Form 40p - Oregon Individual Incometax Return - 1999

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Form
Oregon
1999
0
Individual
4
P
IncomeTax
For office use only
PART-YEAR RESIDENT
Return
Date received
Fiscal year ending
Oregon resident:
Mo
Day
Year
Mo
Day
Year
From
To
Last name
First name and initial
Birth Year
Enter your Social Security No. (SSN)
Remember
Spouse’s
Spouse’s last name if different and joint return
Spouse’s first name and initial if joint return
Enter Spouse’s SSN, if joint return
to write
Birth Year
in your
Current mailing address
Telephone number
Social
(
)
Security No.
City
State
ZIP Code
If you filed a return in 1998, and this
address is different, check here
1
Single
Severely
Filing
Exemptions
Regular
disabled
Total
2
Married filing jointly
Status
6a Yourself
6a
3
Married filing separately
(Spouse’s name)
6b Spouse
b
Check
only one
c
6c All dependents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Spouse’s Social Security number)
box
4
Head of household
d
6d Disabled
(Person who qualifies you)
children only
(First names)
5
Qualifying widow(er) with dependent child
Total
6e
1
2
3
For office
7 Check if:
You were:
65 or older
Blind
Check if you filed an extension
use only
Spouse was:
65 or older
Blind
Federal column
Oregon column
INCOME
8
8 Wages, salaries and other pay for work. Staple all Forms W-2 below . . . . . . . . . .
9
9 Taxable interest income 9a ___________ plus dividend income 9b ____________
10
10 State and local income tax refunds from federal Form 1040, line 10 . . . . . . . . . . . . .
11
11 Alimony received from federal Form 1040, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
12 Business income or loss from federal Form 1040, line 12 . . . . . . . . . . . . . . . . . . . . .
13
13 Capital gain or loss from federal Form 1040, line 13 . . . . . . . . . . . . . . . . . . . . . . . . .
14
14 Other gains or losses from federal Form 1040, line 14 . . . . . . . . . . . . . . . . . . . . . . . .
15
15 Total IRA distributions from federal Form 1040, line 15b . . . . . . . . . . . . . . . . . . . . . .
16
16 Pensions and annuities from federal Form 1040, line 16b . . . . . . . . . . . . . . . . . . . . .
17
17 Rents, royalties, partnerships, etc., from federal Form 1040, line 17 . . . . . . . . . . . . .
18
18 Farm income or loss from federal Form 1040, line 18 . . . . . . . . . . . . . . . . . . . . . . . .
19
19 Unemployment and other income from federal Form 1040, lines 19 through 21 . . . .
20a
20b
20 Total income. Add lines 8 through 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ADJUSTMENTS TO INCOME
21
21 IRA and Keogh contribution from federal Form 1040, lines 23 and 29 . . . . . . . . . . . .
22
22 Student loan interest deduction from federal form 1040, line 24 . . . . . . . . . . . . . . . .
23
23 Medical savings account deduction from federal Form 1040, line 25 . . . . . . . . . . . . .
24
24 Moving expense from federal Form 1040, line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
25 Deduction for self-employment tax from federal Form 1040, line 27 . . . . . . . . . . . . .
26
26 Self-employed health insurance deduction from federal Form 1040, line 28 . . . . . . .
27
27 Penalty on early withdrawal of savings from federal Form 1040, line 30 . . . . . . . . . .
28
28 Alimony paid from federal Form 1040, line 31a . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
29 Total adjustments to income. Add lines 21 through 28 . . . . . . . . . . . . . . . . . . . . . . .
30a
30b
30 Income after adjustments. Line 20 minus line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . .
ADDITIONS
31
31 Interest on government bonds of states other than Oregon . . . . . . . . . . . . . . . . . . .
32
32 Federal election on interest and dividends of a minor child
. . . . . . . . . . . . . . . . . . .
33
33 Other additions. Identify ______________________________________________
34a
34b
34 Total additions. Add lines 31 through 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35a
35b
35 Income after additions. Add lines 30 and 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mail tax-to-pay returns to:
Mail refund returns and no-tax-due returns to:
Oregon Department of Revenue, PO Box 14555, Salem OR 97309-0940
REFUND, PO Box 14700, Salem OR 97309-0930
150-101-055 (Rev. 9-99)
NOW GO TO THE BACK OF THE FORM

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