Form Ia 1040a - Iowa Individual Income Tax - Short Form - 2003

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2003 IA 1040A
Iowa Individual Income Tax Short Form
Click this button to reset the form.
For full-year Iowa residents only.
STEP 1:
Fill in all spaces. You MUST fill in your Social Security Number.
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
B .
Current mailing address (number and street, apartment, lot or suite number) or PO Box
Are your name,
Spouse’s Occupation
your spouse’s
name, if applic-
City, State, ZIP
able, and your
Residence on 12/31/03
address the same
County No.
Sch.Dist.No.
as on last year’s
return?
STEP 2: Filing Status: Mark one box only.
Y E S
N O
School District Name
1
Single: Were you claimed as a dependent on another person’s Iowa return?
YES
NO
NONNO
2
Married filing a joint return.
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
6
Qualifying widow(er) with dependent child.
SSN here. Name:
SSN:
STEP 3
4 0
a. Personal Credit: Enter 1 (Enter 2 if filing joint or head of household) ................... _______
X $ _________ = $ __________
YOU
2 0
(and spouse if
b. Enter 1 for each spouse who is 65 or older and/or 1 for each spouse who is blind
_______
X $ _________ = $ __________
Exemption
filing jointly)
4 0
Credits
c. Dependents: Enter 1 for each dependent ..................................................................... _______
X $ _________ = $ __________
d. Enter first names of dependents here: ____________________________________
e. TOTAL $ ______________
1. Total wages, salaries, tips and unemployment compensation. .................................................................. 1 .
__________________ .00
STEP 4
2. Taxable interest. If more than $1,500, complete Schedule B. ................................................................... 2 .
__________________ .00
Figure
3. Taxable dividends. If more than $1,500, complete Schedule B. ................................................................ 3 .
__________________ .00
your
4. Net income. Add lines 1, 2, and 3.
................................................................................................................. 4 .
__________________ .00
income
5. Federal income tax refund received in 2003. ................................................................................................. 5 .
__________________ .00
6. TOTAL. Add lines 4 and 5. ................................................................................................................................. 6 .
__________________ .00
7. Federal tax payment information.
a .
___________ .00
(a) Federal tax withheld ...............................................
b.
___________ .00 7 .
__________________ .00
(b) Additional paid in 2003 for 2002 and any prior year .
8. Income subject to tax. Subtract line 7 from line 6. If greater than $100,000 you must use IA 1040 long form. 8 .
__________________ .00
STEP 5
9. Tax from tables. See IA 1040A tax tables at ......................................................... 9 .
__________________ .00
10. Total exemption credits from Step 3. ............................................................................................................. 1 0 .
__________________ .00
Figure
11. Iowa Earned Income Credit. (Federal credit $
X .065) ............................................. 1 1 .
__________________ .00
your
12. Total credits. Add lines 10 and 11. ................................................................................................................. 1 2 .
__________________ .00
tax,
credits
13. BALANCE. Subtract line 12 from line 9. If less than zero, enter zero. .................................................. 1 3 .
__________________ .00
and
14. Multiply line 13 by your School District Surtax Rate. See 2003 School District Surtax List. ............ 1 4 .
__________________ .00
checkoff
15. Fish and Wildlife Fund Contribution. $1 or more supports the Wildlife Diversity Program. ............... 1 5 .
__________________ .00
contri-
butions
16. State Fairgrounds Renovation Contribution. $1 or more helps renovate the fairgrounds. ................ 1 6 .
__________________ .00
17. Keep Iowa Beautiful Contribution. $1 or more assists beautification efforts in Iowa. ......................... 1 7 .
__________________ .00
18. Total Tax and Contributions. Add lines 13 through 17. ............................................................................... 1 8 .
__________________ .00
19. Iowa income tax withheld from Box 17 of your W-2 form(s). ................................................................... 1 9 .
__________________ .00
STEP 6
20. If line 19 is more than line 18, subtract line 18 from line 19. This is your REFUND. .......................... 2 0 .
__________________ .00
Mail to Iowa Income Tax Refund Processing, Hoover State Office Bldg, Des Moines IA 50319-0120
Figure
21. If line 19 is less than line 18, subtract line 19 from line 18. This is the AMOUNT OF TAX YOU OWE. ..... 2 1 .
__________________ .00
your
22. Penalty. See back of the IA 1040V payment voucher. ............................................................................... 2 2 .
__________________ .00
refund
or
23. Interest. See back of the IA 1040V payment voucher. .............................................................................. 2 3 .
__________________ .00
amount
24. TOTAL AMOUNT DUE. Add lines 21, 22, and 23 and enter here. .......................................................... 2 4 .
__________________ .00
due
E-Pay at or write check to Treasurer, State of Iowa / Mail to Iowa Income Tax Processing, PO Box 9187, Des Moines IA 50306-9187
POLITICAL CHECKOFF.
SPOUSE
YOU
Next year, (check one)
This checkoff does not
$1.50 to Democratic Party
$1.50 to Democratic Party
Would you like to receive a IA 1040 booklet?
$1.50 to Republican Party
$1.50 to Republican Party
increase the amount of tax you
This option is not available to
0.
Yes
$1.50 to Campaign Fund
$1.50 to Campaign Fund
electronic filers.
owe or decrease your refund.
1.
No
PLEASE
I (We), the undersigned, declare under penalty of perjury that I (we) have examined this return, including all accompanying schedules and statements, and, to the best of my (our)
knowledge and belief, it is a true, correct, and complete return. Declaration of preparer (other than taxpayer) is based on all information of which the preparer has any knowledge.
SIGN HERE
Your Signature
Date
Preparer’s Signature
Date
SIGN HERE
Spouse’s Signature
Date
Address
Verify your Social
Security Number(s)
Daytime Telephone Number
Daytime Telephone Number
Identification Number
S03
Recheck your math
This return is due April 30, 2004.
Attach all W-2s.
41-080 (2/3/04)

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