Last Name Last Name Your First Name Spouse First Name Present Home Address (Number and Street) City State Zip Code Your Taxpayer ID Form PIT-UND If you were a part-year resident in 2021, give the dates you resided in Delaware: 1. 4. 5. 2. 3. Filing Status (Must check one) mm-dd-yyyy mm-dd-yyyy Attached For Fiscal Year beginning Single, Divorced, Widow(er) Joint Married & Filing Combined Separate on this form Married & Filing Separate Forms Head of Household and ending Spouse Taxpayer ID Amended Return M.I. M.I. Suffix Suffix Apartment # FEDERAL AGI AMOUNT FROM FEDERAL FORM 1040 INTEREST RECEIVED ON U.S. OBLIGATIONS FIDUCIARY ADJUSTMENT, OIL DEPLETION DELAWARE STATE TAX REFUND, FIDUCIARY ADJUSTMENT, WORK OPPORTUNITY TAX CREDIT, DELAWARE NOL CARRYFORWARD, ETC. (See instructions) TOTAL - Add Lines 1 through 3 Add Lines 5 through 8 EXCLUSION FOR CERTAIN PERSONS 60 AND OVER OR DISABLED (See instructions) DELAWARE ADJUSTED GROSS INCOME. Subtract Line 11 from Line 10. Enter here. FOREIGN TAXES PAID (See instructions) SUBTOTAL - Add Line 13 through Line 15 NET ITEMIZED DEDUCTIONS - Subtract Line 17 from Line 16. Enter here and on Line 19 (See instructions) INTEREST ON STATE & LOCAL OBLIGATIONS OTHER THAN DELAWARE PENSION/RETIREMENT EXCLUSIONS (For a definition of eligible income, see instructions) TAXABLE SOCIAL SECURITY/RR RETIREMENT BENEFITS/HIGHER EDUCATION EXCLUSION/CERTAIN LUMP SUM DISTRIBUTIONS (See instructions) Subtract Line 9 from Line 4 TOTAL ITEMIZED DEDUCTIONS FROM DELAWARE SCHEDULE A (Must attach PIT-RSA) CHARITABLE MILEAGE DEDUCTION (See instructions) FORM PIT-CRS TAX CREDIT ADJUSTMENT (See instructions) Column A is for Spouse information, Filing status 4 only. All other filing status use Column B. SECTION A - ADDITIONS SECTION B - SUBTRACTIONS SECTION C - DEDUCTIONS If columns A and B are used and you are unable to specifically allocate deductions between spouses, you must prorate in accordance with income. COLUMN B COLUMN A 1. 6. 3. 8. 5. 10. 12. 15. 17. 19. 2. 7. 4. 9. 11. 13. 14. 16. 18. 1. 1. .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 6. 6. 3. 3. 8. 8. 5. 5. 10. 10. 12. 12. 2. 2. 7. 7. 4. 4. 9. 9. 11. 11. 13. 13. SECTION D - CALCULATIONS ADDITIONAL STANDARD DEDUCTIONS (Not Allowed with Itemized Deductions - see instructions) Multiply the number of boxes checked below by $2500. If you are filing a combined separate return (Filing status 4), enter the total for each appropriate column. All others enter total in Column B. Column A - if Spouse was: Column B - if You were: 65 or over 65 or over 20. 21. 22. 21. 21. 22. 22. TOTAL DEDUCTIONS - Add Line 19 and Line 20 and enter here. TAXABLE INCOME - Subtract Line 21 from Line 12, and compute tax on this amount 23. 24. 23. 23. 24. 24. 16. 16. 18. 18. 20. 20. 15. 15. 14. 14. 17. 17. 19. 19. If you elect the DELAWARE STANDARD DEDUCTION check here Filing Statuses 1, 3, & 5 enter $3250 in Column B; Filing Status 2 enter $6500 in Column B; Filing Status 4 enter $3250 in Column A and in Column B Filing Statuses 1, 2, 3, and 5, enter itemized deductions from Line 18 in Column B; Filing Status 4 enter itemized deductions from Line 18 in Columns A and B b. a. If you elect DELAWARE ITEMIZED DEDUCTIONS check here TAX LIABILITY FROM TAX RATE TABLE/SCHEDULE (See instructions) TAX ON LUMP SUM DISTRIBUTION (Form PIT-STC) blind blind Must include page 3 D E L A W A R E D I V I S I O N O F R E V E N U E F O R M Page 1 DELAWARE INDIVIDUAL RESIDENT INCOME TAX RETURN

