Form 40 - Individual Income Tax Return - 2015 Page 2

15000240

Form 40 (2015)

Page 2

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1

1 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART I

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2 Business income or (loss) (attach Federal Schedule C or C-EZ) (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

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3 Gain or (loss) from sale of Real Estate, Stocks, Bonds, etc. (attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

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4a Total IRA distributions

4a

4b Taxable amount (see instructions). . . . . . . . . . . . . . . . . . . . . . . . .

4b

Other

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5a Total pensions and annuities

5a

5b Taxable amount (see instructions). . . . . . . . . . . . . . . . . . . . . . . . .

5b

Income

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6

6 Rents, royalties, partnerships, estates, trusts, etc. (attach Schedule E). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(See page 13)

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7 Farm income or (loss) (attach Federal Schedule F). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

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8 Other income (state nature and source — see instructions)

8

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9 Total other income. Add lines 1 through 8. Enter here and also on page 1, line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

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1a Your IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1a

PART II

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b Spouse’s IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1b

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2 Payments to a Keogh retirement plan and self-employment SEP deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

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3 Penalty on early withdrawal of savings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

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4 Alimony paid. Recipient’s last name

Social security no.

4

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5 Adoption expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5

Adjustments

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6 Moving Expenses (Attach Federal Form 3903) to City

State

ZIP

6

to Income

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7 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

(See page 16)

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8

8 Payments to Alabama College Counts 529 Fund or Alabama PACT Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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9 Health insurance deduction for small employer employee (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

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10 Costs to retrofit or upgrade home to resist wind or flood damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

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11 Deposits to a catastrophe savings account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

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12 Total adjustments. Add lines 1 through 11. Enter here and also on page 1, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12

(4) Did you provide

PART III

Dependents:

1a

(2) Dependent’s social security

(3) Dependent’s

more than one-half

(1) First name

Last name

number.

relationship to you.

dependent's support?

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Dependents

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Do not include

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yourself or

•

your spouse

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b Total number of dependents claimed above. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Amount allowed. (Multiply the total number of dependents claimed on line 1b by the amount from the dependent chart on page 10.)

(See page 17)

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Enter amount here and on page 1, line 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

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1 Residency Check only one box

Full Year

Part Year

From

2015 through

2015.

PART IV

2 Did you file an Alabama income tax return for the year 2014?

Yes

No If no, state reason

General

3 Give name and address of present employer(s). Yours

Information

Your Spouse’s

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4 Enter the Federal Adjusted Gross Income

$

and Federal Taxable Income

$

as reported on your 2015 Federal

All Taxpayers

Individual Income Tax Return.

Must Complete

5 Do you have income which is reported on your Federal return, but not reported on your Alabama return (other than your state tax refund)?

Yes

No

This Section.

If yes, enter source(s) and amount(s) below: (other than state income tax refund)

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Source

Amount

(See page 17)

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Source

Amount

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I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.

Sign Here

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are

In Black Ink

true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature

Date

Daytime telephone number

Your occupation

Keep a copy

(

)

of this return

Spouse’s signature (if joint return, BOTH must sign)

Date

Daytime telephone number

Spouse’s occupation

for your records.

(

)

Date

Preparer’s SSN or PTIN

Preparer’s

Check if

Paid

•

signature

self-employed

Preparer’s

Firm’s name (or yours

Daytime telephone no. (

)

E.I. No.

Use Only

if self-employed)

ZIP Code

and address

If you are not making a payment, mail your return to:

If you are making a payment, mail your return, Form 40V, and payment to:

WHERE TO

Alabama Department of Revenue

Alabama Department of Revenue

FILE

P.O. Box 154

P.O. Box 2401

Montgomery, AL 36135-0001

Montgomery, AL 36140-0001

FORM 40

Mail only your 2015 Form 40 to one of the above addresses. Prior year returns, amended returns, and all other correspondence should be mailed to

Alabama Department of Revenue, P.O. Box 327464, Montgomery, AL 36132-7464.

ADOR