Form 40-2015 - Individual Income Tax Return For Full-Year Residents
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2015 Form 40
Oregon
00461501010000
Individual Income Tax Return
for Full-year Residents Only
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Tax year ending:
For office use only
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Amended return. If amending for an NOL, tax year the NOL was generated:
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Calculated using “as if” federal return.
Bankruptcy.
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Extension filed.
Form 24.
W
F
H
First name and initial
Last name
Deceased
Applied for
Date of birth (mm/dd/yyyy)
Social Security number (SSN)
Spouse’s first name and initial
Spouse’s last name
Spouse’s SSN
Spouse’s date of birth (mm/dd/yyyy)
Deceased
Applied for
Current mailing address
•
Filing status
(check only one box)
City
State
ZIP code
1
Single.
2
Married filing jointly.
Country
Phone
3
Married filing separately (enter spouse’s information above).
4
Head of household (with qualifying person).
5
Qualifying widow(er) with dependent child.
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Exemptions
Total
6a Credits for yourself:
Regular;
Severely disabled ............................................................................................................................. 6a
Check box if someone else can claim you as a dependent.
6b Credits for spouse:
Regular;
Severely disabled ............................................................................................................................. 6b
Check box if someone else can claim your spouse as a dependent.
Dependents. List your dependents.
Dependent’s
Check if child
Dependent’s
First name
Last name
Dependent’s SSN
date of birth
with qualifying
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relationship code
disability
(mm/dd/yyyy)
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6c Total number of dependents ...........................................................................................................................................................................
6c
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6d Total number of dependent children with qualifying disability (see instructions) ............................................................................................
6d
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6e Total exemptions. Add 6a through 6d .................................................................................................................................................... Total
6e
Don’t forget!
Include a copy of your federal Form 1040, 1040A, 1040EZ, 1040NR, or 1040NR-EZ or we may adjust your return.
Page 1
150-101-040 (Rev. 12-15)
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