Form 40n - Oregon Individual Income Tax Return - 2002
ADVERTISEMENT
1
2Oregon
Form
40N
Individual
2002
Income Tax
For office use only
Return
NONRESIDENT
Date received
Fiscal year ending
Oregon resident:
Mo
Day
Year
Mo
Day
Year
From
To
Last name
First name and initial
Birth year
Social Security No. (SSN)
For office
use only
–
–
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
1
–
–
Telephone number
Current mailing address
2
(
)
City
State
3
ZIP code
If you filed a return in 2001, and this
address is different, check here ........
•
Single
1
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
5
Total
Qualifying widow(er) with dependent child
•
•
7d
Check here to donate your
7a
Check if: You were:
7b
Check if you filed
7c Check if you filed a Deferral
65 or older
Blind
•
kicker refund to the State
an extension
of Gain, Form 8824
Spouse was:
65 or older
Blind
School Fund. See instructions .
Federal column
Oregon column
8 Wages, salaries, and other pay for work. Staple all Forms W-2 below ................
8
INCOME
9 Taxable interest income: 9a __________ plus dividend income: 9b ___________
9
10 State and local income tax refunds from federal Form 1040, line 10 ......................
10
11 Alimony received from federal Form 1040, line 11 .................................................
11
12 Business income or loss from federal Form 1040, line 12 ......................................
12
13 Capital gain or loss from federal Form 1040, line 13 ..............................................
13
14 Other gains or losses from federal Form 1040, line 14 ..........................................
14
15 IRA distributions from federal Form 1040, line 15b ................................................
15
Staple W-2
16 Pensions and annuities from federal Form 1040, line 16b .....................................
16
and 1099
forms
17 Rents, royalties, partnerships, etc., from federal Form 1040, line 17 ......................
17
showing
18 Farm income or loss from federal Form 1040, line 18 ............................................
18
Oregon
withholding
19 Unemployment and other income from federal Form 1040, lines 19 through 21 ....
19
here
•
20 Total income. Add lines 8 through 19 ...................................................................
20a
20b
ADJUSTMENTS
21 IRA or SEP and SIMPLE contributions, federal Form 1040, lines 24 and 31 .........
21
TO INCOME
22 Education deductions from federal Form 1040, lines 23, 25, and 26 ......................
22
23 Archer MSA deduction from federal Form 1040, line 27 ........................................
23
24 Moving expenses from federal Form 1040, line 28 ................................................
24
25 Deduction for self-employment tax from federal Form 1040, line 29 ......................
25
26 Self-employed health insurance deduction from federal Form 1040, line 30 ..........
26
27 Penalty on early withdrawal of savings from federal Form 1040, line 32 ................
27
28 Alimony paid from federal Form 1040, line 33a ......................................................
28
29 Total adjustments to income. Add lines 21 through 28 ...........................................
29
•
30 Income after adjustments. Line 20 minus line 29 ..................................................
30a
30b
•
31 Interest on state and local government bonds outside of Oregon ........................
31
ADDITIONS
•
32 Federal election on interest and dividends of a minor child ..................................
32
•
33 Other additions. Identify ____________________________________________
33
•
34 Total additions. Add lines 31 through 33 ...............................................................
34a
34b
•
35 Income after additions. Add lines 30 and 34 .........................................................
35a
35b
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
NOW GO TO THE BACK OF THE FORM.....
150-101-048 (Rev. 12-02)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial