Form Ia 1040 - Iowa Individual Income Tax Return Form - 2016
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1
22016 IA 1040 Iowa Individual Income Tax Return
For fiscal year beginning ____/____ 2016 and ending ____/____ /____
Step 1: Fill in all spaces. You must fill in your Social Security Number (SSN).
Your last name
Your first name/middle initial
Spouse’s last name
Spouse’s first name/middle initial
Current mailing address (number and street, apartment, lot, or suite number) or PO Box
City, State, ZIP
•
•
Email Address:
Spouse SSN
Your SSN
•
Step 2 Filing Status: Mark one box only.
Check this box if you or your spouse was 65 or older as of 12/31/16.
▲
•
•
1
Single: Were you claimed as a dependent on another person’s Iowa return?
Yes
No
Residence on 12/31/16: County No.
School District No.
Dependent children for whom an exemption is claimed in Step 3
2
Married filing a joint return. (Two-income families may benefit by using status 3 or 4.)
How many have health care coverage?(including Medicaid or hawk-i) _____ •
3
Married filing separately on this combined return. Spouse use column B.
How many do not have health care coverage? _____ •
4
Married filing separate returns.
Spouse's name:
▲
Net Income: $
SSN:
5
Head of household with qualifying person. If qualifying person is not claimed as a dependent on this return, enter the person’s name and SSN below.
6
Qualifying Widow(er) with dependent child.
Name:
SSN:
Step 3 Exemptions
B. Spouse (Filing Status 3 ONLY)
A. You or Joint
a.
Personal Credit: Col. A: Enter 1 (enter 2 if filing status 2 or 5); Col. B: Enter 1 if filing status 3
▲
X $ 40 =
$
▲
X $ 40 =
$
$
$
b.
Enter 1 for each taxpayer who is 65 or older and/or 1 for each taxpayer who is blind
▲
X $ 20 =
▲
X $ 20 =
c.
Dependents: Enter 1 for each dependent
▲
X $ 40 =
$
▲
X $ 40 =
$
$ ____________
$ _____________
d.
Enter first names of dependents here
e. Total
e. Total
Step 4 Reportable Social Security Benefits as calculated on line 11 of Iowa social security worksheet
B. Spouse/Status 3 ▲
A. You or Joint ▲
B. Spouse/Status 3
A. You or Joint
B. Spouse/Status 3
A. You or Joint
Step 5
1.
Wages, salaries, tips, etc ..................................................................................
1.
.00
.00
Gross
Taxable interest income. If more than $1,500, complete Sch. B......................
2.
Income
2.
.00
.00
Ordinary dividend income. If more than $1,500, complete Sch. B ...................
3.
3.
.00
.00
4.
Alimony received...............................................................................................
4.
.00
.00
NOTE: Use only
5.
Business income/(loss) from federal Schedule C or C-EZ...............................
5.
.00
.00
blue or black
6.
Capital gain/(loss), federal Sch. D if required for federal purposes .......
ink, no pencils
6.
.00
.00
or red ink.
7.
Other gains/(losses) from federal form 4797 ....................................................
7.
.00
.00
8.
Taxable IRA distributions ..................................................................................
8.
.00
.00
9.
Taxable pensions and annuities ................................................................
9.
.00
.00
10.
Rents, royalties, partnerships, estates, etc.......................................................
10.
.00
.00
11.
Farm income/(loss) from federal Schedule F ...................................................
11.
.00
.00
12.
Unemployment compensation. See instructions ..............................................
12.
.00
.00
13.
Gambling winnings............................................................................................
13.
.00
.00
14.
Other income, bonus depreciation, and section 179 adjustment ....................
14.
.00
.00
15.
Gross Income. Add lines 1-14 .............................................................................................................................................
▲
15.
__________________ .00
_______________ .00
Step 6
Payments to an IRA, Keogh, or SEP ................................................................
16.
16.
.00
.00
Adjust-
ments to
Deductible part of self-employment tax. ...........................................................
17.
17.
.00
.00
Income
Health insurance deduction ..............................................................................
18.
18.
.00
.00
Penalty on early withdrawal of savings.............................................................
19.
19.
.00
.00
Alimony paid................................................................................................
20.
20.
.00
.00
Pension/retirement income exclusion ...............................................................
21.
▲
21.
.00
.00
Moving expense deduction from federal form 3903 .........................................
22.
22.
.00
.00
Iowa capital gain deduction; certain sales only. Include IA 100 .......................
23.
▲
23.
.00
.00
Other adjustments.............................................................................................
24.
24.
.00
.00
25.
Total adjustments. Add lines 16-24 ................................................................................................................................
▲
25.
.00
.00
26.
Net Income. Subtract line 25 from line 15 ................................................................................................................................
▲
26.__________________
.00
_______________ .00
Step 7
Federal income tax refund/overpayment received in 2016 .............................
27.
27.
.00
▲
.00
Federal
Tax
Self-employment/household employment/other federal taxes .........................
28.
▲
28.
.00
.00
Addition
Addition for federal taxes. Add lines 27 and 28................................................................................................................................
29.
and
29.
.00
.00
Deduc-
30.
Total. Add lines 26 and 29 ................................................................................................................................................................
tion
30.
.00
.00
31.
Federal tax withheld .........................................................................................
▲
31.
.00
.00
32.
Federal estimated tax payments made in 2016 ...............................................
▲
32.
.00
.00
33.
Additional federal tax paid in 2016 for 2015 and prior years ...........................
▲
33.
.00
.00
34.
Deduction for federal taxes. Add lines 31, 32, and 33 ........................................................................................................
34.
.00
.00
35.
Balance. Subtract line 34 from line 30. Enter here and on line 36, page 2 ........................................................................
▲
35.
.00
.00
41-001 (05/13/16)
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