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SAVINGS CHECKING DMV STATE ID # ROUTING NUMBER ACCOUNT TYPE ACCOUNT NUMBER SECTION E - DIRECT DEPOSIT INFORMATION If you would like your refund deposited directly to your checking or savings account, complete Section E below. See instructions for details. COLUMN B COLUMN A Enter number of exemptions Enter number of boxes checked on Line 26b TAX IMPOSED BY OTHER STATES PERSONAL CREDITS CHECK BOXES VOLUNTEER FIREFIGHTER CO. # Self (Column B) Spouse (Column A) OTHER NON-REFUNDABLE CREDITS (See instructions) CHILD CARE CREDIT. Must attach Form 2441. (Enter 50% of Federal credit) EARNED INCOME TAX CREDIT. REFUNDABLE NON-REFUNDABLE (See instructions) TOTAL NON-REFUNDABLE CREDITS (See instructions) BALANCE - Subtract Line 31 from Line 25. If Line 31 is greater than Line 25, enter 0. DELAWARE TAX WITHHELD (Attach W2s/1099s) ESTIMATED TAX PAID & PAYMENTS WITH EXTENSIONS S CORP PAYMENTS REFUNDABLE BUSINESS CREDITS CAPITAL GAINS TAX PAYMENTS (Attach form REW-EST) TOTAL REFUNDABLE CREDITS If this is an amended return, enter Line 39 then proceed to Line 47 on page 3 (See instructions) BALANCE DUE If Line 33 plus Line 39 is less than or equal to Line 32, Subtract the sum of Line 33 and Line 39 from Line 32. OVERPAYMENT If Line 33 plus Line 39 is greater than Line 32, Subtract Line 32 from the sum of Line 33 and Line 39. CONTRIBUTIONS TO SPECIAL FUNDS. If electing a contribution, complete and attach PIT-RSS. AMOUNT OF LINE 41 TO BE APPLIED TO 2022 ESTIMATED TAX ACCOUNT PENALTIES AND INTEREST DUE. If Line 40 is greater than $800, see estimated tax instructions NET BALANCE DUE. For Filing Status 4, see instructions. For all other filing statuses Add Line 40, Line 42, and Line 44. NET REFUND. For Filing Status 4, see instructions. For all other filing statuses, Subtract Line 42, Line 43, and Line 44 from Line 41. (Must attach copy of PIT-RSS and other state return.) On Line 26a, enter the number of exemptions for: Column A Column B x $110 TOTAL TAX - Add Line 23 and Line 24 Spouse 60 or over (Column A) Self 60 or over (Column B) 25. 25. 25. 26a. 26a. 26a. 26b. 26b. 26b. 27. 27. 27. 28. 28. 28. 29. 29. 29. 30. 30. 30. 31. 31. 31. 32. 32. 32. 33. 33. 33. 34. 34. 34. 35. 35. 35. 36. 36. 36. 37. 37. 37. 38. 38. 38. 39. 39. 39. 40. 40. 40. 41. 41. 41. 43. 43. 44. 44. 42. 42. 45. 45. 46. 