Form Ia 1040 - Iowa Individual Income Tax Long Form - 1999
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1
2FOR OFFICE USE ONLY
Iowa Individual Income Tax Long Form
IA 1040 1999
Check if first-time Iowa filer.
or fiscal year beginning __/__ 1999 and ending __/__ /__
STEP 1: Place your label below or fill in the blanks if you do not have a label.
•
Last name
Your first name/middle initial
Social Security Number
A.
•
Spouse’s last name
Spouse’s first name/middle initial
Social Security Number
•
Your Occupation
Are your name,
B.
your spouse’s
Current mailing address (number and street, apartment, lot or suite number) or PO Box
name, if applicable,
•
Spouse’s Occupation
and your address
City, State, ZIP
the same as on last
year’s return?
Residence on 12/31/99
•
•
County No.
Sch.Dist.No.
STEP 2 Filing Status: Mark one box only.
YES
NO
1
Single: Were you claimed as a dependent on another person’s Iowa return?
YES
NO
N
ONNO
School District Name
2
Married filing a joint return.
3
Married filing separately on this combined return. Spouse use column B.
4
Married filing separate returns. Spouse’s name:
SSN:
Income: $
5
Head of household with qualifying person. If qualifying person is not claimed as a dependent on this return, enter the person’s name and Social Security Number below.
6
Qualifying widow(er) with dependent child. Name:
SSN:
STEP 3
40
a. Personal Credit: Enter 1 (Enter 2 if filing joint or head of household) .................... _______
X $ _________ = $ __________
YOU
Exemptions
20
b. Enter 1 for each spouse who is 65 or older and/or 1 for each spouse who is blind .... _______
X $ _________ = $ __________
(and spouse IF
filing jointly)
40
c. Dependents: Enter 1 for each dependent ..................................................................... _______
X $ _________ = $ __________
d. Enter first names of dependents here: _____________________________________
e. TOTAL $ ______________
40
a. Personal Credit: Enter 1 ................................................................................................. _______
X $ _________ = $ __________
SPOUSE
20
b. Enter 1 if 65 or older and/or 1 if blind ............................................................................. _______
X $ _________ = $ __________
(IF filing
40
status 3)
c. Dependents: Enter 1 for each dependent ..................................................................... _______
X $ _________ = $ __________
d. Enter first names of dependents here: _____________________________________
e. TOTAL $ ______________
B. Spouse/Status 3
A. You or Joint
B. Spouse/Status 3
A. You or Joint
1. Wages, salaries, tips, etc. ................................................................. 1. ______________ .00
______________ .00
STEP 4
2. Taxable interest income. If more than $400, complete Schedule B. .. 2. ______________ .00
______________ .00
Figure
3. Ordinary dividend income. If more than $400, complete Schedule B. .. 3. ______________ .00
______________ .00
your
4. Alimony received ............................................................................... 4. ______________ .00
______________ .00
gross
5. Business income/(loss) from Federal Schedule C or C-EZ ............. 5. ______________ .00
______________ .00
income
6. Capital gain/(loss) from Federal Schedule D. See page 6. .............. 6. ______________ .00
______________ .00
7. Other gains/(losses) from Federal form 4797. See page 6. ............. 7. ______________ .00
______________ .00
8. Taxable IRA distributions. ................................................................. 8. ______________ .00
______________ .00
9. Taxable pensions and annuities. See page 6. .................................. 9. ______________ .00
______________ .00
10. Rents, royalties, partnerships, estates, etc. See page 7. .................. 10. ______________ .00
______________ .00
11. Farm income/(loss) from Federal Schedule F. ................................. 11. ______________ .00
______________ .00
12. Unemployment compensation .......................................................... 12. ______________ .00
______________ .00
13. Taxable Social Security benefits. See page 7. ................................. 13. ______________ .00
______________ .00
14. Other income. See page 8. ............................................................... 14. ______________ .00
______________ .00
15. GROSS INCOME. ADD lines 1-14. ........................................................................................................................... 15. _______________ .00
_______________ .00
16. Payments to an IRA, KEOGH or SEP .............................................. 16. ______________ .00
______________ .00
STEP 5
17. One-half of self-employment tax ...................................................... 17. ______________ .00
______________ .00
Figure
18. Health insurance deduction. See page 8. ........................................ 18. ______________ .00
______________ .00
your
19. Penalty on early withdrawal of savings ............................................ 19. ______________ .00
______________ .00
adjust-
20. Alimony paid ..................................................................................... 20. ______________ .00
______________ .00
ments
21. Pension/retirement income exclusion. See page 9. ......................... 21. ______________ .00
______________ .00
to
income
22. Moving expense deduction from Federal form 3903 ........................ 22. ______________ .00
______________ .00
23. Iowa capital gains deduction. See page 9. ....................................... 23. ______________ .00
______________ .00
24. Other adjustments. See page 10. ..................................................... 24. ______________ .00
______________ .00
25. Total adjustments. ADD lines 16-24. ......................................................................................................................... 25. _______________ .00
_______________ .00
26. NET INCOME. SUBTRACT line 25 from line 15. See page 11 for possible exemption from tax. ........................... 26. _______________ .00
_______________ .00
27. Federal income tax refund received in 1999. ................................... 27. ______________ .00
______________ .00
STEP 6
28. Self-employment/household employment taxes. .............................. 28. ______________ .00
______________ .00
29. Addition for Federal taxes. ADD lines 27 and 28. ..................................................................................................... 29. _______________ .00
_______________ .00
Figure
30. Total. ADD lines 26 and 29. ....................................................................................................................................... 30. _______________ .00
_______________ .00
your
Federal
31. Federal tax withheld. ......................................................................... 31. ______________ .00
______________ .00
tax
32. Federal estimated tax payments made in 1999. .............................. 32. ______________ .00
______________ .00
addition
33. Additional Federal tax paid in 1999 for 1998 and prior years. ......... 33. ______________ .00
______________ .00
and
34. Deduction for Federal taxes. ADD lines 31, 32, and 33. ........................................................................................... 34. _______________ .00
_______________ .00
deduction
35. BALANCE. SUBTRACT line 34 from line 30. Enter here and on line 36, side 2. .................................................... 35. _______________ .00
_______________ .00
L99
41-001a (8/99)
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