Form Mo-1040a - Single/married With One Income - Short Form

SINGLE/MARRIED WITH ONE INCOME — SHORT FORM

2000

FORM MO-1040A

MISSOURI INDIVIDUAL INCOME TAX RETURN

YOUR LAST NAME

FIRST NAME

MIDDLE INITIAL

YOUR SOCIAL SECURITY NUMBER

SPOUSE’S LAST NAME

FIRST NAME

MIDDLE INITIAL

YOUR SPOUSE’S SOCIAL SECURITY NUMBER

PRESENT ADDRESS (INCLUDE APT. NO. OR RURAL ROUTE)

COUNTY OF RESIDENCE

SCHOOL DISTRICT NO.

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

PLEASE CHECK THE APPROPRIATE BOXES THAT APPLY TO YOU/YOUR SPOUSE

AGE 65 OR OLDER

BLIND

100% DISABLED

NON-OBLIGATED SPOUSE

YOURSELF

SPOUSE

YOURSELF

SPOUSE

YOURSELF

SPOUSE

YOURSELF

SPOUSE

1. What did you report as your total income on your 2000 federal return?

. . . . . . . .

2 –

2. Subtract any state income tax refund included in your 2000 federal income.

. . . . . .

3 =

3. TOTAL MISSOURI INCOME. Subtract Line 2 from Line 1. . . . . . . . . . . . . . . . . . . . . . . .

4. Mark your filing status box below and enter exemption amount here.

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

A. Single — $2,100 (See Box B before checking)

See FAQ

D. Married filing separate — $2,100

B. Claimed as a dependent on another person’s federal

E. Married filing separate (spouse

tax return — $0.00

C. Married filing joint federal & combined Missouri — $4,200

NOT filing) — $4,200

F. Head of household — $3,500

(Only one spouse with income)

G. Qualifying widow(er) with

Check which spouse had income:

CAUTION!

dependent child — $3,500

Yourself

Spouse

5. What was your federal income tax

Enter this amount or $5,000 ($10,000 if

reported on your 2000 federal return?

married filing combined), whichever is less. . . .

6 +

6. What is your standard or itemized deduction (see back of form for amounts)?

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

7. Enter the total number of dependents you claimed on your federal

Do not

7 +

return and multiply by $1,200. (Do not include yourself or spouse.)

x $1,200 . . . .

include

yourself or

8. Enter the total number of dependents age 65 or older claimed on your

your

8 +

federal return and multiply by $1,000. (Do not include yourself or your spouse.)

x $1,000 .

spouse.

9 +

9. Enter your long-term care insurance deduction

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

10 =

10. TOTAL DEDUCTIONS. Add Lines 4 through 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ENCLOSE

11. TOTAL MISSOURI INCOME (Line 3) minus TOTAL DEDUCTIONS

COPY OF

(Line 10). This is your Missouri taxable income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

W-2(s)/

1099-R(s)

12. TOTAL TAXES. Use the tax table on the back of this form to figure the tax.

. . . . .

13. What is the Missouri withholding for you or your spouse?

Enter the total amount from all Form W-2(s) and Form 1099-R(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Did you make any Missouri estimated tax payments for 2000? If so, include

any amount of your 1999 refund credited to your 2000 estimated payments.

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

15. TOTAL PAYMENTS. Add Lines 13 and 14 and enter amount here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16. If amount of TOTAL PAYMENTS (Line 15) is larger than amount of TOTAL TAXES (Line 12),

enter the difference here. You have overpaid. If not, enter the amount on Line 20. . . . . . . . . . . . . . . . . . .

Children’s

Veterans

Elderly Home

Missouri National

17. You may donate part of your refund or contribute additional payments to any

Trust Fund

Delivered Meals

Guard Trust Fund

Trust Fund

or all of the trust funds listed to the right. Please indicate your choices and

the amount of your donation for each fund in the appropriate boxes. . . . . . . .

18. What is the amount from Line 16 you want applied to next year’s taxes?

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

19. Your REFUND. Line 16 minus Lines 17 and

20. If Line 15 is less than Line 12, you have an

18. Mail to: Department of Revenue,

AMOUNT DUE. Mail to: Department of Revenue,

P.O. Box 500, Jefferson City,

P.O. Box 329, Jefferson

MO 65106-0500. . . . . . . . . . . . .

City, MO 65107-0329. . . .

DOR

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct and complete. Declaration of preparer

S E P

(other than taxpayer) is based on all information of which he/she has any knowledge. As provided in Chapter 143, RSMo, a penalty of up to $500 shall be imposed on any individual who files a frivolous return.

ONLY

PREPARER’S PHONE NUMBER

I authorize the Director of Revenue or delegate to discuss my return and enclosures with the preparer or any member of his/her firm.

YES

YOUR SIGNATURE

DATE

PREPARER’S SIGNATURE

FEIN, SSN OR PTIN

SPOUSE’S SIGNATURE

DAYTIME TELEPHONE

PREPARER’S ADDRESS AND ZIP CODE

DATE