Form 40s - Oregon Individual Income Tax Return - 2009
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1Clear Form
OREGON
Amended Return
Form
40S
2009
For office use only
Individual Income Tax Return
FULL-YEAR RESIDENTS ONLY
SHORT FORM
A
K
F
P
Last name
First name and initial
Date of birth (mm/dd/yyyy)
Social Security No. (SSN)
–
–
Deceased
Spouse’s/RDP’s last name if joint return
Spouse’s/RDP’s first name and initial if joint return Spouse’s/RDP’s SSN if joint return
Date of birth (mm/dd/yyyy)
–
–
Deceased
Current mailing address
Telephone number
(
)
City
State
ZIP code
Country
If you filed a return last year, and your
name or address is different, check here
•
Filing
1
Single
Exemptions
Status
•
•
2a
Married filing jointly
Total
2b
Registered domestic partners (RDP) filing jointly
Check
6a
6a
Yourself ...........
Regular
...... Severely disabled
....
only
3a
Married filing separately:
one
6b
b
Spouse/RDP ...
Regular
...... Severely disabled
......
Spouse’s name _____________________________ Spouse’s SSN ___________________
box
•
3b
Registered domestic partner filing separately:
6c
c
All dependents
First names __________________________________
Partner’s name _____________________________ Partner’s SSN ___________________
•
6d
d
Disabled
First names __________________________________
4
Head of household:
Person who qualifies you ________________________________
children only
•
Total
6e
5
Qualifying widow(er) with dependent child
(see instructions)
•
•
•
•
•
•
Check
7a
7b
You
7c
You have
7d
Someone else
7e
If there is a kicker refund,
all that
You were:
65 or older
Blind
filed an
federal Form 8886
can claim you as
I want to donate mine to the
apply
➛
Spouse/RDP was:
65 or older
Blind
extension
a dependent
State School Fund
8 Wages (enter in box 8a) + unemployment (enter in box 8b) + interest and dividends (enter in box 8c)
Round to the nearest dollar
➛
•
•
•
•
.00
= TOTAL INCOME
8
8a
.00
+
8b
.00
+
8c
.00
•
.00
9 2009 federal tax liability ($0–$5,850; see instructions for the correct amount) .......
9
•
.00
10 Standard deduction from the back of this form .........................................................
10
•
.00
11 Add lines 9 and 10 .........................................................................................................................................
11
•
.00
12 Oregon taxable income. Line 8 minus line 11. If line 11 is more than line 8, enter -0- ..................................
12
Include
•
proof of
.00
13 Tax. See instructions, page 13. Enter tax from tax tables or charts here ......................................................
13
withholding
•
.00
14 Exemption credit. Multiply your total exemptions on line 6e by $176 .....................
14
(W-2s,
•
.00
15 Child and dependent care credit. See instructions, page 13.....................................
15
1099s),
•
payment,
•
•
•
•
.00
16b $
16d $
16 Other credits. Identify:
16a
16c
16
and payment
•
.00
17 Total non-refundable credits. Add lines 14 through 16 .................................................................................
17
voucher
•
.00
18 Net income tax. Line 13 minus line 17. If line 17 is more than line 13, enter -0- ...........................................
18
•
.00
19 Oregon income tax withheld. Include your Form(s) W-2 and 1099 ........................
19
•
.00
ADD TOGETHER
20 Earned income credit. See instructions, page 14 ......................................................
20
Include Schedule
•
.00
WFC if you claim
21 Working family child care credit from WFC, line 18 ...............................................
21
this credit
•
.00
22 Mobile home park closure credit. Include Schedule MPC .........................................
22
•
.00
23
23 Total payments and refundable credits. Add lines 19 through 22 .................................................................
➛
•
.00
24 Refund. If line 23 is more than line 18, you have a refund. Line 23 minus line 18 ................. REFUND
24
➛
•
.00
25 Tax to pay. If line 18 is more than line 23, you have tax to pay. Line 18 minus line 23 .... TAX TO PAY
25
•
•
.00
.00
CHARITAbLE
26
27
Oregon Nongame Wildlife
St. Vincent de Paul Society
CHECkOFF
•
•
.00
.00
28
29
The Nature Conservancy
Doernbecher Children’s Hospital
DONATIONS,
•
•
.00
.00
30
31
Oregon Humane Society
The Salvation Army
PAGE 14
These will
•
•
.00
.00
32
33
Oregon Veterans’ Home
Planned Parenthood of Oregon
reduce
I want to donate
•
•
.00
.00
34
35
Oregon Lions Sight & Hearing
Shriners Hospitals for Children
your refund
part of my tax
•
•
.00
.00
36
37
refund to the
Special Olympics Oregon
Susan G. Komen for the Cure
•
•
•
•
following fund(s)
.00
.00
38a
38b
39a
39b
Charity code
Charity code
•
.00
40 Total. Add lines 26 through 39. Total can’t be more than your refund on line 24..........................................
40
•
➛
.00
41 NET REFUND. Line 24 minus line 40. This is your net refund ....................................... NET REFUND
41
42 For direct deposit of your refund, see instructions, page 29.
•
Type of Account:
Checking or
Savings
DIRECT
DEPOSIT
•
•
Routing No.
Account No.
•
Will this refund go to an account outside the United States?
Yes
Under penalty for false swearing, I declare that the information in this return is true, correct, and complete.
•
License No.
Your signature
Date
Signature of preparer other than taxpayer
X
X
Address
Telephone No.
Spouse’s/RDP’s signature (if filing jointly, BOTH must sign)
Date
X
150-101-044 (Rev. 12-09)
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