Important: You are responsible for the accuracy and completeness of the information provided. Please review all entries carefully.
Did you live or work in two or more states during the year?
If married, were you married on the last day of the year?
Did you and your spouse live apart during the last 6 months of the year?
Dependents
If you are due a refund, how would you like to receive it?
If you have a balance due, how would you like to pay?
Check all that apply: