Form 40p - Oregon Individual Income Tax Return For Part-Year Residents - 2015

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2015 Form 40P

Oregon

00611501010000

Individual Income Tax Return

for Part-year Residents

•

For office use only

Oregon resident (mm/dd/yyyy)

Tax year ending:

From:

To:

•

Amended return. If amending for an NOL, tax year the NOL was generated:

•

Calculated using “as if” federal return.

Bankruptcy.

Military.

•

Extension filed.

Form 24.

Employment Exception.

First name and initial

Last name

Deceased

Applied for

Date of birth (mm/dd/yyyy)

Social Security number (SSN)

Spouse’s first name and initial

Spouse’s last name

Spouse’s SSN

Spouse’s date of birth (mm/dd/yyyy)

Deceased

Applied for

Current mailing address

•

Filing status

(check only one box)

City

State

ZIP code

Single.

Married filing jointly.

Country

Phone

Married filing separately (enter spouse’s information above).

Head of household (with qualifying person).

Qualifying widow(er) with dependent child.

•

Exemptions

Total

6a Credits for yourself:

Regular;

Severely disabled ............................................................................................................................. 6a

Check box if someone else can claim you as a dependent.

6b Credits for spouse:

Regular;

Severely disabled ............................................................................................................................. 6b

Check box if someone else can claim your spouse as a dependent.

Dependents. List your dependents.

Dependent’s

Check if child

Dependent’s

Last name

Dependent’s SSN

First name

date of birth

with qualifying

•

relationship code

(mm/dd/yyyy)

disability

•

6c Total number of dependents ...........................................................................................................................................................................

•

6d Total number of dependent children with qualifying disability (see instructions) ............................................................................................

•

6e Total exemptions. Add 6a through 6d .................................................................................................................................................... Total

Don’t forget!

Include a copy of your federal Form 1040, 1040A, 1040EZ, 1040NR, or 1040NR-EZ or we may adjust your return.

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150-101-055 (Rev. 12-15)