Fillable Printable Fill-In Form
Fillable Printable Fill-In Form
Fill-In Form
Homestead credit (Schedule H or H-EZ) – Attach required documents (W-2s, W-2Gs, 1099-Rs, original rent
certicate(s), tax bill(s), legal documents, and statements).
Closing certicate forduciaries (Schedule CC) –Estates – Attacha copy of thedecedent’s will and the probate
inventory. Trusts– Attach a copy of the trust instrument and three years of accountings.
Amended return (Form 1X)– Attach forms, documentsand/or schedules that support the item(s) changed, asneeded.
Angel investment credit (Schedule VC) – Attach a copy of the new business venture certication form provided by the
Department of Commerceand the tax credit vericationformissued bythe Department of Commerce or a copy of
your Schedule 3K-1 or 2K-1.
Dairy cooperatives credit (Schedule DM) –Attach Schedules DM and DMK-1.
Dairy manufacturingfacility investment credit (Schedule DM) – Attacha copy ofyour Department of Commerce
certication or Schedule 5K-1, 3K-1, or 2K-1.
Development zones credit (Schedule DC) – Attacha copy of your certication to claim tax benets and the verication
of expenses from the Department of Commerce.Also attach a statement from the Department of Commerce verifying
the amount ofcredit for environmental remediation andforjobcreation or retention.Ifcredit is from a pass-through
entity, attach Schedule 5K-1, 3K-1, or 2K-1 instead.
Early stage seed investment credit (Schedule VC) – Attach a copy ofthe certication issued by the Department of
Commerce to the business and to thefund managerand a statement from the fund manager containing (1) name and
address of the fund manager and (2) for each investment, the date, total amount of investment, amount invested in a
qualied new business venture, and amount of tax credit or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Economic developmentcredit (Schedule ED) – Attachacopy of your certication and the notice of eligibility to receive
tax benets from the Department of Commerce or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Eligible veterans and surviving spouses property tax credit – Attachreal estate taxbill(s) for all taxespaid in2010,
proof of payment, and your Wisconsin Department of VeteransAffairs certication, if required.
Enterprise zone jobs credit (Schedule EC) – Attach a copy ofyour certication to claimtaxbenets and the verication
of your expenses from the Department of Commerce or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Farmland preservation credit (Schedule FC orFC-A) – Seetheinstructions for the scheduleyou are ling for the
required attachments.
Film production company investment credit (Schedule FP) – Attach a copy of the certication from the Department of
Commerce that the credits claimed are forexpenses related to establishing a lm production company in Wisconsin
or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Film productionservices credits (Schedule FP)– Attach a copy of the approved applicationfrom the Department of
Commerce or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Required
Attachments
for Electronic Filing
PAPER CLIP required attachments here
I-041i (R. 4-11)
Refer to instructions on back.
Check the applicable box(es) to identify the attachments.
FORM
W-RA
2010
Wisconsin
Department of Revenue
Your legal last name Legal rst name M.I. Your social security number
If joint return, spouse’s legal last name Spouse’s legal rst name M.I. Spouse’s social security number
Address (number and street) Apt. no. Daytime phone number
City or post ofce State Zip code E-mail address
Taxpayer Information(
USE BLACK INK ONLY
)
Attachments – Submit this form only if you electronically led your return or homestead credit claim.
Legal name of estate, trust, or corporation FEIN
Tab to navigate within form. Use mouse to check
applicable boxes, press spacebar or press Enter.
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Clear
Food processing plant and food warehouse investment credit – Attach a copy of your certication to claim tax benets
issued by the Department of Commerce and the notice of the amount of credit allocated to you by the Department of
Commerce or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Health insurance risk-sharing plan assessments credit – Attach a copy of your Schedule 5K-1 or 3K-1.
Historic rehabilitation credit (Schedule HR) – See Schedule HR for the required attachments.
Internet equipment credit (Schedule IE) – Attach a copy of your certication to claim tax benets and the verication
of your expenses from the Department of Commerce or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Jobs tax credit – Attach a copy of your certication to claim tax benets issued by the Department of Commerce and
the notice of eligibility to receive tax benets that reports the amount of tax benet from the Department of Commerce
or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Manufacturing investment credit (Schedule MI) –Attach a copy of thecerticationfrom the Departmentof Commerce.
Meat processing facility investment credit (Schedule MP) – Attacha copy of your Department of Commerce certication
and allocation of credits or Schedule 5K-1, 3K-1, or 2K-1.
Model Form for legislators who make the sec. 162(h) election – If using electronic ling software that does not submit
the SPL-01 Model Form as part of the electronic return, attach a copy of the 2010 Model Form.
Tax paid toanother state (Schedule OS) – Attach a copy of your income tax return from the other state andwithholding
statements or a copy of your Schedule 3K-1 or 5K-1 if credit based on tax paid by a pass-through entity.
Technology zone credit (Schedule TC) – Attach a copy of your certication for tax benets issued by the Department of
Commerce and astatement from the Department of Commerce verifying the amount of your credits for property taxes
paid, capital investments made, andwages paid for jobs created ina technology zoneor a copy of your Schedule
5K-1, 3K-1, or 2K-1.
Woody biomass harvesting and processing credit – Attach a copy of your certication to claim tax benets issued by
the Department of Commerce and the notice of the amount of creditallocated to you by the Department of Commerce
or a copy of your Schedule 5K-1, 3K-1, or 2K-1.
Other – Attach any other documents you were instructed to attach when e-ling.
General Instructions
Purpose of Form
Use Form W-RAtosubmit supporting documentation when
you electronicallyle an income orfranchise taxreturnand
claim any of the credits or items listed. You may also be
instructed to submit Form W-RA when using Wisconsin
e
-le.
Legislatorsmaking thespecial section162(h) electionmust
mail the Model Form to the department when using electronic
ling software that does not submit the Model Form as part of
the electronic return.
Paper clip your attachments to Form W-RA.
Refunds can be processed faster if you use paper clips
instead of staples.
When to File
The W-RAand required attachments must be mailed tothe
department within 48 hoursof receipt of your Wisconsin
acknowledgment. Refunds may not complete processinguntil
the W-RAand attachments have been received.
Note Individuals and tax practitioners ling on behalf of
individualsrequired to sendthe Form W-RAattachments to the
department may transmit this data in an electronic le over the
Internet. Further information can be found on the department’s
web site at: http://www.revenue.wi.gov/eserv/w-ra.html.
Where to File
Send Form W-RAand all attachments to one of the addresses
listed below. Failure to mail timely to the correct address with
all attachments will result in a delay in issuing the refund or
closing certicate for duciaries.
Homestead credit claims and requests for a closing
certicate
If sending attachments required for homestead credit or a
request for a closing certicate, send the Form W-RA and
attachments to:
Wisconsin Department of Revenue
PO Box 8977
Madison WI 53708-8977
The Form W-RAfor anyreturn including homestead credit
shouldbe mailedto the above address regardless of any other
credits that may also be claimed.
Others
If you are not claiming homestead creditor requestinga
closing certicate for duciaries, send the Form W-RAand
attachments to:
Wisconsin Department of Revenue
PO Box 8967
Madison WI 53708-8967
NoteIf you use amail service provider that is not the U.S.
PostalService, deliver to: Wisconsin Department of Revenue,
Mail Stop 1-151, 2135 Rimrock Road, Madison WI 53713.
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Your legal name Social security number or FEIN
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