Form 40s - Individual Income Tax Return - 2005
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1
2Clear Form
•
Amended Return
Form
OREGON
For office use only
40S
2005
Individual Income Tax Return
FULL-YEAR RESIDENTS ONLY
A
K
F
P
SHORT FORM
Date of birth (mm/dd/yyyy)
Last name
First name and initial
Social Security No. (SSN)
–
–
Deceased
Date of birth (mm/dd/yyyy)
Spouse’s last name if joint return
Spouse’s first name and initial if joint return
Spouse’s SSN if joint return
–
–
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
•
•
•
Exemptions
Total
Filing
1
Single
Status
2
6a Yourself......
6a
Married filing jointly
Regular
........ Severely disabled
.........
Check
3
6b Spouse ......
b
Married filing
Regular
........ Severely disabled
...........
Spouse’s name
only
separately
one
•
6c All de pen dents
c
Spouse’s SSN
First names ________________________________
box
4
•
Head of household
6d Disabled
d
Person who qualifies you
First names ________________________________
children only
•
5
Qualifying widow(er) with dependent child
6e
Total
•
•
•
•
•
7a
Check
7b
You
7c
You
7d
Someone else
You were:
65 or older
Blind
all that
filed an
can claim you as
filed federal
➛
apply
extension
a dependent
Spouse was:
65 or older
Blind
Form 8886
+
+
Round to the nearest dollar
8 Wages
)
unemployment
interest and dividends
(enter in box 8a
(enter in box 8b)
(enter in box 8c)
➛
.00
+ •
+ •
=
•
•
TOTAL INCOME
8a
.00
8b
.00
8c
.00
8
.00
•
9 2005 federal tax liability ($0–$4,500; 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, fill in -0
.....................................
-
12
.00
•
13 Tax. See pages 21 through 23 for tax tables or charts and enter tax here ....................................................
13
.00
•
14
Exemption credit.
Multiply your total exemptions on line 6e by $154 .......................
14
Staple
.00
•
15 Earned income credit. See instructions, page 10........................................................
15
W-2s,
.00
•
16 Child and dependent care credit. See instructions, page 10.......................................
payment,
16
and
.00
•
$
$
17 Other credits.
•
•
•
•
17a
17b
17c
17d
17
payment
.00
•
18 Total credits. Add lines 14 through 17 .............................................................................................................
18
voucher
•
.00
19 Net income tax. Line 13 minus line 18. If line 18 is more than line 13, fill in -0- ..............................................
19
here
.00
•
20 Oregon income tax withheld. Attach your Form(s) W-2 and 1099 ...........................
20
Attach Schedule
➛
.00
•
21
Working family child care credit
from WFC, line
18.............CREDIT AMOUNT
21
WFC if you claim
$
•
•
Number from WFC, line 5
Amount from WFC, line 16
21a
21b
this credit
•
.00
22 Total payments. Add lines 20 and 21 ..............................................................................................................
22
➛
.00
•
23
Re fund.
If line 22 is more than line 19, you have a refund. Line 22 minus line 19 ...................
RE FUND
23
➛
•
.00
...........TAX TO PAY
24
Tax to pay.
If line 19 is more than line 22, you have tax to pay. Line 19 minus line 22
24
.00
•
CHARITABLE
25 Oregon Nongame Wildlife ...............
$1 ......
$5 .....
$10 .....
25
Other $______
CHECKOFFS
.00
•
26 Child Abuse Prevention...................
$1 ......
$5 .....
$10 .....
26
Other $______
PAGE 12
These will
I want to
.00
•
27 Alzheimer’s Disease Research .......
$1 ......
$5 .....
$10 .....
27
Other $______
reduce
donate part
.00
•
28 Stop Domestic & Sexual Violence...
$1 ......
$5 .....
$10 .....
of my tax
28
Other $______
your refund
refund to
.00
•
29 AIDS/HIV Education and Services ...
$1 ......
$5 .....
$10 .....
29
Other $______
the following
.00
•
•
fund(s)
30 Other charity. Code
......
$1 ......
$5 .....
$10 .....
30a
30
Other $______
.00
•
31 Total. Add lines 25 through 30. Total can’t be more than your refund on line 23.............................................
31
➛
.00
•
32
NET REFUND.
Line 23 minus line 31. This is your net refund...........................................
NET REFUND
32
33 For direct deposit of your refund, see the instructions on page 34.
DIRECT
•
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 accompanying sched ules and
I authorize the Department of
state ments. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person other than the
Revenue to contact this preparer
taxpayer, this declaration is based on all information of which the preparer has any knowledge.
about the processing of this return.
•
Your signature
Date
Signature of preparer other than taxpayer
License No.
X
X
SIGN
HERE
Address
Telephone No.
Spouse’s signature
(if filing jointly, BOTH must sign)
Date
X
150-101-044 (Rev. 12-05) Web
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