Form It-40 - Individual Income Tax Return - 2005 (Page 2 of 4) in pdf

30. Enter the Total Tax from line 21 on the front of this form ..................................................................

31. Enter the Total Credits from line 29 on the front of this form ............................................................

32. If line 31 is more than line 30, subtract line 30 from line 31 (if smaller, skip to line 39) ...................

33.

Amount of line 32 to be donated to the Indiana Nongame Wildlife Fund ............................

(see instructions on page 30) ...............................................................................................

34. Subtract line 33 from line 32 ....................................................................................

SUBTOTAL

35. Amount to be applied to your 2006 estimated tax account (see instructions on page 30) ...............

36. Penalty for underpayment of estimated tax for 2005: attach Schedule IT-2210 or IT-2210A ..........

37. Refund: Line 34 minus lines 35 and 36 (if less than zero see instructions on page 31)......Y

OUR

EFUND

If you want to

38a. Routing Number

DIRECT DEPOSIT

b. Account Number

your refund, see

instructions on page 31.

c. Type of Account

Checking

Savings

Hoosier Works MC

39. If line 30 is more than line 31, subtract line 31 from line 30. Add to this any amounts

from lines 35 and 36, and enter total here (see instructions on page 32) ............

SUBTOTAL

40. Penalty if filed after due date (see instructions on page 32) ............................................................

41. Interest if filed after due date (see instructions on page 32) ............................................................

42. Amount Due: Add lines 39, 40 and 41 ................................................................. A

MOUNT

No payment is due if you owe less than $1. 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.

Out-of-State Income Information

Yourself $

Enter any salary, wage, tip &/or commission received from

Spouse

Illinois, Kentucky, Michigan, Ohio, Pennsylvania and/or Wisconsin:

If two-thirds of your gross income was made from farming or fishing, please check here.

Your Daytime Telephone Number

Important: If you checked the box, you must attach Schedule IT-2210 or IT-2210A .

Spouse’s Daytime Telephone Number

Are you filing a federal income tax return for 2005?

Yes

I authorize the department to discuss my return with my tax preparer.

E-mail address where we can reach you (see page 33)

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 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

(department) to furnish my financial institution with my routing number, account number, account type, and social security number to

ensure my refund is properly deposited. I give permission to the department to contact the Social Security Administration in order to

confirm the Social Security number(s) used on this return are correct.

Your Signature

Date

If any individual listed at the top of the IT-40

died during 2005, enter date of death below.

Taxpayer’s date

2005

of death

Spouse's Signature

Date

Spouse’s date

2005

of death

Paid Preparer’s name

Federal I.D. Number

PTIN

Social Security Number

Address

Preparer’s daytime telephone number

City

Preparer’s Signature

Date

State

Zip Code + 4

Please mail to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.

Keep a copy for your records.

Form It-40 - Individual Income Tax Return - 2005 Page 2

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