Form 40n - Oregon Individual Income Tax Return - 2000

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Oregon
Form
2000
N
40
Individual
Income Tax
For office use only
Return
Date received
NONRESIDENT
Fiscal year ending
Oregon resident:
Mo
Day
Year
Mo
Day
Year
From
To
Last name
First name and initial
Birth year
For office
Enter your Social Security No. (SSN)
use only
1
Spouse’s last name if different and joint return
Spouse’s first name and initial if joint return
Enter spouse’s SSN, if joint return
Spouse’s
birth year
2
Current mailing address
Telephone number
(
)
3
City
State
ZIP code
If you filed a return in 1999, and this
address is different, check here
•
1
Single
Severely
Exemptions
•
Filing
Regular
disabled
Total
2
Married filing jointly
Status
6a Yourself
6a
3
Married filing separately
Check
6b Spouse
b
(Spouse’s name)
only one
•
c
6c All dependents
(Spouse’s Social Security number)
box
(First names)
4
•
Head of household
d
6d Disabled
(Person who qualifies you)
children only
(First names)
6e
5
•
Qualifying widow(er) with dependent child
Total
Check here to donate your kicker
•
•
7 Check if:
You were:
65 or older
Blind
Check if you filed an extension
•
refund to the School Fund
•
•
65 or older
Blind
Spouse was:
Federal column
Oregon column
INCOME
8 Wages, salaries, and other pay for work. Staple all Forms W-2 below
8
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
16 Pensions and annuities from federal Form 1040, line 16b
16
17 Rents, royalties, partnerships, etc., from federal Form 1040, line 17
17
18 Farm income or loss from federal Form 1040, line 18
18
19 Unemployment and other income from federal Form 1040, lines 19 through 21
19
•
20 Total income. Add lines 8 through 19
20a
20b
ADJUSTMENTS TO INCOME
21 IRA and Keogh contribution from federal Form 1040, lines 23 and 29
21
22 Student loan interest deduction from federal form 1040, line 24
22
23 Medical savings account deduction from federal Form 1040, line 25
23
24 Moving expense from federal Form 1040, line 26
24
25 Deduction for self-employment tax from federal Form 1040, line 27
25
26 Self-employed health insurance deduction from federal Form 1040, line 28
26
27 Penalty on early withdrawal of savings from federal Form 1040, line 30
27
28 Alimony paid from federal Form 1040, line 31a
28
29 Total adjustments to income. Add lines 21 through 28
29
•
30 Income after adjustments. Line 20 minus line 29
30a
30b
ADDITIONS
•
31 Interest on government bonds of states other than Oregon
31
•
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
150-101-048 (Rev. 9-00) Web
NOW GO TO THE BACK OF THE FORM

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