Form Mo-A - Individual Income Tax Adjustments

Attachment Sequence No. 1040-01

2003

MISSOURI DEPARTMENT OF REVENUE

INDIVIDUAL INCOME TAX

FORM

MO-A

ADJUSTMENTS

ATTACH TO FORM MO-1040. SEE INSTRUCTIONS TO ASSIST YOU IN COMPLETING THIS FORM.

LAST NAME

FIRST NAME

INITIAL

SOCIAL SECURITY NO.

SPOUSE’S LAST NAME

FIRST NAME

INITIAL

SPOUSE’S SOCIAL SECURITY NO.

PART 1 — MISSOURI MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME (SEE PAGE 10.)

Y—YOURSELF

S—SPOUSE

ADDITIONS

1. Interest on state and local obligations other than Missouri source (reduced by related expenses

if expenses were over $500) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Partnership;

Fiduciary;

S corporation;

Net Operating Loss (Carryback/Carryforward);

Other (description)

. . . . . . . . . . . . . . . . . . . . . .

3. Nonqualified distribution received from Missouri Savings for Tuition Program (MO$T) (distribution

withdrawn early or distribution not used for qualified higher education expenses) . . . . . . . . . . . . . . . . 3Y

4. Missouri depreciation adjustment (Section 143.121, RSMo) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Y

5. TOTAL ADDITIONS — Add Lines 1, 2, 3, and 4. Enter here and on Form MO-1040, Line 2. . . . .

SUBTRACTIONS

6. Interest from exempt federal obligations included in federal adjusted gross income (reduced by

related expenses if expenses were over $500). Attach a detailed list or all Federal Form 1099(s). 6Y

7. Any state income tax refund included in federal adjusted gross income . . . . . . . . . . . . . . . . . . . . .

Partnership;

Fiduciary;

S corporation;

Railroad retirement benefits;

Other (description)

Attach supporting documentation. 8Y

9. Exempt contributions made to the Missouri Savings for Tuition Program

(MO$T) (maximum contribution subtraction is $8,000 per taxpayer) . . . . . . . . . . . . . . . . . . . . . . . .

10. Missouri depreciation adjustment (Section 143.121, RSMo) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Y

10S

11. TOTAL SUBTRACTIONS — Add Lines 6, 7, 8, 9, and 10. Enter here and on Form MO-1040, Line 4. 11Y

11S

PART 2 — MISSOURI ITEMIZED DEDUCTIONS — Complete this section only if you itemize deductions on your federal

return. Attach a copy of your Federal Form 1040 (pages 1 and 2) and Federal Schedule A.

1. Total federal itemized deductions from Federal Form 1040, Line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. 2003 (FICA) — yourself — Social security $

+ Medicare $

. . .

3. 2003 (FICA) — spouse — Social security $

+ Medicare $

. . .

4. 2003 Railroad retirement tax — yourself (Tier I and Tier II) $

+ Medicare $

. .

5. 2003 Railroad retirement tax — spouse (Tier I and Tier II) $

+ Medicare $

. .

6. 2003 Self-employment tax — Amount from Federal Form 1040, Line 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. TOTAL — Add Lines 1 through 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. State and local income taxes — See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Earnings taxes included in Line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Net state income taxes — Subtract Line 9 from Line 8 or enter Line 8 from the worksheet below. . . . . . . . . . . . . . . . . . . . . . .

11. MISSOURI ITEMIZED DEDUCTIONS — Subtract Line 10 from Line 7. Enter here and on Form MO-1040, Line 14. . . . . . . .

NOTE: IF LINE 11 IS LESS THAN YOUR FEDERAL STANDARD DEDUCTION, SEE INSTRUCTIONS.

Complete this worksheet only if your federal adjusted gross income from Federal Form 1040, Line 34 is more than $139,500 ($69,750 if married filing sepa-

rate). If your federal adjusted gross income is less than or equal to these amounts, do not complete this worksheet. See the instructions for the amount to

enter on Line 10 above. Attach a copy of your Federal Itemized Deduction Worksheet (Page A-6 of Federal Schedule A instructions).

1. Enter amount from Federal Itemized Deduction Worksheet, Line 3

(See page A-6 of Federal Schedule A instructions.) If $0 or less, enter “0”. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Enter amount from Federal Itemized Deduction Worksheet, Line 9

(See page A-6 of Federal Schedule A instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. State and local income taxes from Federal Form 1040, Schedule A, Line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Earnings taxes included on Federal Form 1040, Schedule A, Line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Subtract Line 4 from Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Divide Line 5 by Line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Multiply Line 2 by Line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Subtract Line 7 from Line 5. Enter here and on Form MO-A, Part 2, Line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . .

MO 860-1881 (11-2003)

For Privacy Notice, see the instructions.