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FORM MO-1040P

14. Total Missouri taxable income amount from Line 13 .....................................................................................

Yourself

Spouse

15. Multiply Line 14 by the percentages you determined on Line 5.

Do this for you and your spouse. ............................................................................................

16. Use the tax table on page 4 of Form MO-1040P to figure the

tax on amounts from Line 15 for you and your spouse. ..........................................................

Line 16

17. TOTAL TAXES — Add your tax and your spouse’s tax from Line 16. ..........................................................

18. Missouri withholding for you and your spouse from your Forms W-2 and 1099.

Line 18

Attach copies of Forms W-2 and 1099. .......................................................................................................... 18

19. Any Missouri estimated tax payments for 2011 (Be sure to include

any amount of your 2010 overpayment credited to your 2011 Missouri tax return.) ...................................... 19

Line 19

Attach

Form MO-PTS.

20. PROPERTY TAX CREDIT — Enter amount from Form MO-PTS,

MO-PTS

Line 14. Attach Form MO-PTS. .................................................................................................................... 20

Line 20

21. TOTAL PAYMENTS AND CREDITS

Add Lines 18, 19, and 20 and enter amount here. ........................................................................................ 21

22. If amount of TOTAL PAYMENTS AND CREDITS (Line 21) is larger than amount of

TOTAL TAXES (Line 17), enter the difference here. You have overpaid.

If not, enter the amount on Line 26. ................................................................................................................ 22

Line 23

23. Enter the amount from Line 22 you want applied to your 2012 estimated tax. ............................................... 23

24. Enter the amount of

Additional

eneral

your donation in the

Workers

LEAD

Fund Code

evenue

Missouri

trust fund boxes to

(See Instr.)

Children’s

Veterans

Elderly Home

After School

Childhood

National Guard

Workers’

General

Military Family

Trust Fund

Delivered Meals

Organ Donor

the right. See

Retreat

Lead Testing

Revenue

Trust Fund

Memorial

Relief Fund

______|______

Trust Fund

Program Fund

Fund

instructions for trust

Line 24

fund codes........... 24.

25. Subtract Lines 23 and 24 from Line 22 and enter here. This is your refund. Sign below and

Line 25

mail to: Department of Revenue, P.O. Box 3385, Jefferson City, MO 65105-3385. ........................ REFUND 25

If you would like your refund deposited directly to your checking or savings account, complete boxes a, b, and c below.

Checking

a. Routing Number

b. Account Number

Savings

26 . If Line 21 is less than Line 17, enter the difference here. You have an amount due. Sign below and mail to:

Line 26

Department of Revenue, P.O. Box 3395, Jefferson City, MO 65105-3395. ...................... AMOUNT YOU OWE 26

If you pay by check, you authorize the Department of Revenue to process the check electronically.

Any check returned unpaid may be presented again electronically.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true,

correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which he/she has any knowledge. As provided in Chapter 143, RSMo, a

penalty of up to $500 shall be imposed on any individual who files a frivolous return. I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as

defined under federal law and that I am not eligible for any tax exemption, credit or abatement if I employ such aliens.

I authorize the Director of Revenue or delegate to discuss my return and

E-MAIL ADDRESS

PREPARER’S PHONE NUMBER

attachments with the preparer or any member of the preparer’s firm.

(

)

YES

SIGNATURE

DATE

PREPARER’S SIGNATURE

FEIN, SSN, OR PTIN