Form 40p - 2004 Individual Income Tax Return For Part-Year Residents Page 2
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1
2Page 2 — 2004 Form 40P
Federal column
Oregon column
.00
.00
36 Amount from front of form, line 35...........................................................................
36
.00
•
SUB TRAC TIONS
37 Social Security and tier 1 Railroad Retirement Board benefi ts included on line 20....
37
.00
.00
•
•
38 Other subtractions. Identify _________________________________________
38a
38b
.00
.00
•
39 Income after subtractions. Line 36 minus lines 37 and 38 ......................................
39a
39b
__ __ __.__ %
40 Oregon percentage. Line 39b ÷ line 39a (not more than 100%) ........
40
➛
.00
41 Amount from line 39a (federal amount)...................................................................
41
DEDUCTIONS
.00
•
42 Item ized deductions from federal Schedule A, line 28 ...........................................
42
AND
.00
•
43 State income tax claimed as itemized deduction. See instructions, page 24
..........
43
MODIFICATIONS
EITHER,
.00
44 Net Oregon itemized deductions. Line 42 minus line 43.........................................
44
NOT BOTH
.00
•
45 Standard deduction from page 24..........................................................................
45
.00
•
46 2004 federal tax liability ($0–$4,000; see instructions for the correct amount) ......
46
.00
•
47 Other deductions and modifi cations. Identify ____________________________
47
.00
48 Add lines 45, 46, and 47 or lines 44, 46, and 47. Fill in the larger amount ........................................................
48
.00
49 Taxable income. Line 41 minus line 48 ...........................................................................................................
•
49
OREGON
.00
50 Tax from tax rate charts (see instructions, page 26) ................
50
TAX
51 Oregon income tax. Line 50 ✕ Oregon percentage from line 40..........................
.00
EITHER,
•
51
NOT BOTH
.00
•
52 Or, check if from:
Form FIA or
Worksheet FCG and enter tax here .............
52
.00
•
53 Interest on certain installment sales.......................................
53
➛
.00
54 Total tax. Add lines 51 and 53 OR add lines 52 and 53 ..................................................... OREGON TAX
54
CREDITS
55 Exemption credit. Line 6e ✕ $151 ✕ Oregon percentage from line 40 ..............
.00
•
55
.00
•
56 Earned income credit. See instructions, page 27...................................................
56
ADD TOGETHER
.00
•
57 Child and dependent care credit. See instructions, page 27..................................
57
.00
•
58 Credit for income taxes paid to another state. State:___________. Attach proof
58
.00
•
59 Other credits. Identify______________________________________________
59
.00
60 Total credits. Add lines 55 through 59 ................................................................................................................
60
.00
•
61 Net income tax. Line 54 minus line 60. If line 60 is more than line 54, fi ll in -0- ..............................................
61
PAYMENTS,
.00
•
62 Oregon income tax withheld from income. Attach Forms W-2 and 1099 ............
62
PENALTY, AND
ADD TOGETHER
.00
•
63 Estimated tax payments for 2004 and payments made with your extension ........
INTEREST
63
➛
Attach Schedule
.00
•
Working family child care credit
CREDIT AMOUNT
64
from WFC-N/P, line 20...
64
WFC-N/P if you
.00
•
•
Number from WFC-N/P, line 5
Amount from WFC-N/P, line 17
64a
64b
claim this credit
.00
65 Total payments. Add lines 62, 63, and 64 ...........................................................................................................
65
➛
.00
•
Overpayment.
Is line 61 less than line 65? If so, line 65 minus line 61 .......................
OVERPAYMENT
66
66
➛
.00
TAX TO PAY
•
Is line 61 more than line 65? If so, line 61 minus line 65 ..................................
67
Tax to pay.
67
.00
68 Penalty and interest for fi ling or paying late. See instructions, page 29...................
68
ADD TOGETHER
➛
.00
•
69 Interest on estimated tax underpayment.
Attach Form 10 and check box
.....
69
.00
70 Total penalty and interest due. Add lines 68 and 69...........................................................................................
70
➛
.00
Amount you owe.
AMOUNT YOU OWE
71
Line 67 plus line 70 ......................................................................
71
➛
.00
Is line 66 more than line 70? If so, line 66 minus line 70 .................................................
REFUND
Refund.
72
72
.00
•
Estimated tax.
Fill in the part of line 72 you want applied to 2005 estimated tax ....
73
73
.00
CHARITABLE
•
74 Oregon Nongame Wildlife ...............
$1 ....
$5 ....
$10 .....
74
Other $_____
CHECKOFFS
.00
•
75 Child Abuse Prevention...................
$1 ....
$5 ....
$10 .....
These will
75
Other $_____
I want to
reduce
.00
•
donate part
76 Alzheimer’s Disease Research .......
$1 ....
$5 ....
$10 .....
76
Other $_____
your refund
of my tax
.00
•
77 Stop Domestic & Sexual Violence...
$1 ....
$5 ....
$10 .....
77
Other $_____
refund to
the following
.00
•
78 AIDS/HIV Education and Services ..
$1 ....
$5 ....
$10 .....
78
Other $_____
fund(s)
.00
•
•
79 Other charity. Enter code
____ ....
$1 ....
$5 ....
$10 .....
79
Other $_____
.00
80 Total. Add lines 73 through 79. Total can’t be more than your refund on line 72 ...............................................
80
➛
.00
...............................................NET REFUND
NET REFUND.
81
Line 72 minus line 80. This is your net refund
81
DIRECT
•
Type of Account:
Checking or
82 For direct deposit of your refund, see the instructions on page 32.
Savings
DE POS IT
•
•
Routing No.
Account No.
I authorize the Department of Rev-
Under penalties for false swearing, I declare that I have examined this return, including ac com pa ny ing sched ules
and statements. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person
enue to contact this preparer about
other than the taxpayer, this dec la ra tion is based on all in for ma tion of which the preparer has any knowledge.
the processing of this return.
Your signature
License No.
Signature of preparer other than taxpayer
Date
X
X
Telephone No.
Address
Spouse’s signature
(if fi ling jointly, BOTH must sign)
Date
X
150-101-055 (Rev. 12-04)
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