Form 39R Resident Supplemental Schedule 2021 Names as shown on return Social Security number A. Additions. See instructions, page 27. 1 00 1. Federal net operating loss deduction included on Form 40, line 7 .......................................... ▪ 2. Capital loss carryover incurred outside the state before becoming an Idaho resident ............ ▪ 2 00 3. Non-Idaho state and local bond interest and dividends ........................................................... ▪ 3 00 4. Idaho college savings account withdrawal .............................................................................. ▪ 4 00 5. Bonus depreciation. Include federal Form 4562s Check the box if you have a current year federal passive loss limitation ▪ ................... ▪ 5 00 6. Other additions. Include explanation ....................................................................................... ▪ 6 00 7. Total additions. Add lines 1 through 6. Enter here and on Form 40, line 8 .............................. ▪ 7 00 B. Subtractions. See instructions, page 29. 1 00 1. Idaho net operating loss carryover ▪ Idaho net operating loss carryback ▪ Enter total here .............................. 2. State income tax refund, if included in federal income ............................................................ ▪ 2 00 3. Interest from U.S. government obligations .............................................................................. ▪ 3 00 4. Energy efficiency upgrades ..................................................................................................... ▪ 4 00 5. Alternative energy device deduction Year Acquired Type of Device Total Cost Percentage a. 2021 $ X 40% = 5a ▪ 00 b. 2020 $ X 20% = 5b ▪ 00 c. 2019 $ X 20% = 5c ▪ 00 d. 2018 $ X 20% = 5d ▪ 00 e. Add lines 5a through 5d. Can’t exceed $5,000 ................................................................ ▪ 5e 00 6. Child/dependent care. Complete worksheet on page 30, and include federal Form 2441 ..... ▪ 6 00 7. Social Security and railroad benefits, if included in federal income ........................................ ▪ 7 00 8. Retirement benefits deduction a. If single, enter $37,776 or if married filing jointly, enter $56,664 ▪ 8a 00 b. Federal Railroad Retirement benefits received ........................... ▪ 8b 00 c. Social Security benefits received ................................................ ▪ 8c 00 d. Line 8a minus lines 8b and 8c. If less than zero, enter zero ....... 8d 00 e. Qualified retirement benefits included in federal income ............. ▪ 8e 00 f. Enter the smaller of line 8d or 8e here ............................................................................. ▪ 8f 00 9. Technological equipment donation .......................................................................................... ▪ 9 00 10. Idaho capital gains deduction. Include Form CG .................................................................... ▪ 10 00 11. Active duty military pay earned outside of Idaho ..................................................................... ▪ 11 00 12. Adoption expenses .................................................................................................................. ▪ 12 00 13. Idaho medical savings account. Contributions Interest ▪ 13 00 Financial institution Account number 14. Idaho college savings program ............................................................................................... ▪ 14 00 15. Home for the aged or developmentally disabled. Complete Part E, line 3 ............................. ▪ 15 00 16. Idaho lottery winnings, less than $600 per prize ..................................................................... ▪ 16 00 17. Income earned on a reservation by an American Indian ......................................................... ▪ 17 00 EFO00088 09-23-2021 Page 1 of 2

EFO00088 09-23-2021 Page 2 of 2 18. Health insurance premiums ..................................................................................................... ▪ 18 00 19. Long-term care insurance ....................................................................................................... ▪ 19 00 20. Workers’ compensation insurance .......................................................................................... ▪ 20 00 21. Bonus depreciation. Include Form 4562s ................................................................................ ▪ 21 00 22. First-time home buyer savings account. Contributions Interest  22‌ 00  Financial institution Account number ▪ ▪ By checking the box, I attest that I am a first-time home buyer. See instructions. 23. Other subtractions. Include explanation .................................................................................. ▪ 23 00 24. Total subtractions. Add lines 1 through 4, 5e through 7, and 8f through 23. Enter here and on Form 40, line 10 ........................................................................................ ▪ 24 00 Names as shown on return Social Security number C. Credit for income tax paid to other states. See instructions, page 36. This credit is being claimed for taxes paid to: ▪ (State name) 1. Idaho tax, Form 40, line 20 ................................................................ 1 00 Include a copy of the income tax return and a separate Form 39R for each state for which a credit is claimed. 2. Federal adjusted gross income earned in other state adjusted for Idaho modifications. See instructions ................................................ ▪ 2 00 3. Idaho adjusted income. See instructions ........................................... 3 00 4. Divide line 2 by line 3. Enter percentage here ................................... 4 % 5. Multiply line 1 by line 4. Enter amount here ............................................................................. 5 00 6. Other state’s tax due minus its income tax credits .................................................................. ▪ 6 00 7. Enter the smaller of lines 5 or 6 here and on Form 40, line 22 ................................................ ▪ 7 00 D. Credits for Idaho educational entity and Idaho youth and rehabilitation facility contributions, and live organ donation expenses. See instructions, page 37. 1. Credit for Idaho educational entity contributions ..................................................................... ▪ 1 00 2. Credit for Idaho youth and rehabilitation facility contributions ................................................. ▪ 2 00 3. Credit for live organ donation expenses .................................................................................. ▪ 3 00 4. Total credits. Add lines 1 through 3. Enter total here and on Form 40, line 23 ........................ 4 00 E. Maintaining a home for a family member age 65 or older or a family member with a developmental disability. See instructions, page 39. 1. Did you maintain a home for an immediate family member age 65 or older (not including you and your spouse) and provide more than one-half of that person’s support? ................... Yes No 2. Did you maintain a home for an immediate family member with a developmental disability (including you and your spouse) and provide more than one-half of that person’s support? .... Yes No 3. List each family member you’re claiming: Family Member’s Name Family Member’s Social Security Number Relationship to Person Filing Return Family Member’s Birthdate (mm/dd/yyyy) Check Here if Developmentally Disabled First Name Last Name 4. Total amount claimed ($100 for each qualifying member but not more than $300). Enter here and on Form 40, line 44 ......................................................................................... 4 00 F. Dependents: (Continued from Form 40, page 1, line 6) First Name Last Name Social Security Number Birthdate (mm/dd/yyyy) Form 39R 2021 (continued)