Form Inc 250 - Individual Income Tax Return
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1
2TENNESSEE DEPARTMENT OF REVENUE
INDIVIDUAL INCOME TAX RETURN
Beginning:
ACCOUNT NUMBER
YOUR SSN:
INC
Taxable
Year
Ending:
250
SPOUSE'S SSN:
FEIN:
(If filing jointly, include first names and initials of both spouses)
Taxpayers filing on a calendar year basis must file their
NAME
return by April 15 of the following year. Make your
check payable to the Tennessee Department of Rev-
enue for the amount of tax computed and mail to:
SPOUSE'S NAME
Tennessee Department of Revenue
Andrew Jackson State Office Building
500 Deaderick Street
ADDRESS
Nashville, TN 37242
Should you need assistance, please contact the Tax-
ZIP
CITY
payer Services Division by calling our statewide num-
STATE
ber 1-800-342-1003 or (615) 741-2594.
Please provide the county and city (if within an incorporated municipality) of the taxpayer's legal residence
on the lines below; or you may enter the 4-digit code for the correct county or city from the provided list.
}
If this is an AMENDED RETURN,
County ________________________________________
4-Digit
please check the box at right
Location
City ___________________________________________
Code ________________________
AFFIDAVIT FOR EXEMPTION
Any person 65 years of age or over (no matter which spouse is over 65) may qualify for total exemption from income tax if gross income from
all sources (i.e. social security, pensions, wages, etc.) is $9,000 or less for single filers ($15,000 or less for joint filers). IF YOU QUALIFY FOR
THE EXEMPTION, DO NOT COMPLETE THE SCHEDULES BELOW. CHECK THE BOX AT RIGHT AND SIGN RETURN ON THE BACK.
CHECK ALL BOXES WHICH APPLY:
1 .
Single
6.
Blind
9.
Partnership
(yourself)
2.
Married Filing Jointly
4.
Quadriplegic
7.
Blind
10.
Limited Liability
(yourself)
(your spouse)
Company
3.
Married Filing Separately
5.
Quadriplegic
8.
Trust
1 1 .
Estate
(enter spouse's SSN # above)
(your spouse)
WRITE NUMBERS LIKE THIS
ROUND TO THE NEAREST DOLLAR
TAX COMPUTATION
00
1. TOTAL TAXABLE INCOME (From Schedule A) ................................................................... (1)
{
$1,250 if single or married filing separately
00
2. SUBTRACT EXEMPTION
............................. (2)
$2,500 if married filing jointly
00
3. AMOUNT SUBJECT TO TAX (Line 1 less Line 2) .............................
(3)
00
4. INCOME TAX (6% of Line 3) .............................................................
(4)
00
5. ENTER: Estimated tax payment for taxable year ................................................................ (5)
If filed late, compute penalty at 5% of the tax (Line 4 minus Line 5) for each 1 to 30 DAY
{
00
PERIOD for which TAX IS DELINQUENT (Total penalty NOT TO EXCEED 25%.) Minimum
6. PENALTY
................ (6)
penalty is $15 regardless of the amount of tax due or whether there is any tax due
{
00
If filed late, compute interest at 12.50% per annum on the tax (Line 4
7. INTEREST
........................................ (7)
minus Line 5) from the due date of payment to the date paid
00
8. TOTAL AMOUNT DUE (Add Lines 4, 6, and 7; subtract Line 5) ......................................... (8)
00
9. REFUND (If Line 5 exceeds total of Lines 4, 6, and 7, enter overpayment here) .............. (9)
FOR OFFICE
USE ONLY
RV-R0003501
INTERNET (11-98)
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