State INT/DIV exemption worksheet

Taxpayer Information:

Taxpayer's Name: Tax Year:
Income source (broker name):

Indicate which forms are provided by this broker statement that need your attention: 1099-DIV, 1099-INT, 1099-OID
Instructions:

Broker statements often have 1099-DIV, 1099-INT and 1099-OID statements included in a consolidated report, with the detailed source of each respective income. Determing any portion of each source that could be excluded from income and, in the case of tax-exempt income, that which could be taxable, can be a daunting process. It may also take considerable research for very little gain. Fortunately, it is becoming more common to have a table near the end of the consoldated statement that shows the percentage of each fund that can be attributed to government obligations, government possessions, and individual states. Some are actually doing the math.

This tool can help with the process and provide a record to the taxpayer to show how the exclusions or additional taxable income is derived. Create and print a separate sheet for each broker statement on which entries need to be made.

Note that some broker statements will distinguish between direct and indirect government obligations. Generally, direct obligations are excludable but indirect obligations are dependent on state tax laws. If your state law allows the latter, add the two percentages for the government obligations column. (Colorado does not.)

Government possessions often include: Puerto Rico, Guam, and US Virgin Islands.

Note on Tax Exempt US Government Obligation or Possession Income:
This information is found only in the broker statement supplemental information.
Currently there is no known tax exempt income from these sources so be sure before listing them as tax exempt.

Data entry:
  1. If there are savings bonds or tax-exempt amounts on the broker form, enter those first in the boxes above the table.
  2. Enter the name of each fund or it's CUSIP number or exchange symbol in a separate line. The table will expand to always have a blank line.
  3. If a fund is part of the Tax exempt interest amount, check the "Tax exempt" box so that it is associated with that amount. Typically, the fund amount is from bonds, and those from your state of residence will be tax exempt.
  4. For the Federal and State data entries, precede the amount by a "$" if using an actual amount or (optionally) follow the amount with a "%" if using percent. Fund earnings will always use dollar amounts but the entry is only needed if using "%" in that line. Only enter state source data for your state of residence.
  5. Print a copy for the taxpayer.
  6. Enter the results into TaxSlayer® as indicated.
1099-DIV Income: Exempt interest dividends (box 12):
Fund name and/or symbol Tax exempt US obligations
(see instruction note)		 US possesions
(see instruction note)		 State source Fund earnings State exempt State tax exempt Index

TaxSlayer entries
TaxSlayer lineamount
State Exempt Dividends 0
Taxable state dividends 0
0 0
1099-INT Income: Savings bond interest (box 3): Tax exempt interest (box 8):
Fund name and/or symbol Tax exempt US obligations
(see instruction note)		 US possesions
(see instruction note)		 State source Fund earnings State exempt State tax exempt Index

TaxSlayer entries
TaxSlayer lineamount
State Exempt Interest 0
Taxable state interest 0
0 0
1099-OID Income: OID on treasury obligations (box 8): Tax exempt OID (box 11):
Fund name and/or symbol Tax exempt US obligations
(see instruction note)		 US possesions
(see instruction note)		 State source Fund earnings State exempt State tax exempt Index

TaxSlayer entries
TaxSlayer lineamount
State Exempt OID 0
Taxable state OID 0
0 0
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