Form 40n - Individual Income Tax Return For Nonresidents - 2005 Page 2
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1
2Page 2 — 2005 Form 40N
Federal column
Oregon column
.00
.00
36 Amount from front of form, line 35..........................................................................
36
•
.00
SUB TRAC TIONS
37 Social Security and tier 1 Railroad Retirement Board benefits included on line 20....
37
.00
.00
•
•
•
•
$
•
•
$
38 Other subtractions.
38c
38d
38e
38f
38a
38b
.00
.00
•
•
39 Income after subtractions. Line 36 minus lines 37 and 38 .....................................
39a
39b
40 Oregon percentage. Line 39b ÷ line 39a (not more than 100%) ........
40
__ __ __.__ %
•
.00
DEDUCTIONS
41 Itemized deductions from federal Schedule A, line 28 ...........................................
41
AND
.00
•
42 State income tax or sales tax claimed as itemized deduction................................
42
MODIFICATIONS
EITHER,
.00
•
43 Net Oregon itemized deductions. Line 41 minus line 42........................................
43
NOT BOTH
•
.00
44 Standard deduction from page 24..........................................................................
44
•
.00
45 2005 federal tax liability ($0–$4,500; see instructions for the correct amount) ...
45
.00
•
46 Other deductions and modifications. Identify:
...................
46a
46b
46
.00
47 Deductions and modifications ✕ Oregon percentage. See page 26 .......................
47
•
.00
48 Deductions and modifications not multiplied by the Oregon percentage. See page 26 ...
48
•
.00
49 Total deductions and other modifications. Add lines 47 and 48 .......................................................................
49
•
.00
50 Oregon taxable income. Line 39b minus line 49 ..............................................................................................
50
.00
•
OREGON
51 Tax. See pages 26 and 27 for instructions. Enter tax here ...................................
51
TAX
•
•
Check if tax is from:
Form FIA-40N or
Worksheet FCG
•
.00
52 Interest on certain installment sales.......................................................................
52
➛
•
.00
53 Total tax. Add lines 51 and 52 ............................................................................................. OREGON TAX
53
.00
•
54 Exemption credit. Line 6e ✕ $154 ✕ Oregon percentage from line 40 ..............
CREDITS
54
•
.00
55 Earned income credit. See instructions, page 27...................................................
55
ADD TOGETHER
•
.00
56 Child and dependent care credit. See instructions, page 28..................................
56
•
.00
•
57 Credit for income taxes paid to another state. State:
Attach proof
57a
57
.00
•
•
•
$
•
•
$
58 Other credits.
...
58a
58b
58c
58d
58
•
.00
59 Total credits. Add lines 54 through 58 ..............................................................................................................
59
•
.00
60 Net income tax. Line 53 minus line 59. If line 59 is more than line 53, fill in -0- ...............................................
60
PAYMENTS,
•
.00
61 Oregon income tax withheld from income. Attach Forms W-2 and 1099 ............
61
PENALTY, AND
ADD TOGETHER
.00
•
62 Estimated tax payments for 2005 and payments made with your extension ........
62
INTEREST
Attach Schedule
➛
•
.00
63
Working family child care credit
from WFC-N/P, line 21...
CREDIT AMOUNT
63
WFC-N/P if you
•
$
•
Number from WFC-N/P, line 5
Amount from WFC-N/P, line 18
63a
63b
claim this credit
.00
•
64 Total payments. Add lines 61, 62, and 63 ........................................................................................................
64
➛
.00
•
65
Overpayment.
Is line 60 less than line 64? If so, line 64 minus line 60 ......................
OVERPAYMENT
65
➛
•
.00
Is line 60 more than line 64? If so, line 60 minus line 64 ..................................
TAX TO PAY
66
Tax to pay.
66
.00
67 Penalty and interest for filing or paying late. See instructions, page 30..................
67
ADD TOGETHER
➛
•
.00
68 Interest on estimated tax underpayment.
....
Attach Form 10 and check box
68
•
Exception # from Form 10, line 1
68a
.00
•
69 Total penalty and interest due. Add lines 67 and 68.........................................................................................
69
➛
•
.00
70
Amount you owe.
Line 66 plus line 69 ..................................................................
AMOUNT YOU OWE
70
➛
•
.00
Is line 65 more than line 69? If so, line 65 minus line 69 .............................................
REFUND
71
Refund.
71
.00
•
72
Estimated tax.
Fill in the part of line 71 you want applied to 2006 estimated tax ....
72
CHARITABLE
•
.00
73 Oregon Nongame Wildlife ...............
$1 ....
$5 ....
$10 .....
73
Other $_____
CHECKOFFS
These will
•
.00
74 Child Abuse Prevention...................
$1 ....
$5 ....
$10 .....
74
PAGE 31
Other $_____
reduce
I want to
•
.00
75 Alzheimer’s Disease Research .......
$1 ....
$5 ....
$10 .....
75
Other $_____
your refund
donate part
.00
•
76 Stop Domestic & Sexual Violence...
$1 ....
$5 ....
$10 .....
of my tax
76
Other $_____
refund to
•
.00
77 AIDS/HIV Education and Services ...
$1 ....
$5 ....
$10 .....
77
Other $_____
the following
•
.00
fund(s).
•
78 Other charity. Code
......
$1 ....
$5 ....
$10 .....
78a
78
Other $_____
•
.00
79 Total. Add lines 72 through 78. Total can’t be more than your refund on line 71 .............................................
79
➛
•
.00
80
NET REFUND.
Line 71 minus line 79. This is your net refund...........................................
NET REFUND
80
DIRECT
81 For direct deposit of your refund, see the instructions on page 33.
•
Type of Account:
Checking or
Savings
DE POS IT
•
•
Routing No.
Account No.
Under penalties for false swearing, I declare that I have examined this return, including ac com pa ny ing sched ules
I authorize the Department of Rev-
and statements. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person
enue to contact this preparer about
other than the taxpayer, this dec la ra tion is based on all in for ma tion of which the preparer has any knowledge.
the processing of this return.
•
Your signature
Signature of preparer other than taxpayer
License No.
Date
X
X
Telephone No.
Address
Spouse’s signature
(if filing jointly, BOTH must sign)
Date
X
150-101-048 (Rev. 12-05) Web
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