2011-2012 Separation of Income (SOI) Form
This form is for a student or parent (in the case of a dependent student) who filed a joint return for the year 2010 but is now widowed, divorced, or separated. Student or parent must use the joint return to factor out the individual income and taxes paid. Read the instructions below before completing this form. Attach a copy of your signed joint federal tax return if you have not yet submitted it to the University. To assist you with completing the Separation of Income (SOI) form, specific line references for the 2010 U.S. tax returns are provided. INSTRUCTIONS Starting with the income figures from your W-2(s), add in any income from the joint return that represents your personal income. Any other income or interest earned should be assessed at 50 percent, to include business or farm gains or losses. ITEM $ Amount IRS 1040 IRS 1040A IRS 1040EZ 0 NA NA NA 2010 earnings from W-2 form(s) Line 8a Line 8a Line 2 Taxable interest Line 9a Line 9a NA Ordinary dividends Taxable refunds, credits, or offsets of state and Line 10 NA NA local income taxes Line 11 NA NA Alimony received Line 12 NA NA Business income (+) or loss (-) Line 13 Line 10 NA Capital gain (+) or loss (-) Line 14 NA NA Other gains (+) or losses (-) Line 15b Line 11b NA IRA distributions Taxable amount Line 16b Line 12b NA Pensions and annuities Taxable amount Rental real estate, royalties, partnerships, S Line 17 NA NA corporations, trusts, etc. Line 18 NA NA Farm income (+) or loss (-) Line 19 Line 13 Line 3 Unemployment compensation Line 20b Line 14b NA Social security benefits Taxable amount Line 21 NA NA Other income (1) TOTAL INCOME 0 Next, if the adjusted gross income (AGI) listed on your joint return was adjusted (Adjustments to Income), you should reduce the AGI by the portion of the adjustment that applies solely to you.
Example: If an adjustment was made for moving expenses for you and your spouse, only 50 percent of the adjusted amount can be applied against your income. If you do not assess these items at 50 percent, you must provide the appropriate tax documents to support your assessment amounts.

ITEM Educator expenses Certain business expenses of reservists, performing artists, and fee-basis government officials Health savings account deduction Moving expenses One-half of self-employment tax Self-employed SEP, SIMPLE and qualified plans Self-employed health insurance deduction
AFA

$ Amount

IRS 1040 Line 23 Line 24 Line 25 Line 26 Line 27 Line 28 Line 29

IRS 1040A Line 16 NA NA NA NA NA NA

IRS 1040EZ NA NA NA NA NA NA NA
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2011-2012 Separation of Income (SOI) Form
Penalty on early withdrawal of savings Alimony paid IRA deduction Student loan interest deduction Tuition and fees Domestic production activities deduction (2) TOTAL ADJUSTMENTS TO INCOME Line 30 Line 31a Line 32 Line 33 Line 34 Line 35 Line 36 NA NA Line 17 Line 18 Line 19 NA Line 20 NA NA NA NA NA NA NA

0

Next, calculate your AGI by subtracting the total adjustments from the total income.
(1)-(2)=Total 2010 Adjusted Gross Income (AGI)
0

Line 37

Line 21

Line 4

Next, establish what percentage of the joint AGI was credited to you and