Form 40x - Oregon Amended Individual Income Tax Return printable pdf download

FORM

OREGON AMENDED

40X

For Office Use Only

INDIVIDUAL INCOME

Original return number

Date received

TAX RETURN

Code

Tax

P&I

Payment Amount

Check if amending to change from

FOR TAX YEAR _________

married filing separate to filing joint.

Last name

First name and initial

Social Security number (SSN)

Birth year

—

Spouse’s

Spouse’s last name, if different and joint return

Spouse’s first name and initial, if joint return

Spouse’s SSN if joint return

birth year

—

Current mailing address

City

State

ZIP code

Telephone number

(

)

As Originally

Net Change

Reported or

(increase or

INCOME AND DEDUCTIONS

Correct

as Adjusted

decrease)

(Please read instructions)

Amount

)

(see specific inst.)

(explain on the back

1. Income ........................................................................................................................... 1

2. Additions (Form 40 only) ................................................................................................ 2

3. Federal tax liability (Form 40S only) .............................................................................. 3

4. Subtractions (Form 40 only) .......................................................................................... 4

5. Deductions (standard deduction or itemized deductions) .............................................. 5

6. Oregon taxable income .................................................................................................. 6

TAX AND CREDITS

7. TAX ................................................................................................................................ 7

8. Interest on certain installment sales .............................................................................. 8

9. TOTAL OREGON TAX (add lines 7 and 8) ................................................................... 9

10. Exemption credit (see instructions) .............................................................................. 10

11. Other credits (do not include working family credit for tax year 2003 and later) .......... 11

12. Total credits (add lines 10 and 11) (

) ........ 12

the total can’t be more than amount on line 9

13. Tax after credits (line 9 minus line 12) ......................................................................... 13

14. Surcharge (applies to tax year 2003 only) ................................................................... 14

15. Net income tax (add lines 13 and 14) .......................................................................... 15

PAYMENTS

16. Kicker—if applicable (see instructions) ........................................................................ 16

17. Oregon income tax withheld ........................................................................................ 17

18. Working family credit for tax year 2003 and later ........................................................ 18

19. Estimated tax payment(s) for the tax year and payments made with extension requests ......................................... 19

20. Amount paid with original return and any later payment(s) for the tax year (

) ... 20

include only TAX paid—see instructions

21. Total payments (add lines 16 through 20) ................................................................................................................. 21

22. Încome tax refunds received (including working family child care credit and kicker refund) ..................................... 22

23. Net payments (line 21 minus line 22) ........................................................................................................................ 23

REFUND OR BALANCE DUE

24. Refund. If line 23 is more than line 15C, you overpaid. Line 23 minus line 15C ...................................................... 24

25. Amount of refund on line 24 you want applied to you 200__ estimated tax .............................................................. 25

26. NET REFUND. Line 24 minus line 25. Enter the amount of line 24 you want refunded to you ................................. 26

27. Additional tax to pay. If line 15C is more than line 23, you have tax to pay. Line 15C minus line 23 ...................... 27

28. Interest on additional tax to pay (see instructions) .................................................................................................... 28

29. AMOUNT YOU OWE. Add lines 27 and 28. Pay in full with this return ..................................................................... 29

Refunds may take four to six months or longer to process.

Be sure to complete the back and sign

150-101-046 (Rev. 10-03)