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2008 FORM MO-1040A

MISSOURI DEPARTMENT OF REVENUE

INDIVIDUAL INCOME TAX RETURN

000

VENDOR CODE

SINGLE/MARRIED (ONE INCOME)

SOCIAL SECURITY NUMBER

SPOUSE’S SOCIAL SECURITY NUMBER

NAME (LAST)

(FIRST)

M.I. JR, SR

SPOUSE’S (LAST)

(FIRST)

M.I. JR, SR

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

PRESENT ADDRESS (INCLUDE APARTMENT NO. OR RURAL ROUTE)

COUNTY OF RESIDENCE

SCHOOL DISTRICT NO.

PLEASE CHECK THE APPROPRIATE BOXES THAT APPLY TO YOURSELF OR YOUR SPOUSE.

CITY, TOWN, OR POST OFFICE

STATE

ZIP CODE

AGE 65 OR OLDER

BLIND

100% DISABLED

NON-OBLIGATED SPOUSE

YOURSELF

SPOUSE

1. Federal adjusted gross income from your 2008 Federal Forms 1040—Line 37;

1040A—Line 21; or 1040EZ—Line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 –

2. Any state income tax refund included in your 2008 federal income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 =

3. Total Missouri Adjusted Gross Income — Subtract Line 2 from Line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Mark your filing status box below and enter the appropriate exemption amount on Line 4.

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

D. Married filing separate — $2,100

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

E. Married filing separate (spouse

tax return — $0.00

NOT filing) — $4,200

F. Head of household — $3,500

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

G. Qualifying widow(er) with

Check which spouse had income:

dependent child — $3,500

Yourself

Spouse

5. Tax from federal return (Do not

Enter this amount on Line 5 or $5,000, whichever is less.

enter amount from your Form W-2(s)—

If married filing combined, enter this amount on Line 5

NOT federal tax withheld.)

or $10,000, whichever is less. . . . . . . . . . . . . . . . . . . .

6. Missouri standard deduction or itemized deductions. Single or Married Filing Separate— $5,450; Head of

Household — $8,000; Married Filing a Combined Return or Qualifying Widow(er) — $10,900 . If you are age 65 or

older, blind, claimed as a dependent, or if you claimed an additional standard deduction, see your federal return

6 +

or page 6. If itemizing, see back of form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Federal Form 1040 OR 1040A, Line 6c

7. Number of dependents you claimed on your

7 +

(Do not include yourself or your spouse.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

8 +

8. Long-term care insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 =

9. Total Deductions — Add Lines 4 through 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Missouri Taxable Income — Subtract Line 9 from Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Tax — Use the tax table on the back of this form to figure the tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Missouri tax withheld from your Form W-2(s) and Form 1099(s). Attach copies

of Form W-2(s) and Form 1099(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. Any Missouri estimated tax payments made for 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Total Payments — Add Lines 12 and 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15. If Line 14 (Total Payments) is more than Line 11 (Total Tax), enter the difference (amount of overpayment)

here. (If Line 14 is less than Line 11, skip to Line 19.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16. Amount from Line 15 that you want applied to next year’s taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17. Enter the amount

Children’s

Veterans

Elderly

Missouri

Workers’

Childhood

After

Addl. Trust

Missouri

General

LEAD

of your donation

Military

Revenue

School

Fund Code

Home

National

Memorial

Lead

Workers

eneral

Family

Retreat

(See Instr.)

in the trust fund

Delivered

Guard

Testing

evenue

Relief

_____|_____

Meals

boxes to the right.

See the instructions

for fund codes.

18. Subtract Lines 16 and 17 from Line 15 and enter here. This is your refund. Sign below and

mail to: Department of Revenue, P.O. Box 3222, Jefferson City, MO 65105-3222. . . . . . . . . . . . . .REFUND

19. If Line 14 is less than Line 11, enter the difference here. You have an amount due. Sign below and

mail to: Department of Revenue, P.O. Box 3370, Jefferson City, MO 65105-3370. . . . . .AMOUNT YOU OWE

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 attachments

E-MAIL ADDRESS

PREPARER’S PHONE

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

YES

SIGNATURE

DATE

PREPARER’S SIGNATURE

FEIN, SSN, OR PTIN

SPOUSE’S SIGNATURE

DAYTIME TELEPHONE

PREPARER’S ADDRESS AND ZIP CODE