Form 40 - Oregon Individual Income Tax Return (Full-Year Residents Only) - 2003 Page 2
ADVERTISEMENT
1
2Page 2 —2003 Form 40
.00
29 Oregon taxable income from front of form, line 28 ...........................................................................................
29
.00
•
30 Tax. See page 23 for t ax tables or charts and enter tax here .....................................
30
EITHER,
OR
NOT BOTH
.00
•
31 Check if tax is from:
Form FIA-40 or
Worksheet FCG and enter tax here .....
31
.00
•
32 Interest on certain installment sales .......................................
32
.00
33 Total tax. Add lines 30 and 32 OR add lines 31 and 32 ........................................................ OREGON TAX
33
.00
•
CREDITS
34 Exemption credit. Multiply your total exemptions on line 6e by $147 ......................
34
.00
•
35 Earned income credit. See instructions, page 32 ......................................................
35
.00
•
36 Retirement income credit. See instructions, page 32 ................................................
36
.00
•
37 Child and dependent care credit. See instructions, page 33 .....................................
37
ADD TOGETHER
.00
•
38 Credit for the elderly or the disabled. See instructions, page 33 ...............................
38
.00
•
39 Political contribution credit. See limits, page 33 ........................................................
39
.00
•
40 Credit for income taxes paid to another state. State:______________. Attach proof
40
.00
•
41 Other credits. Identify_________________________________________________
41
.00
42 Total credits. Add lines 34 through 41 .............................................................................................................
42
.00
•
•
43 Tax after credits. Line 33 minus line 42. If line 42 is more than line 33, fill in -0- .......
................................
43
.00
•
SURCHARGE
44 Surcharge. See instructions, page 35 .......................................................................
44
.00
•
•
45 Net income tax. Add lines 43 and 44 ........................................................................
................................
45
.00
•
TAX
46 Oregon income tax withheld. Attach Form(s) W-2 and 1099 ..................................
46
PAYMENTS,
.00
ADD TOGETHER
•
47 Estimated tax payments for 2003. Include payments made with your extension ....
47
PENALTY,
.00
•
48 Working family child care credit. Attach Schedule WFC, see page 21 ....................
AND
48
INTEREST
.00
49 Total payments. Add lines 46, 47, and 48 ........................................................................................................
49
.00
•
•
50
Overpayment.
If line 45 is less than line 49, you overpaid. Line 49 minus line 45 ...
OVERPAYMENT
50
•
.00
•
TAX TO PAY
51
Tax to pay.
....
51
If line 45 is more than line 49, you have tax to pay. Line 45 minus line 49 ....
.00
52 Penalty and interest for filing or paying late. See instructions, page 36 .........................
52
.00
•
53 Interest on estimated tax underpayment.
Attach Form 10 and check here
.......
53
.00
54 Total penalty and interest due. Add lines 52 and 53 ........................................................................................
54
.00
55
Amount you owe.
Line 51 plus line 54 ...................................................................
AMOUNT YOU OWE
55
.00
REFUND
56
Refund.
Is line 50 more than line 54? If so, line 50 minus line 54 ...............................................
56
•
.00
57
Estimated tax.
Fill in the part of line 56 you want applied to 2004 estimated tax ............
57
.00
•
CHARITABLE
58 Oregon Nongame Wildlife ..............
$1 ...
$5 ...
$10 ....
58
Other $______
CHECKOFFS
These will
.00
•
59 Child Abuse Prevention ..................
$1 ...
$5 ...
$10 ....
59
Other $______
I wish to
reduce
.00
donate
•
60 Alzheimer’s Disease Research .......
$1 ...
$5 ...
$10 ....
60
Other $______
your refund
part of my
.00
•
61 Stop Domestic & Sexual Violence ..
$1 ...
$5 ...
$10 ....
61
Other $______
tax refund
to the
.00
•
62 AIDS/HIV Education and Services ..
$1 ...
$5 ...
$10 ....
62
Other $______
following
.00
•
•
63 Other charity. Enter code
____ ....
$1 ...
$5 ...
$10 ....
63
fund(s)
Other $______
.00
64 Total. Add lines 57 through 63. Total can’t be more than your refund on line 56 ..............................................
64
.00
65
NET REFUND.
Line 56 minus line 64. This is your net refund ............................................
NET REFUND
65
•
DIRECT
66 For direct deposit of your refund, see the instructions on page 38.
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
I authorize the Department of
statements. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person other
Revenue to discuss this return
than the taxpayer, this declaration is based on all information of which the preparer has any knowledge.
with this preparer.
Your signature
Date
License No.
Signature of preparer other than taxpayer
X
SIGN
X
HERE
Address
Telephone No.
Spouse’s signature
(if filing jointly, BOTH must sign)
Date
X
Important: Attach a copy of your federal Form 1040, 1040A, 1040EZ, 1040NR, or TeleFile Tax Record.
Make check or money order payable to:
Oregon Department of Revenue.
Write your Social Security number and
“2003 Form 40”
on your payment. Attach your payment to
Form
RPC—the payment coupon on page 37.
Oregon Department of Revenue
REFUND
Mail
TAX-TO-PAY
Mail
REFUND
returns and
PO Box 14555
PO Box 14700
returns to
NO-TAX-DUE
returns to
Salem OR 97309-0940
Salem OR 97309-0930
150-101-040 (Rev. 12-03)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial