2021 Virginia Schedule A Itemized Deductions Name(s) as shown on Virginia Return Filing Status Claimed on Federal Return Enter in box to the right: 1=Single 2=Joint 3=Married Filing Separately 4=Head of household (HOH) 5=Qualifying widow(er) (QW) Medical and Dental Expenses Caution: Do not include expenses reimbursed or paid by others. 1 Medical and dental expenses...................................................................................1 2 Enter adjusted gross income from federal return. If negative enter 0.................................2 3 Multiply Line 2 by 10% (0.10)...................................................................................3 4 Subtract Line 3 from Line 1. If Line 3 is more than Line 1, enter -0-..................................4 Taxes You Paid 5 a State and local income taxes or general sales taxes. If you are claiming a deduction for general sales taxes instead of income taxes, fill in this oval........................................... 5a b State and local real estate taxes...............................................................................5b c State and local personal property taxes......................................................................5c 6 Other deductible taxes. List type and amount.

Foreign income taxes 6 7 Add Lines 5a, 5b, 5c and 6......................................................................................7 Interest You Paid Caution: Your mortgage interest deduction may be limited. 8 Home mortgage interest and points. If you didn’t use all of your home mortgage loan(s) to buy, build, or improve your home fill in this oval...................................................... Home mortgage interest and points reported to you on federal Form 1098.........................8a a b Home mortgage interest not reported to you on federal Form 1098. If paid to the person from whom you bought the home, show that person’s name, identifying no., and address. ▶ 8b c Points not reported to you on federal Form 1098..........................................................8c d Mortgage insurance premiums.................................................................................8d e Add Lines 8a through 8d.........................................................................................8e 9 Investment interest. ...............................................................................................9 10 Add Lines 8e and 9................................................................................................10 Gifts to Charity Caution: Report the limited amount as defined under federal law. 11 Gifts by cash or check............................................................................................11 12 Other than by cash or check....................................................................................12 13 Carryover from prior year.........................................................................................13 14 Add Lines 11 through 13.........................................................................................14 Casualty and Theft Losses 15 Casualty and theft loss(es) from a federally declared disaster (other than net qualified disaster losses). Enter the amount from Line 18 of federal Form 4684.........................................15 Other Itemized Deductions 16 a Gambling Losses..................................................................................................16a b Other. List type and amount. ▶

16b c Add Lines 16a and 16b...........................................................................................16c Total Itemized Deductions 17 Add Lines 4, 7, 10, 14, 15 and 16c. Enter here. If Line 1 on Forms 760, 760PY, or 763 is over $334,150 if filing jointly or qualifying widow(er), $306,300 if head of household, $278,450 if single, or $167,075 if married filing a separate return, complete the itemized deduction worksheet first. Itemized deductions may be limited. If so, enter amount from Line 12a or 12b of the limited itemized deduction worksheet.............................................................................. 17 18 If your total on Line 17 was limited, enter the amount from Part B, Line 15 of the limited itemized deduction worksheet here. Otherwise, enter the state and local income tax from Line 5a and any foreign income tax from Line 6 above. See instructions......................................... 18 19 Virginia Itemized Deductions: Subtract Line 18 from Line 17 and enter the result here and on Form 760 Line 10, Form 760PY Line 11, or Form 763 Line 10. If negative enter 0................... 19 . 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 , , VA Dept. of Taxation 2601053 VA Sch A Rev. 09/21 *VASCHA121888* Your Social Security Number - - See instructions before completing Schedule A

FDC Worksheet - Fixed Date Conformity Modifications to Itemized Deductions Complete the FDC Worksheet before completing Virginia Schedule A. Enter the information requested on each line. On the Virginia Schedule A, Medical and Dental Expenses (Line 4), Gifts to Charity (Line 14), and Casualty and Theft Loss (Line 15) may require modification due to fixed date conformity adjustments. These amounts should be recomputed by substituting the amount on Line 5 of this worksheet for the FAGI that you used to compute your federal limitations. Also use the amount on Line 5 of this worksheet instead of Line 1 from Forms 760, 760PY, and 763 when computing Virginia Schedule A, Line 17. 1. Federal Adjusted Gross Income (FAGI) from federal return........................................................................................... 1 .00 2. Fixed date conformity additions to FAGI ....................................................................................................................... 2 .00 3. Subtotal. Add Lines 1 and 2........................................................................................................................................... 3 .00 4. Fixed date conformity subtractions from FAGI .............................................................................................................. 4 .00 5. Fixed date conformity FAGI. Subtract Line 4 from Line 3.............................................................................................. 5 .00 LIMITED ITEMIZED DEDUCTION WORKSHEET Part A – Compute Your Itemized Deduction Limitation Complete this worksheet after completing Lines 1-16 of the Virginia Schedule A. All taxpayers must complete Lines 1-11 of this worksheet as though they were residents of Virginia for the entire taxable year. If your filing status is different for federal and Virginia purposes, see instructions. 1. Enter the total amount from Virginia Schedule A, Lines 4, 5a (not to exceed $10,000 or $5,000 if married filing separately), 5b, 5c, 6, 10, 14, 15, and 16c .................................................................................................................................. 1. .00 2. Enter the total amount from Virginia Schedule A, Lines 4, 9, and 15, plus any gambling losses included on Line 16a. 2. .00 3. Subtract Line 2 from Line 1. If the result is zero or less, the limitation does not apply. Stop here and follow the instructions for Line 17 of Virginia Schedule A. .......................................................................................................................... 3. .00 4. Multiply Line 3 above by 80% (0.80).............................................................................................................................................. 4. .00 5. Enter the total from Line 1 of Form 760, Form 760PY, or Line 763 (or amount from Line 5 of FDC Worksheet)............ 5. .00 6. Enter $334,150 if filing jointly or qualifying widow(er), $306,300 if head of household, $278,450 if single, or $167,075 if married filing a separate return.................................................................................................................................................... 6. .00 7. Subtract Line 6 from Line 5. If the result is zero or less, stop here, the limitation does not apply. Stop here and follow the instructions for Line 17 of Virginia Schedule A...................................................................................................................... 7. .00 8. Multiply Line 7 above by 3% (0.03)................................................................................................................................................ 8. .00 9. Enter the smaller of Line 4 or Line 8.............................................................................................................................................. 9. .00 10. Enter the amount from Line 3 above............................................................................................................................................. 10. .00 11. Divide Line 9 by Line 10. Enter the result to 3 decimal places................................................................................................. 11. 12. Limited Itemized Deduction Total 12a. Resident (Form 760) and Nonresident (Form 763) filers Subtract Line 9 from Line 1 and enter here and on Virginia Schedule A , Line 17. Continue to Part B of the worksheet............................................................................................................................................................................. 12a. .00 12b. Part-Year Resident (Form 760PY) filers Enter only the itemized deductions paid while a Virginia resident on Virginia Schedule A. Use the steps below to compute the amount to enter on Line 17 of Virginia Schedule A if you are subject to the itemized deduction limitation. 1) Enter the total amount from Virginia Schedule A Lines 4, 5a (not to exceed $10,000 or $5,000 if married filing separately on the Virginia return), 5b, 5c, 6, 10, 14, 15, and 16c. 1 .00 2) Multiply the total amount from Virginia Schedule A, Lines 5a (not to exceed $10,000 or $5,000 if married filing separately on the Virginia return), 5b, 5c, 6, 8e, 14, and 16c (minus any gambling losses reported on Line 16a) by Line 11................................................................................................................................... 2 .00 3) Subtract Line 2 from Line 1. Enter here and on Virginia Schedule A, Line 17................................................... 12b. .00 Part B – Compute Your State and Local Income Tax Modification 13. Enter state and local income tax from Virginia Schedule A, Line 5a (not to exceed $10,000 or $5,000 if married filing separately on the Virginia return). Part year residents enter only the amount paid while a resident. For foreign income tax, see instructions.......................................................................................................................................................................... 13. .00 14. Multiply Line 13 by Line 11.............................................................................................................................................................. 14. .00 15. Subtract Line 14 from Line 13. Enter here and on Virginia Schedule A, Line 18................................................................... 15. .00

2021 Virginia Schedule ADJ (Form 760-ADJ) *VA0ADJ121888* Name(s) as shown on Virginia return Dollar Amount Additions to Federal Adjusted Gross Income 1. Interest on obligations of other states, exempt from federal income tax but not from state tax.............. 1 2. Other additions to federal adjusted gross income.

