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EFTA01220935

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Form 8689 Department or the Treasury Internal Revenue Service Name(s) shown on Form 1040 Allocation of Individual Income Tax to the U.S. Virgin Islands ► Attach to Form 1040. Ir. Information about Form 8689 and Its Instructions Is at www.irs.gov/form8689. OMB No. 1545-0074 2014 Attachment Sequence No. 85 Your social security number Part I 1 Wages, salaries, tips, etc. 1 2 Taxable interest 2 3 Ordinary dividends 3 4 Taxable refunds, credits, or offsets of local USVI income taxes 4 5 Alimony received 5 6 Business income or (loss) 6 7 Capital gain or (loss) 7 8 Other gains or (losses) 8 9 IRA distributions (taxable amount) 9 10 Pensions and annuities (taxable amount) 10 11 Rental real estate, royalties, partnerships, S corporations, trusts, etc 11 12 Farm income or (loss) 12 13 Unemployment compensation 13 14 Social security benefits (taxable amount) 14 15 Other income. List type and amount la. 15 16 Add lines 1 through 15. This is your total USVI income ► 16 Income From the U.S. Virgin Islands (USW) Adjusted Gross Income From the USVI 17 Educator expenses 17 18 Certain business expenses of reservists, performing artists, and fee-basis government officials 18 19 Health savings account deduction 19 20 Moving expenses 20 21 Deductible part of self-employment tax 21 22 Self-employed SEP, SIMPLE, and qualified plans 22 23 Self-employed health insurance deduction 23 24 Penalty on early withdrawal of savings 24 25 IRA deduction 25 26 Student loan interest deduction 26 27 Tuition and fees deduction 27 28 Add lines 17 through 27 28 I 29 Subtract line 28 from line 16. This is your USVI adjusted gross income P. 29 Lial111_ Allocation of Tax to the USVI 30 Enter amount from Form 1040, line 63 31 Enter the total of the amounts from Form 1040, lines 57, 58, 60a, 66a, 67, 68, and 73 (box d). Include any uncollected social security and Me

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