Clear Form
FORM
OREGON AMENDED
40X
For Offi ce Use Only
INDIVIDUAL INCOME
Original return number
Date received
TAX RETURN
Code
Tax
P&I
Pay ment Amount
Check if amending to change from
FOR TAX YEAR _________
married fi ling separate to fi ling joint.
Last name
First name and initial
Social Security number (SSN)
Date of Birth
(mm/dd/yyyy)
—
—
Spouse’s last name, if different and joint return
Spouse’s fi rst name and initial, if joint return
Spouse’s SSN if joint return
Spouse’s
Date of Birth
(mm/dd/yyyy)
—
—
Current mailing address
City
State
ZIP code
Telephone number
(
)
A.
B.
C.
As Originally
Net Change
Reported or
(increase or
Correct
INCOME AND DEDUCTIONS
as Adjusted
decrease)
Amount
(Please read instructions)
)
(see specifi c inst.)
(explain on the back
1. Income............................................................................................................................1
2. Additions (Form 40 only) ................................................................................................2
3. Federal tax liability (Form 40S only)...............................................................................3
4. Subtractions (Form 40 only) ...........................................................................................4
5. Deductions (standard deduction or itemized deductions) ..............................................5
6. Oregon taxable income ..................................................................................................6
TAX AND CREDITS
7. TAX.................................................................................................................................7
8. Interest on certain installment sales ...............................................................................8
9. TOTAL OREGON TAX (add lines 7 and 8).....................................................................9
10. Exemption credit (see instructions) ..............................................................................10
11. Other credits (do not include working family credit for tax year 2003 and later) .......... 11
12. Total credits (add lines 10 and 11) (
the total can’t be more than amount on line 9
) .........12
13. Net income tax (line 9 minus line 12) ...........................................................................13
PAYMENTS
14. Kicker—if applicable (see instructions) ........................................................................14
15. Oregon income tax withheld.........................................................................................15
16. Working family child care credit for tax year 2003 and later ..........................................16
17. Estimated tax payment(s) for the tax year and payments made with ex ten sion re quests ......................................... 17
18. Amount paid with original return and any later payment(s) for the tax year (
).... 18
include only TAX paid—see instructions
19. Total payments (add lines 14 through 18) .................................................................................................................. 19
20. Income tax refunds received (including working family child care credit and kicker refund) ...................................... 20
21. Net payments (line 19 minus line 20) ......................................................................................................................... 21
REFUND OR BALANCE DUE
22. Refund. If line 21 is more than line 13C, you overpaid. Line 21 minus line 13C....................................................... 22
23. Amount of refund on line 22 you want applied to your 200__ estimated tax.............................................................. 23
24. NET REFUND. Line 22 minus line 23. Enter the amount of line 22 you want refunded to you.................................. 24
25. Additional tax to pay. If line 13C is more than line 21, you have tax to pay. Line 13C minus line 21 ....................... 25
26. Interest on additional tax to pay (see instructions) ..................................................................................................... 26
27. AMOUNT YOU OWE. Add lines 25 and 26. Pay in full with this return ...................................................................... 27
Amended returns may take six months or longer to process.
Be sure to complete the back and sign ➛
150-101-046 (Rev. 12-04) Web