Form 40n - Oregon Individual Income Tax Return For Nonresidents - 2011

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Clear Form
OREGON
Amended Return
Form
40N
2011
Individual Income Tax Return
For office use only
FOR NONRESIDENTS
Fiscal year ending
Oregon resident:
mm
dd
yyyy
mm
dd
yyyy
K
F
P
J
From
To
Last name
First name and initial
Date of birth
(mm/dd/yyyy)
Social Security No. (SSN)
Deceased
Spouse’s/RDP’s last name if joint return
Spouse’s/RDP’s first name and initial if joint return
Spouse’s/RDP’s SSN if joint return
Date of birth
(mm/dd/yyyy)
Deceased
Current mailing address
Telephone number
(
)
City
State
ZIP code
Country
If you filed a return last year, and your
name or address is different, check here
Filing
1
Single
Exemptions
Status
2a
Married filing jointly
Total
2b
Registered domestic partners (RDP) filing jointly
Check
6a
6a
Yourself ...........
Regular
...... Severely disabled
....
only
3a
Married filing separately:
one
6b
b
Spouse/RDP ...
Regular
...... Severely disabled
......
Spouse’s name _____________________________ Spouse’s SSN ___________________
box
3b
Registered domestic partner filing separately:
6c
c
All dependents
First names __________________________________
Partner’s name _____________________________ Partner’s SSN ___________________
6d
d
Disabled
First names __________________________________
4
Head of household:
Person who qualifies you ________________________________
children only
Total
6e
5
Qualifying widow(er) with dependent child
(see instructions)
• 
 •
• 
Check
7a
7b
You
7c
You have
7d
7e
If there is a kicker refund,
You filed
all that
You were:
65 or older
Blind
filed an
federal
I want to donate mine to the
Oregon
apply
Spouse/RDP was:
65 or older
Blind
extension
Form 8886
State School Fund
Form 24
Federal column (F)
Oregon column (S)
•  
.00
.00
8 Wages, salaries, and other pay for work. Include all Forms W-2 ........................ 8F
8S
INCOME
•  
.00
.00
9 Taxable interest income from federal Form 1040, line 8a ...................................... 9F
9S
.00
.00
10 Dividend income from federal Form 1040, line 9a ................................................. 10F
10S
.00
.00
11 State and local income tax refunds from federal Form 1040, line 10 .................... 11F
11S
.00
.00
12 Alimony received from federal Form 1040, line 11 ................................................ 12F
12S
.00
.00
Include proof
13 Business income or loss from federal Form 1040, line 12 ..................................... 13F
13S
of withholding
.00
.00
14 Capital gain or loss from federal Form 1040, line 13 ............................................. 14F
14S
(W-2s, 1099s),
.00
.00
15 Other gains or losses from federal Form 1040, line 14 .......................................... 15F
15S
payment,
.00
.00
and
16 IRA distributions from federal Form 1040, line 15b ............................................... 16F
16S
payment
.00
.00
17 Pensions and annuities from federal Form 1040, line 16b ..................................... 17F
17S
voucher
.00
.00
18 Rents, royalties, partnerships, etc., from federal Form 1040, line 17 .................... 18F
18S
.00
.00
19 Farm income or loss from federal Form 1040, line 18 ........................................... 19F
19S
.00
.00
20 Unemployment and other income from federal Form 1040, lines 19 through 21 ... 20F
20S
.00
.00
21 Total income. Add lines 8 through 20 .................................................................
21F
21S
.00
.00
22 IRA or SEP and SIMPLE contributions, federal Form 1040, lines 28 and 32 ......... 22F
22S
ADJUSTMENTS
.00
.00
TO INCOME
23 Education deductions from federal Form 1040, lines 23, 33, and 34 .................... 23F
23S
.00
.00
24 Moving expenses from federal Form 1040, line 26 ................................................ 24F
24S
.00
.00
25 Deduction for self-employment tax from federal Form 1040, line 27 .................... 25F
25S
.00
.00
26 Self-employed health insurance deduction from federal Form 1040, line 29 ........ 26F
26S
.00
.00
27 Alimony paid from federal Form 1040, line 31a ..................................................... 27F
27S
.00
.00
28y $
28 Other adjustments to income. Identify:
28x
28z
28F
28S
Schedule
.00
.00
29 Total adjustments to income. Add lines 22 through 28 ......................................
29F
29S
.00
.00
30 Income after adjustments. Line 21 minus line 29 ...............................................
30F
30S
.00
.00
31 Interest on state and local government bonds outside of Oregon .....................
31F
31S
ADDITIONS
.00
.00
32 Federal election on interest and dividends of a minor child ...............................
32F
32S
.00
.00
33y $
33 Other additions. Identify:
33x
33z
......
33F
33S
Schedule included
• 
.00
.00
34 Total additions. Add lines 31 through 33 ............................................................
34F
34S
• 
.00
.00
35 Income after additions. Add lines 30 and 34 ......................................................
35F
35S
.00
36 Social Security and tier 1 Railroad Retirement Board benefits included on line 20F ...
36F
SUBTRACTIONS
.00
.00
37y $
37 Other subtractions. Identify:
37x
37z
37F
37S
Schedule included
.00
.00
38F
38 Income after subtractions. Line 35 minus lines 36 and 37 .................................
38S
.
Carry this
__ __ __
__ %
39 Oregon percentage. Line 38S ÷ line 38F (not more than 100.0%)
39
amount to line 40
NOW GO TO THE BACK OF THE FORM
150-101-048 (Rev. 12-11)

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