2a. FIXED DATE CONFORMITY ADDITION - SEE INSTRUCTIONS................................................. 2a 2b - 2c. Refer to the Form 760 instructions for Other Addition Codes. 2b 2c 3. Total Additions. Add Lines 1 and 2a - 2c. Enter here and on Form 760, Line 2...................................... 3 Subtractions from Federal Adjusted Gross Income 4. Income (interest, dividends, or gains) from obligations or securities of the U.S. exempt

from state income tax, but not from federal tax....................................................................................... 4 5. Disability income reported as wages (or payments in lieu of wages) on your federal return.

5a. Enter YOUR disability subtraction................................................................................................... 5a

5b. Enter SPOUSE’s disability subtraction........................................................................................... 5b 6. Other subtractions as provided in instructions.

6a. FIXED DATE CONFORMITY SUBTRACTION - SEE INSTRUCTIONS......................................... 6a

6b - 6d. Refer to the Form 760 instructions for Other Subtraction Codes. 6b 6c 6d 7. Total Subtractions. Add Lines 4, 5a, 5b, and 6a - 6d. Enter here and on Form 760, Line 7.................... 7 . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , . 00 , , Deductions from Virginia Adjusted Gross Income 8. Refer to the Form 760 instructions for Deduction Codes. 8a 8b 8c 9. Total Deductions. Add Lines 8a - 8c. Enter here and on Form 760, Line 13........................................... 9 Use Schedule ADJS if you are claiming more additions, subtractions or deductions than the Schedule ADJ allows. Refer to the Form 760 Instructions for Other Codes. Fill in this oval.....................................................

Continue with Line 10 on Page 2. loss . 00 , , loss . 00 , , loss . 00 , , loss . 00 , , Your Social Security Number - - Code Certification Number Code Code WEB

*VA0ADJ221888* 2021 Virginia Schedule ADJ Page 2 2601050 Rev. 06/21 18. Addition to tax. Fill in oval if addition came from: Form 760C Form 760F.... 18 19. Penalty Late Filing Penalty Extension Penalty .......................... 19 20. Interest (accrued on the tax you owe)........................................................................................ 20 21. Total Addition to Tax, Penalty, and Interest (add Lines 18 through 20). Enter here and on Line 32 of Form 760...................................................................................... 21 . 00 , , . 00 , , . 00 , , . 00 , , Addition to Tax, Penalty, and Interest 11. Enter the total number of exemptions reported in the table above. Next, refer to the Poverty Guidelines Table in the Form 760 instructions to see if you qualify for this credit.......................................................... 11 12. If you qualify for this credit, enter the number of personal and dependent exemptions reported on your Form 760 (see instructions)...................................................................................................................................12 13. Multiply Line 12 by $300. Enter the result on Line 13. If you do not qualify for the Tax Credit for Low-Income Individuals but claimed the Earned Income Credit on your federal return, enter $0.................................13 14. Enter the amount of Earned Income Credit claimed on your federal return. If you did not claim the Earned Income Credit on your federal return, enter $0.................................................................................................14 15. Multiply Line 14 by 20% (.20)........................................................................................................................................15 16. Enter the greater of Line 13 or Line 15 above...............................................................................................................16 17. Compare the amount on Line 16 above to the amount of tax on Line 18 of Form 760. Enter the lesser of the two amounts here and on Line 23 of Form 760. This is your credit amount.............................................17 . 00 , . 00 , . 00 , . 00 , . 00 , Family VAGI Name Social Security Number Virginia Adjusted Gross Income (VAGI) You Spouse Dependent Dependent 10. Total If more than 4 exemptions, attach schedule listing the name, SSN, & VAGI. Enter total Family VAGI here. loss . 00 , Your Social Security Number - - Use Schedule VAC to make contributions. Credit for Low-Income Individuals or Virginia Earned Income Credit Health Care Coverage Contact Information If you marked the oval on the front of Form 760 to authorize the sharing of information from this return with DMAS and have a preferred contact method, please provide the information below. 22. Indicate your preferred method of contact by filling in the appropriate oval below and providing your information.

Email Email address

Phone Daytime number Mail Provide address if different from the information you provided on page one of your Virginia income tax return. Number and Street City, town, or post office State ZIP Code WEB