Computation of Recovery Exclusion For State Income Tax Deduction (Internal Revenue Code Section 111) • Keep for your records 2018 Name(s) Shown on Return Social Security Number 2017 State Income Tax Deduction and 2018 Recovery Amount 1 State income tax deduction from 2017 Schedule A, line 5 2 Is 2018 recovery amount (2017 state income tax refund amt.) known-) -Elves I—I No 3 If yes, enter 2017 state income tax refund received in 2018 (2018 recovery amount) If no, Part III is not completed. 2018 Recovery Exclusion 4 Recovery exclusion (amount deducted that did not reduce tax). From line column (i) of Pad IV.) You may exclude from your 2018 income any recovery of the 2017 state income tax deduction up to the amount on line 4. ileartifil 2017 Tax Benefit Amount (Applies only if 2018 recovery amount is known) 5 Tax benefit amount (amount of recovery that reduced tax). You must include in your 2018 income the amount on line 5 Recomputation of 2017 Tax Varying Deduction for State Income Tax (a) No. (b) Using State Income Tax Deduction Resulting Amounts Are (h) Tax Change Amount Tentative (c) State and Local Tax Deduction (d) Regular Tax (e) Alternative Minimum Tax plus Excess Adv Prem Tax Credit (f) Total Tax Before Credits (g) Total Tax After Credits flt Exclusion Amount (l) Tax Benefit Amount EFTA01222431