Form It-40 - Indiana Full-Year Resident Individual Income Tax Return - 2012 Page 2
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2.00
12. Enter credits from Schedule 5, line 8 (enclose schedule) ____
12
.00
13. Enter offset credits from Schedule 6, line 7 (enclose schedule)
13
14. Automatic Taxpayer Refund credit.
Leave blank if not eligible. See instructions on page 9.
Enter $ 111 if you are eligible
Enter $ 222 if joint fi ling and both are eligible
.00
Enter $ 111 if joint fi ling but only one is eligible ___________
14
.00
15. Add lines 12, 13 and 14 ___________________________________________ Indiana Credits
15
.00
16. Enter amount from line 11 ___________________________________________ Indiana Taxes
16
.00
17. If line 15 is equal to or more than line 16, subtract line 16 from line 15 (if smaller, skip to line 24)
17
.00
18. Amount from line 17 to be donated to the Indiana Nongame Wildlife Fund ______________
18
.00
19. Subtract line 18 from line 17 _________________________________________ Overpayment
19
20. Amount from line 19 to be applied to your 2013 estimated tax account
(see instructions on page 11 ).
.00
Enter your county code
county tax to be applied _ $
a
.00
Spouse’s county code
county tax to be applied _ $
b
.00
Indiana adjusted gross income tax to be applied _________ $
c
.00
Total to be applied to your estimated tax account (a + b + c; cannot be more than line 19) _____
20d
.00
21. Penalty for underpayment of estimated tax from Schedule IT-2210 or IT-2210A (enclose sch.) _
21
.00
22. Refund: Line 19 minus lines 20d and 21. Note: If less than zero, see line 24 ___ Your Refund
22
23. Direct Deposit (see page 12 ) c. Type:
Checking
Savings
Hoosier Works MC
a. Routing Number
b. Account Number
d. Place an “X” in the box if refund will go to an account outside the United States
24. If line 16 is more than line 15, subtract line 15 from line 16. Add to this any amount on line 21
.00
(see instructions on page 13 ) ____________________________________________________
24
.00
25. Penalty if fi led after due date (see instructions) ______________________________________
25
.00
26. Interest if fi led after due date (see instructions) ______________________________________
26
.00
27. Amount Due: Add lines 24, 25 and 26 ______________________________ Amount You Owe
27
Do not send cash. Please make your check or money order payable to: Indiana Department of Revenue.
Sign and date this return after reading the Authorization statement on Schedule 7. You must enclose Schedule 7.
_____________________________________________________
_________________________________________________
Your Signature
Date
Spouse’s Signature
Date
• If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN 46207-7224.
• Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.
15112121694
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