Form 40 - Oregon Individual Income Tax Return (Full-Year Residents Only) - 2003
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1
2Oregon
2003
Form
40
Individual
For office use only
Income Tax
Date received
FULL-YEAR
Return
Fiscal year ending
RESIDENTS ONLY
Last name
First name and initial
Birth year
Social Security No. (SSN)
For office
__ __ __ __
use only
–
–
Spouse’s last name if 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
ZIP code
3
If you filed a return last year, 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
•
•
7a
Check if: You were:
7c Check if you filed an
7b
Check if you filed
65 or older
Blind
an extension...
Oregon Form 24 .......
Spouse was:
65 or older
Blind
Attach a copy of your federal Form 1040, 1040A, 1040EZ, 1040NR, or TeleFile Tax Record. Do not attach federal schedules.
8 Federal adjusted gross income. Federal Form 1040, line 34; 1040A, line 21;
.00
•
•
1040EZ, line 4; 1040NR, line 33; or TeleFile Tax Record, line I. See instructions ....
................................
8
•
.00
9 Interest on state and local government bonds outside of Oregon .............................
ADDITIONS
9
•
.00
10 Other additions. Identify ______________________________________________
10
.00
11 Total additions. Add lines 9 and 10 .................................................................................................................
11
.00
12 Income after additions. Add lines 8 and 11 .....................................................................................................
12
.00
•
13 2003 federal tax liability ($0–$3,500; see instructions for the correct amount) ..........
13
SUBTRACTIONS
•
.00
14 Social Security included on federal Form 1040, line 20b; or Form 1040A, line 14b ...
14
•
.00
15 Oregon income tax refund included in federal income ..............................................
15
Staple
.00
•
16 Interest from U.S. government, such as Series EE and HH bonds ...........................
16
W-2
.00
•
17 Federal pension income (see instructions on page 28) ______% .............................
wage
17
slips
•
.00
18 Other subtractions. Identify ____________________________________________
18
here
.00
19 Total subtractions. Add lines 13 through 18 ....................................................................................................
19
.00
20 Income after subtractions. Line 12 minus line 19 ............................................................................................
20
If you are claiming itemized deductions, fill in lines 21–25. If you are claiming the standard deduction, fill in line 26 only.
DEDUCTIONS
.00
•
21 Itemized deductions from Schedule A, line 28 ..........................................................
21
•
.00
22 Special Oregon medical deduction (age restricted, see instructions, page 30) .........
22
.00
23 Total Oregon itemized deductions. Add lines 21 and 22 .............................................
23
.00
•
24 State income tax claimed as an itemized deduction from Schedule A, line 5 ......
24
.00
25 Net Oregon itemized deductions. Line 23 minus line 24 ............................................
25
Either line 25 or 26
OR
.00
•
26 Standard deduction from page 31 ............................................................................
26
.00
27 Total deductions. Line 25 or line 26, whichever is larger .............................................................................
27
•
•
.00
28 Oregon taxable income. Line 20 minus line 27. If line 27 is more than line 20, fill in -0- ....
................................
28
NOW GO TO THE BACK OF THE FORM.....
150-101-040 (Rev. 12-03)
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