Form It-40 - Indiana Full-Year Resident Individual Income Tax Return - 2001
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Indiana Full-Year Resident Individual
2001
IT-40
Due April 15, 2002
Income Tax Return
State Form 154
(R / 8-01)
If you are not filing for the calendar year January 1 through December 31, 2001,enter period from: _________to: _________
Check the box if you
Your Social
Spouse’s Social
are married filing
Security Number
Security Number
C
separately.
A
B
Your first name
Initial
Last name
F
D
E
If filing a joint return, spouse’s first name
Initial
Last name
G
H
I
Present address (number and street or rural route) (If you have a P.O. box, see page 5.)
School District
Number (see page 34)
N
J
City
State
Zip Code + 4
Foreign Country
(if applicable)
L
M
O
K
If you have a loss (or negative entry),
Enter the 2-digit county code numbers (found on page 6 in the instruction booklet) for the
please indicate so by placing it in a
county where you lived and worked on January 1, 2001.
bracket. Example: ( 1.00 )
Taxpayer
Spouse
P
Q
R
S
Please round all entries to
County where
County where
County where
County where
nearest whole dollar
you lived
you worked
you lived
you worked
(see instructions, pg 7)
1
1. Enter your federal adjusted gross income from your federal return (see page 9) .........................
2
2. Tax Add-Back: certain taxes deducted from federal Schedule C, C-EZ, E, and/or F ....................
3
3. Net operating loss carryforward from federal Form 1040, ‘Other income’ line ..............................
4
4. Income taxed on federal Form 4972 (attach Form 4972: see page 9) .........................................
5
5. Add lines 1 through 4 ................................................................................Total Indiana Income
6
6. Indiana deductions: Enter amount from Schedule 1, line 20 and attach Schedule 1 ...................
7
7. Line 5 minus line 6 ................................................................. Indiana Adjusted Gross Income
8. Number of exemptions claimed on your federal return
x $1,000.
00
8
(If no federal return was filed, enter $1,000 per qualifying person: see page 14.) ........................
9. Additional exemption for certain dependent children (see page 15.)
00
9
Enter number
x $1,500 .....................................................................................................
10. Check box(es) below for additional exemptions if, by December 31, 2001:
You were:
65 or older
or blind. Spouse was:
65 or older
or blind.
00
10
Total the number of boxes checked
x $1,000 .................................................................
11. Check box(es) below for additional exemptions if, by December 31, 2001:
You were:
65 or older and line 1 above is less than $40,000.
Spouse was:
65 or older and line 1 above is less than $40,000.
00
11
Total the number of boxes checked
x $500 ....................................................................
12
00
12. Add lines 8, 9, 10 and 11 ............................................................................... Total Exemptions
13
13. Line 7 minus line 12
..................... State Taxable Income
(if answer is less than zero, leave blank)
14
14. State adjusted gross income tax: Multiply line 13 by 3.4% (.034) ................................................
15
15. County income tax. See instructions on page 15 .........................................................................
16
16. Use tax due on out-of-state purchases (see page 18) ...................................................................
17
17. Household employment taxes: Attach Schedule IN-H (see page 18) ...........................................
18
18. Add lines 14 through 17. Enter here and on line 27 on the back ................................ Total Tax
19
19. Indiana state tax withheld:
......................
(From box 17 of your W-2s, box A of WH-18s or from 1099s)
20
20. Indiana county tax withheld:
(From box 19 of your W-2s, box B of WH-18s or from 1099s) ...................
21
21. 2001 Estimated tax paid: Include any extension payment made on Form IT-9 ............................
22
22. Unified tax credit for the elderly: see instructions on page 19 .................................................
23
23. Earned income credit: Enter amount from Section D, line D4 and attach Schedule IN-EIC ........
24
24. Lake County residential income tax credit (see page 24) ..............................................................
25
25. Indiana credits: Enter the total from Schedule 2, line 12 and attach Schedule 2 ..........................
26
26. Add lines 19 through 25. Enter here and on line 28 on the back ...........................Total Credits
Turn the page
DD
AA
BB
CC
TT
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