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2011 FORM MO-1040P

MISSOURI DEPARTMENT OF REVENUE

MISSOURI INDIVIDUAL INCOME TAX RETURN AND

PROPERTY TAX CREDIT CLAIM/

INSTRUCTIONS

002

PENSION EXEMPTION— SHORT FORM

VENDOR CODE

006

- You must use the print button at the top of page to print form

- Don't forget to attach all required forms

SOCIAL SECURITY NUMBER

SPOUSE’S SOCIAL SECURITY NUMBER

- You can tab from one field to another or use the mouse to click

in the field you want.

NAME (LAST)

(FIRST)

M.I.

JR, SR

- You must use your mouse to click in the check box you want.

- If a field does not allow a negative number, and a negative

SPOUSE’S (LAST)

(FIRST)

M.I.

JR, SR

number is entered, a zero will be displayed.

- Click on the gray boxes to view the instructions for that line.

IN CARE OF NAME (ATTORNEY, EXECUTOR, PERSONAL REP., ETC.)

PRESENT ADDRESS (INCLUDE APARTMENT NO. OR RURAL ROUTE)

APT. NUMBER

COUNTY OF RESIDENCE

SELECT COUNTY

CITY, TOWN, OR POST OFFICE

STATE

ZIP CODE

PLEASE CHECK THE APPROPRIATE BOXES THAT APPLY TO YOURSELF OR YOUR SPOUSE AS OF DECEMBER 31, 2011.

AGE 62 THROUGH 64 AGE 65 OR OLDER

BLIND

100% DISABLED

NON-OBLIGATED SPOUSE

YOURSELF

SPOUSE

You may contribute to any one or all

After

Workers’

Childhood

Missouri

General

Elderly

Missouri

of the trust funds that are listed to the

School

Memorial

LEAD

Lead

Military

Revenue

Home

National

Workers

eneral

right. Place the total amount contributed

Retreat

Fund

Testing

Fund

Children’s

Family Relief

Veterans

Delivered

Guard

evenue

Fund

on Line 24. See the instructions for a

Organ Donor

Fund

Trust Fund

Fund

Meals Trust Fund

Program Fund

list of Trust Fund Codes.

Yourself

Spouse

1. Federal Adjusted Gross Income from your 2011 federal return

Worksheet

(See worksheet on page 8.) ....................................................................................................

Line 1

Line 2

2 –

–

2. Any state income tax refund included in your 2011 federal adjusted income ..............................

3 =

3. Subtract Line 2 from Line 1. This is your Missouri adjusted gross income. ...........................

4. TOTAL MISSOURI ADJUSTED GROSS INCOME — Add both numbers on Line 3 and enter here.

5. Income percentages — Divide Line 3 by Line 4 for both you and your spouse.

(The total of the two must equal 100%. Round to the nearest whole number.) .............................................

Line 5

6. Mark your filing status box below and enter the appropriate exemption amount on Line 6.

E. Married filing separate (spouse

A. Single — $2,100 (See Box B before checking.)

NOT filing) — $4,200

B. Claimed as a dependent on another person’s federal

tax return — $0.00

F. Head of household — $3,500

C. Married filing joint federal & combined Missouri — $4,200

G. Qualifying widow(er) with

dependent child — $3,500

D. Married filing separate — $2,100

Line 6

CAUTION!

7. Tax from federal return (Do not

Single—maximum of $5,000;

enter amount from your Forms W-2 —

Married filing combined—maximum

7 +

NOT federal tax withheld.)

of $10,000 ...............................................

See Page 6,

Line 7

Line 7.

Missouri Standard or Itemized Deduction

Taxpayers Under Age 65

Taxpayers Age 65 or Older

Single ............................................. $5,800

Single ...................................................................$7,250

If 65 or older

Married Filing Combined .............. $11,600

Married Filing Combined and YOU are Age

or blind the

Married Filing Separate ...................$5,800

65 or Older .....................................................$12,750

appropriate

Head of Household..........................$8,500

Married Filing Combined and You and Your

boxes must

Qualifying Widow(er) .....................$11,600

Spouse are BOTH Age 65 or Older ..............$13,900

be checked

above.

Married Filing Separate ........................................$6,950

Head of Household ..............................................$9,950

Qualifying Widow(er) ..........................................$12,750

Itemized Worksheet

If blind or claimed as a dependent, see your federal return or page 6 and 7 of the instructions.

Do not

8 +

If itemizing, see page 4 of the Form MO-1040P. ........................................................................................................

include

Line 8

9. Number of dependents from Federal Form 1040 OR 1040A, Line 6c

yourself

9 +

or your

(DO NOT INCLUDE YOURSELF OR SPOUSE.)

x $1,200 ............................

Line 9

spouse.

10. Pension exemption (Complete worksheet on page 3 of Form MO-1040P.) Attach worksheet

Pension Exemption Wksht

10 +

on page 3, a copy of federal return, Forms W-2P, and 1099-R. ..................................................................

Line 10

11 +

11. Long-term care insurance deduction .............................................................................................................

Long Term Care Worksheet

Line 11

12 =

12. TOTAL DEDUCTIONS — Add Lines 6 through 11. ......................................................................................

13. Missouri Taxable Income — Subtract Line 12 (Total Deductions) from Line 4 (Total Missouri Income)

and enter here. ...............................................................................................................................................

For Privacy Notice, see instructions.

MO 860-2954 (12-2011)

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