Virginia Form 760PY Part-Year Resident Income Tax Return

Your First Name

MI

Your Last Name

Check if deceased

Suffix

A Your Social Security Number

Spouse’s First Name

MI

Spouse’s Last Name

Check if deceased

Suffix

B Spouse’s Social Security Number

Present Home Address (Number and Street, or Rural Route)

City, Town or Post Office

State

ZIP Code

Locality Code

14 Prorated exemption amount

15 Deductions from Schedule 760PY ADJ

16 Add Lines 13, 14 and 15

17 Virginia Taxable Income

18 Tax amount

19 Total Tax

20a Your Virginia income tax withheld

20b Spouse’s Virginia income tax withheld

21 Combined estimated tax payments

22 2015 overpayment credited

23 Extension payment

24 Tax credit / EIC

25 Credit for taxes paid to another state

26 Credit for Political Contributions

27 Credits from Schedule CR

28 Total payments and credits

29 Income tax you owe

30 Overpayment amount

31 Credit to 2017 estimated tax

32 Virginia College Savings Plan Contributions

33 Other Voluntary Contributions

34 Addition to Tax, Penalty and Interest

35 Consumer’s Use Tax

36 Add Lines 31 through 35

37 Amount you owe

38 Your refund

Your Name

Your SSN

Bank Routing Transit Number

Bank Account Number

Checking

Savings

Your Signature

Your Phone Number

Date

Spouse’s Signature

Spouse’s Phone Number

Date

Preparer’s Name

Preparer’s Phone Number

Date

Firm’s Name

Preparer’s PTIN

Vendor Code

Filing Election Code

Office Use Only