taxed by another state ....... 3 00 a separate Form 39NR
for each state for which
4. Idaho tax, line 44, Form 43 ....................................................................... 4 00 a credit is claimed.
5. Divide line 3 by line 1. Enter percentage here ......................................... 5 %
6. Multiply line 4 by line 5 .................................................................................................................... 6 00
7. Other state's tax due less its income tax credits ...................................... 7 00
8. Divide line 3 by line 2. Enter percentage here .......................................... 8 %
9. Multiply line 7 by line 8 ................................................................................................................... 9 00
10. Enter the smaller of line 6 or 9 here and on line 45, Form 43 ........................................................  10 00

D. Credit for Income Tax Paid to Other States by Idaho Residents on Active Military Duty.
See instructions, page 32.
This credit is being claimed for taxes paid to: .__________________________________ (State name)
1. Idaho tax, line 44, Form 43 ....................................................................... 1 00 Attach a copy of the
2. Other state's adjusted income .................................................................. 2 income tax return and
00 a separate Form 39NR
3. Idaho adjusted income from line 33, Column B, Form 43 ........................ 3 00 for each state for which
4. Divide line 2 by line 3. Enter percentage here .......................................... 4 % a credit is claimed.
5. Multiply line 1 by line 4. Enter amount here ................................................................................... 5 00

6. Other state's tax due less its income tax credits ............................................................................ 6 00

7. Enter the smaller of line 5 or 6 here and on line 45, Form 43 ........................................................ 7 00
E. Maintaining a Home for a Family Member Age 65 or Older, or a Family Member With a
Developmental Disability. See instructions, page 32.
1. Did you maintain a home for an immediate family member age 65 or older and provide more than
Yes No
one-half of his/her support? You and your spouse do not qualify .................................................
2. Did you maintain a home for an immediate family member with a developmental disability and
Yes No
provide more than one-half of his/her support? You and your spouse may qualify .......................
3. List each family member you are claiming:
Check here if
Name of Family Member Social Security Number Relationship to Person Date of Birth ofdevelopmen-
First Name Last Name of Family Member Filing Return Family Member tally disabled

4. Total amount claimed ($100 for each qualifying member but not more than $300).
Enter on line 65, Form 43. (Credit cannot be claimed if you took $1,000 deduction on
Part B, line 11.) ................................................................................................................4 00
F. Dependents: (Continued from Form 43, page 1)
First Name Last Name Social Security Number

G. Standard Deduction. See page 32 of the instructions.
1. Real estate taxes from federal Schedule L, line 9 ........................................................................... 1 00
2. Disaster loss from federal Schedule L, line 6 .................................................................................. 2 00
3. Qualiied motor vehicle tax deduction from federal Schedule L, line 20 .......................................... 3 00
4. Total of lines 1 through 3 ................................................................................................................. 4 00

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