Form 40s - Oregon Individual Income Tax Return - 2002
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1Oregon
Form
2002
Individual
40S
For office use only
Income Tax
Date received
FULL-YEAR
Return
RESIDENTS ONLY
SHORT FORM
Last name
Birth year
First name and initial
Social Security No. (SSN)
For office
use only
–
–
1
Spouse’s last name if different and joint return
Spouse’s first name and initial if joint return
Spouse’s SSN, if joint return
Birth year
–
–
2
Current mailing address
Telephone number
(
)
City
State
3
ZIP code
If you filed a return in 2001, and this
address is different, check here ..........
•
1
Single
Exemptions
Severely
Filing
•
Total
Regular
disabled
2
Status
Married filing jointly
6a
6a Yourself
3
Married filing separately
b
6b Spouse
Check
(Spouse’s name)
only one
c
6c All dependents
•
box
(Spouse’s Social Security number)
(First names)
d
4
•
Head of household
(Person who qualifies you)
6d Child(ren) with
(First names)
a disability
•
6e
Total
5
Qualifying widow(er) with dependent child
•
•
7d
Check here to donate your
7a
Check if: You were:
7b
Check if you filed
7c If someone else can claim you
65 or older
Blind
•
kicker refund to the State
an extension
Spouse was:
as a dependent, check here
65 or older
Blind
School Fund. See instructions .
•
8 Wages, salaries, tips, commissions, and other pay for work ........................................
8
•
9 Interest: 9a _____________________ plus dividends: 9b _____________________
9
•
10 Unemployment benefits. See instructions, page 9 .......................................................
10
11 Total income. Add lines 8 through 10 .................................................................................................................
11
•
12 2002 federal tax liability ($0–$3,250; see instructions for the correct amount) .............
12
13 Standard deduction from the back of this form ................................................................
13
14 Add lines 12 and 13 ............................................................................................................................................
14
•
•
15 Oregon taxable income.
Line 11 minus line 14. If line 14 is more than line 11, fill in -0- ...
...............................
15
•
•
16 Tax from tables. See instructions, page 9 ....................................................................
...............................
16
Staple
17
Exemption credit.
Multiply your total exemptions on line 6e by $145 ............................
17
W-2
•
18 Earned income credit. See instructions, page 9 ...........................................................
wage
18
slips
•
19 Working family child care credit. See instructions, page 10 .........................................
19
here
•
20 Child and dependent care credit. See instructions, page 10 ........................................
20
•
21 Other credits (see instructions). Identify ____________________________________
21
22 Total credits. Add lines 17 through 21 ................................................................................................................
22
•
•
23 Net income tax. Line 16 minus line 22. If line 22 is more than line 16, fill in -0- ............
...............................
23
•
24 Oregon income tax withheld. Attach your Form(s) W-2 and 1099 .............................
24
•
•
25
Refund.
If line 24 is more than line 23, you have a refund. Line 24 minus line 23 .......
..........
REFUND
25
•
•
TAX TO PAY
26
Tax to pay.
If line 23 is more than line 24, you have tax to pay. Line 23 minus line 24 ....
....
26
•
CHARITABLE
27 Oregon Nongame Wildlife ..............
$1 ....
$5 ....
$10 ....
27
Other $______
CHECKOFFS
•
28 Child Abuse Prevention ..................
$1 ....
$5 ....
$10 ....
28
Other $______
I wish to
These will
•
donate
29 Alzheimer’s Disease Research .......
$1 ....
$5 ....
$10 ....
29
Other $______
reduce
part of my
•
30 Stop Domestic & Sexual Violence ..
$1 ....
$5 ....
$10 ....
30
your refund
Other $______
tax refund
to the
•
31 AIDS/HIV Education and Services ..
$1 ....
$5 ....
$10 ....
31
Other $______
following
•
•
32 Other charity. Enter code
____ ....
$1 ....
$5 ....
$10 ....
32
Other $______
fund(s)
33 Total. Add lines 27 through 32. Total can’t be more than your refund on line 25 .................................................
33
34
NET REFUND.
Line 25 minus line 33. This is your net refund ...................................................
NET REFUND
34
•
DIRECT
35 For direct deposit of your refund, see the instructions on page 12.
Type of Account:
Checking or
Savings
DEPOSIT
•
•
Routing No.
Account No.
Under penalties for false swearing, I declare that I have examined this return, including accompanying schedules and state-
I authorize the Department of Revenue
ments. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person other than the taxpayer,
to discuss this return with
this declaration is based on all information of which the preparer has any knowledge.
this preparer.
Yes
No
Your signature
Date
License No.
Signature of preparer other than taxpayer
X
X
SIGN
HERE
Telephone No.
Spouse’s signature
Date
Address
(if filing jointly, BOTH must sign)
X
150-101-044 (Rev. 12-02)
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