Form It-40 - Indiana Full-Year Resident Individual Income Tax Return - 2012

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Form
Indiana Full-Year Resident
Due April 15, 2013
2012
IT-40
Individual Income Tax Return
State Form 154
(R11 / 9-12)
If fi ling for a fi scal year, enter the dates (see instructions) (MM/DD/YYYY):
from
to:
Your Social
Spouse’s Social
Security Number
Security Number
Place “X” in box if applying for ITIN
Place “X” in box if applying for ITIN
Your fi rst name
Initial
Last name
Suffi x
If fi ling a joint return, spouse’s fi rst name
Initial
Last name
Suffi x
Present address (number and street or rural route)
Place “X” in box if you are
married fi ling separately.
City
State
Zip/Postal code
Foreign country 2-character code (see pg. 6 )
School corporation number (see pages 59 and 60 )
Enter below the 2-digit county code numbers (found on the back of Schedule CT-40) for the county where you lived and
worked on January 1, 2012.
County where
County where
County where
County where
you lived
you worked
spouse lived
spouse worked
Round all entries
1. Enter your federal adjusted gross income (AGI) from your federal tax return (from Form 1040,
.00
line 37; Form 1040A, line 21; or from Form 1040EZ, line 4) ___________________ Federal AGI
1
.00
2. Enter amount from Schedule 1, line 8, and enclose Schedule 1 ________ Indiana Add-Backs
2
.00
3. Add line 1 and line 2 ____________________________________________________________
3
.00
4. Enter amount from Schedule 2, line 12, and enclose Schedule 2 _______ Indiana Deductions
4
.00
5. Subtract line 4 from line 3 __________________________________ Indiana Adjusted Income
5
6. You must complete Schedule 3. Enter amount from Schedule 3, line 5,
.00
and enclose Schedule 3 ______________________________________ Indiana Exemptions
6
.00
7. Subtract line 6 from line 5 _____________________________________ State Taxable Income
7
8. State adjusted gross income tax: multiply line 7 by 3.4% (.034)
.00
(if answer is less than zero, leave blank) ____________________
8
9. County tax. Enter county tax due from Schedule CT-40
.00
(if answer is less than zero, leave blank) ____________________
9
.00
10. Other taxes. Enter amount from Schedule 4, line 4 (enclose sch.)
10
.00
11. Add lines 8, 9 and 10. Enter total here and on line 16 on the back ___________ Indiana Taxes
11
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15112111694

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