Form 40n - Individual Income Tax Return October - 2001 Page 2
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1
2Clear Form
Form 40N
Page 2 –
2001
Federal column
Oregon column
36 Amount from front of form, line 35
36
•
37 Social Security and tier 1 railroad retirement income included on line 19
37
SUBTRACTIONS
•
•
38a
38 Other subtractions. Identify
38b
•
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
DEDUCTIONS
41 Itemized deductions from federal Schedule A, line 28
•
41
AND
42 State income tax claimed as itemized deduction. See instructions, page 17
•
42
EITHER,
MODIFICATIONS
43
43 Net Oregon itemized deductions. Line 41 minus line 42
NOT BOTH
44 Standard deduction from page 17
44
•
45 2001 federal tax ($0 – $3,000, see instructions for the correct amount)
45
•
46 Other deductions and modifications. Identify
46
47 Add lines 44, 45, and 46 or lines 43, 45, and 46. Fill in the larger amount
47
48
48 Allowable deductions and modifications. Line 47
line 40
•
49
49 Deductions and modifications
NOT multiplied by the Oregon percentage. See page 18
50
50 Total deductions and other modifications. Add lines 48 and 49
•
•
51 Oregon taxable income. Line 39b minus line 50
51
•
OREGON
52 Tax on amount shown on line 51. See page 18
52
ADD TOGETHER
TAX
•
53 Interest on certain installment sales
53
54 TOTAL TAX. Add lines 52 and 53
54
55 Exemption credit. Line 6e
$142
Oregon percentage from line 40
CREDITS
55
•
56 Earned income credit. See instructions, page 19
56
•
57 Working family child care credit. See instructions, page 19
57
ADD TOGETHER
•
58 Credit for income taxes paid to another state (AZ, CA, IN, VA). Attach proof
58
•
59 Child and dependent care credit. See instructions, page 20
59
•
60 Other credits. Identify
60
61 Total credits. Add lines 55 through 60
61
•
•
62 Net income tax. Line 54 minus line 61. If line 61 is more than line 54 fill in -0-
62
•
63 Oregon income tax withheld from income. Attach Forms W-2 and 1099
63
TAX
ADD TOGETHER
•
PAYMENTS,
64 Estimated tax payments for 2001 and payments made with your extension
64
PENALTY,
65 Total payments. Add lines 63 and 64
65
AND
•
•
66 Overpayment.
Is line 62 less than line 65? If so, line 65 minus line 62
OVERPAYMENT
66
INTEREST
•
•
TAX-TO-PAY
67 Tax-to-pay.
Is line 62 more than line 65? If so, line 62 minus line 65
67
•
68 Penalty and interest for filing or paying late. See instructions on page 21
68
ADD TOGETHER
•
69 Interest on estimated tax underpayment.
If Form 10 is attached, check
69
70 Total penalty and interest due. Add lines 68 and 69
70
71 Amount-you-owe.
Add lines 67 and 70
Stop here! AMOUNT-YOU-OWE
71
REFUND
72 Refund.
Is line 66 more than line 70? If so, line 66 minus line 70
72
73 Estimated tax.
•
Fill in the part of line 72 you want applied to your 2002 estimated tax
73
•
DONATIONS
$1,
$5,
$10,
Other $ _____
74 Oregon Nongame Wildlife
74
•
$1,
$5,
$10,
Other $ _____
I wish to
75
75 Child Abuse Prevention
These will
donate
•
$1,
$5,
$10,
Other $ _____
reduce
76 Alzheimer’s Disease Research
76
part of my
your refund
•
$1,
$5,
$10,
Other $ _____
tax refund
77
77
Stop Domestic & Sexual Violence
to the
•
$1,
$5,
$10,
Other $ _____
78
78
AIDS/HIV Education and Services
following
•
•
79 Other charity. Enter code ____
$1,
$5,
$10,
Other $ _____
fund(s)
79
80 Total. Add lines 73 through 79. Total can’t be more than your refund on line 72
80
81
Line 72 minus line 80. This is your net refund
NET REFUND.
NET REFUND
81
•
DIRECT
82 For direct deposit of your refund, see the instructions on pages 3 and 22.
Type of account:
Checking or
Savings
DEPOSIT
•
•
Routing No.
Account No.
Attach a Copy of Federal Form 1040, 1040A, or 1040EZ. Do Not Attach Other Federal Schedules.
Under penalties for false swearing, I declare that I have examined this return, including accom-
I authorize the Department of Revenue to discuss
panying schedules and statements. To the best of my knowledge and belief it is true, correct,
this return with this preparer or any member of his
Yes
No
and complete. If prepared by a person other than the taxpayer, this declaration is based on all
or her firm.
information of which the preparer has any knowledge.
Your signature
Date
Signature of preparer other than taxpayer
License No.
X
X
SIGN
HERE
Spouse’s signature (If filing jointly, BOTH must sign)
Date
Address
Telephone No.
X
150-101-048 (Rev. 10-01)
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