46. Column A is for Spouse information, Filing status 4 only. All other filing status use Column B. If you are Filing Status 3, see instructions. If you use Filing Status 4, enter the total for each appropriate column. All others enter total in Column B. Enter credit amount x $110 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 Is this refund going to or through an account that is located outside of the United States? YES NO YOUR SIGNATURE PAID PREPARER SIGNATURE ADDRESS CITY EIN, SSN or PTIN PHONE NUMBER EMAIL ADDRESS STATE ZIP CODE DATE DATE EMAIL ADDRESS HOME PHONE NUMBER SPOUSE SIGNATURE DATE BUSINESS PHONE NUMBER Delaware Division of Revenue PO Box 508, Wilmington, DE 19899-0508 BALANCE DUE WITH PAYMENT ENCLOSED (LINE 45) MAIL COMPLETED FORM TO: Delaware Division of Revenue PO Box 8710 Wilmington, DE 19899-8710 REFUND (LINE 46) MAIL COMPLETED FORM TO: Delaware Division of Revenue PO Box 8711 Wilmington, DE 19899-8711 ALL OTHER RETURNS MAIL COMPLETED FORM TO: BE SURE TO SIGN YOUR RETURN BELOW AND KEEP A COPY FOR YOUR RECORDS PAID PREPARER INFORMATION PLEASE REMEMBER TO ATTACH W-2, 1099-R AND APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN Make check payable to: Delaware Division of Revenue D E L A W A R E D I V I S I O N O F R E V E N U E F O R M Page 2 DELAWARE INDIVIDUAL RESIDENT INCOME TAX RETURN

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COLUMN B COLUMN A Estimated tax carryover and/or Special Funds contributions as shown on original return Subtract Line 50 and Line 51 from Line 49. BALANCE DUE. If Line 32 is greater than Line 52, Subtract 52 from 32. OVERPAYMENT. If Line 52 is greater than Line 32, Subtract 32 from 52. AMOUNT OF LINE 54 TO BE APPLIED TO YOUR ESTIMATED TAX ACCOUNT (See instructions) PENALTIES AND INTEREST DUE NET BALANCE DUE For Filing Status 4, see instructions. For all other filing statuses Add Line 53, Line 55, and Line 56. NET REFUND For Filing Status 4, see instructions. For all other filing statuses, Subtract Line 55 and Line 56 from Line 54. Is an amended Federal return being filed? Has the Delaware Division of Revenue advised you your original return is being audited? Is this amended return being filed as a protective claim? If no, please explain. If the changes pertain to the DE return only, list the line numbers being amended. A detailed explanation of all changes must be provided in this space. All supporting schedules and/or documentation must be attatched. Yes Yes Yes No No No TOTAL REFUNDABLE CREDITS - Add Line 39 and any EITC on Line 33. AMOUNT PAID ON ORIGINAL RETURN SUBTOTAL. Add Lines 47 and 48. REFUND RECEIVED (If any, see instructions) 50. 50. 50. 51. 51. 51. 52. 52. 53. 54. 52. 53. 53. 54. 54. 55. 55. 59. 60. 61. 48. 48. 47. 47. 47. 48. 56. 57. 58. 56. 57. 58. 49. 49. 49. FOR AMENDED RETURNS ONLY .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 Delaware Division of Revenue PO Box 508, Wilmington, DE 19899-0508 NET BALANCE DUE WITH PAYMENT ENCLOSED (LINE 57) MAIL COMPLETED FORM TO: Delaware Division of Revenue PO Box 8710 Wilmington, DE 19899-8710 NET REFUND (LINE 58) MAIL COMPLETED FORM TO: Delaware Division of Revenue PO Box 8711 Wilmington, DE 19899-8711 ALL OTHER RETURNS MAIL COMPLETED FORM TO: PLEASE REMEMBER TO ATTACH W-2, 1099-R AND APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN Make check payable to: Delaware Division of Revenue D E L A W A R E D I V I S I O N O F R E V E N U E F O R M Page 3 DELAWARE INDIVIDUAL RESIDENT INCOME TAX RETURN

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