Form Mo-1040a - Individual Income Tax Return Single/married (One Income) - 2004

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2004 FORM MO-1040A

MISSOURI DEPARTMENT OF REVENUE

INSTRUCTIONS

INDIVIDUAL INCOME TAX RETURN

- Enter numbers without decimals (integers)

VENDOR CODE

SINGLE/MARRIED (ONE INCOME)

- Don't forget to attach all required forms

(Assigned by DOR)

- You can tab from one field to another or use the mouse to click

SOCIAL SECURITY NUMBER

SPOUSE’S SOCIAL SECURITY NUMBER

in the field you want.

- Use the print button at the top of page to print form

NAME (LAST)

(FIRST)

M.I. JR, SR

- Click on the blue boxes to carry an amount to another field.

- If a field does not allow a negative number, and a negative

number is entered, a zero will be displayed.

SPOUSE’S (LAST)

(FIRST)

M.I. JR, SR

- If you are using Adobe Reader, the data cannot be saved—you

must print the forms, sign the forms and mail to the Department

IN CARE OF NAME (ATTORNEY, EXECUTOR, PERSONAL REP., ETC.)

PRESENT ADDRESS (INCLUDE APARTMENT NO. OR RURAL ROUTE)

COUNTY OF RESIDENCE

SCHOOL DISTRICT NO.

SELECT COUNTY

SELECT or TYPE SCHOOL DISTRICT

PLEASE CHECK THE APPROPRIATE BOXES THAT APPLY TO YOURSELF OR YOUR SPOUSE.

CITY, TOWN, OR POST OFFICE

STATE

ZIP CODE

AGE 65 OR OLDER

BLIND

100% DISABLED

NON-OBLIGATED SPOUSE

YOURSELF

SPOUSE

1. Federal adjusted gross income from your 2004 Federal Forms 1040—Line 36;

1040A—Line 21; 1040EZ—Line 4; or TeleFile—Line I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Any state income tax refund included in your 2004 federal income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Total Missouri Adjusted Gross Income — Subtract Line 2 from Line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Mark your filing status box below and enter the appropriate exemption amount on Line 4.

A. Single — $2,100 (See Box B before checking.)

D. Married filing separate — $2,100

B. Claimed as a dependent on another person’s federal

E. Married filing separate (spouse

tax return — $0.00

NOT filing) — $4,200

C. Married filing joint federal & combined Missouri — $4,200

F. Head of household — $3,500

Check which spouse had income:

G. Qualifying widow(er) with

. . . . . . .

Yourself

Spouse

dependent child — $3,500

5. Tax from federal return (Do not

Single—maximum of $5,000;

enter amount from your Form W-2(s)—

Married filing combined

NOT federal tax withheld.)

—maximum of $10,000 . . . . . . . . . . . . . . . . . . .

6. Missouri standard deduction or itemized deductions. Single — $4,850; Head of Household — $7,150;

Itemized Worksheet

Married Filing Separate — $4,850; Married Filing a Combined Return or Qualifying Widow(er) — $9,700

If claimed as a dependent, age 65 or older, or blind, see federal return. If itemizing, see back of form. . . . . . . .

Federal Form 1040 OR 1040A, Line 6c

7. Number of dependents you claimed on your

(Do not include yourself or your spouse.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

x $1,200 = . . . . . . .

8. Long-term care insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Total Deductions — Add Lines 4 through 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Missouri Taxable Income — Subtract Line 9 from Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Total Tax — Use the tax table on the back of this form to figure the tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Missouri tax withheld from your Form W-2(s) and Form 1099(s). Attach copies

of Form W-2(s) and Form 1099(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. Any Missouri estimated tax payments made for 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Total Payments — Add Lines 12 and 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15. If Line 14 (Total Payments) is more than Line 11 (Total Tax), enter the difference (amount of

overpayment) here. (If Line 14 is less than Line 11, skip to Line 19.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16. Amount from Line 15 that you want applied to next year’s taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Elderly Home

Workers’

Trust Fund Code

Children’s

Veterans

Missouri National

17. Enter the amount of your

(See Instructions)

Delivered

Memorial

Guard

Workers

donation in the trust fund

Meals

____________

boxes to the right. See the

instructions for fund codes.

18. Subtract Lines 16 and 17 from Line 15 and enter here. This is your refund. Sign below and

mail to: Department of Revenue, P.O. Box 3222, Jefferson City, MO 65105-3222. . . . . . . . . . . . . .REFUND

19. If Line 14 is less than Line 11, enter the difference here. You have an amount due. Sign below and

mail to: Department of Revenue, P.O. Box 3370, Jefferson City, MO 65105-3370. . . . . .AMOUNT YOU OWE

The Department of Revenue may electronically resubmit checks returned for insufficient or uncollected funds.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true,

DOR

S E P F

correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which he/she has any knowledge. As provided in Chapter 143, RSMo, a penalty

ONLY

of up to $500 shall be imposed on any individual who files a frivolous return.

PAID PREPARER’S PHONE

I authorize the Director of Revenue or delegate to discuss my return and attachments with the preparer or any member

of the preparer’s firm.

YES

SIGNATURE

DATE

PAID PREPARER’S SIGNATURE

FEIN, SSN, OR PTIN

SPOUSE’S SIGNATURE

DAYTIME TELEPHONE