Form It-40 - Indiana Full-Year Resident Individual Income Tax Return - 2001 Page 2
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527. Enter the Total Tax from line 18 on the front of this form ..................................................................
27
28. Enter the Total Credits from line 26 on the front of this form ............................................................
28
29. If line 28 is more than line 27, subtract line 27 from line 28 (if smaller, skip to line 36) ...................
29
30.
Amount of line 29 to be donated to the Indiana Nongame and
Endangered Wildlife Fund (see instructions on page 30) .................................................
30
31. Subtract line 30 from line 29 ....................................................................................
31
SUBTOTAL
32. Amount to be applied to your 2002 estimated tax account (see instructions on page 30) ...............
32
33. Penalty for Underpayment of Estimated Tax for 2001: Attach Schedule IT-2210 or IT-2210A ........
33
34. Refund: Line 31 minus lines 32 and 33 (if less than zero see instructions on page 31)......Y
R
34
OUR
EFUND
If you want to
35a. Routing Number
DIRECT DEPOSIT
b. Account Number
your refund, you must
complete lines
c. Type of Account
Checking
Savings
See Instructions on page 31
35a, b & c on the left.
36. If line 27 is more than line 28, subtract line 28 from line 27. Add to this any amounts
36
from lines 32 and 33, and enter total here (see instructions on page 32) ............
SUBTOTAL
37
37. Penalty if filed after due date (see instructions on page 32) ............................................................
38. Interest if filed after due date (see instructions on page 32) ............................................................
38
39. Amount Due: Add lines 36, 37 and 38 ................................................................. A
Y
O
39
MOUNT
OU
WE
No payment is due if you owe less than $1.00. Do Not Send Cash. Please make your check or money
order payable to: Indiana Department of Revenue. Credit card payers must see page 32 for
instructions.
SS
Note: Check box if paying by credit card.
Out-of-State Income Information
Taxpayer $
T
• Enter any salary, wage, tip &/or commission received from
Spouse
$
Illinois, Kentucky, Michigan, Ohio, Pennsylvania and/or Wisconsin:
U
If any individual listed at the top of the IT-40
V
Taxpayer - Check box if you filed federal Schedule C or C-EZ for 2001.
died during 2001, enter date of death below.
W
Spouse
- Check box if you filed federal Schedule C or C-EZ for 2001.
EE
Taxpayer’s
2001
m
m
d
d
date of death
• If two-thirds of your gross income was made from farming or fishing, please check here.
X
Spouse’s date
Important: If you checked the box, you must attach Schedule IT-2210 or IT-2210A .
2001
FF
m
m
d
d
of death
Y
• Enter the number of motor vehicles you and/or your spouse own or lease.
Z
• Are all these vehicles registered with the Indiana Bureau of Motor Vehicles?
Yes
No
If No, attach an explanation.
Authorization
Under penalty of perjury, I have examined this return and all attachments and to the best of my knowledge and belief, it is true, complete
and correct. I also understand that if this is a joint return, any refund will be made payable to us jointly and each of us is liable for all
taxes due under this return. Also, my request for direct deposit of my refund includes my authorization to the Indiana Department of
Revenue to furnish my financial institution with my routing number, account number, account type, and social security number to
insure my refund is properly deposited.
Your Daytime Telephone Number
GG
HH
Yes
No
I authorize the Department to discuss my return with my tax preparer.
Spouse’s Daytime Telephone Number
II
Your Signature
Date
E-mail address where we can reach you (see page 33)
JJ
Spouse's Signature
Date
Paid Preparer’s name
KK
Federal I.D. Number,
PTIN
OR
Social Security Number
MM
LL
Address
Preparer’s daytime telephone number
NN
City
RR
OO
Preparer’s Signature
Date
State
Zip Code + 4
PP
QQ
Please mail to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.
Keep a copy for your records.
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