Grocery Credit Worksheet, Form 40 - Idaho Individual Income Tax Return

Form 40 - 2010

Page 2

JOHN TAXPAYER

EFO00089p2 08-12-10

21. Tax amount from line 20 ............................................................................................................................................

CREDITS. Limits apply. See instructions, page 8.

22. Income tax paid to other states. Include Form 39R and a copy of other state return ......

23. Credit for contributions to Idaho educational entities ......................................................

24. Credit for contributions to Idaho youth and rehabilitation facilities ..................................

25. Credit for live organ donation expenses ..........................................................................

26. Total business income tax credits from Form 44, Part I, line 12. Include Form 44 ........

27. TOTAL CREDITS. Add lines 22 through 26 .............................................................................................................

28. Subtract line 27 from line 21. If line 27 is more than line 21, enter zero ..................................................................

OTHER TAXES. See instructions, page 9.

29. Fuels tax due. Include Form 75 ................................................................................................................................

30. Sales/Use tax due on mail order, Internet, and other nontaxed purchases ..............................................................

31. Total tax from recapture of income tax credits from Form 44, Part II, line 7. Include Form 44 .................................

32. Tax from recapture of qualified investment exemption (QIE). Include Form 49ER ..................................................

_____

33. Permanent building fund. Check the box if you are receiving Idaho public assistance payments ..................

NRF

34. TOTAL TAX. Add lines 28 through 33 .......................................................................................................................

DONATIONS. See instructions, page 9.

I wish to donate to:

35. Nongame Wildlife Conservation Fund ...........

________ 36. Idaho Children's Trust Fund ............ _________

37. Special Olympics Idaho .................................

________ 38. Idaho Guard and Reserve Family ... _________

39. American Red Cross of Greater Idaho Fund ..

________ 40. Veterans Support Fund ................... _________

41. Idaho Foodbank ............................................

________ 42. Opportunity Scholarship Program ... _________

43. Enter total donations. Add lines 35 through 42 ........................................................................................................

44. TOTAL TAX PLUS DONATIONS. Add lines 34 and 43 ............................................................................................

PAYMENTS and OTHER CREDITS. Complete the grocery credit refund worksheet on page 10.

45. Grocery credit. Computed Amount (from worksheet) ..................................................................

______________

210

To donate your grocery credit to the Cooperative Welfare Fund, check the box and enter zero on line 45.

210

To receive your grocery credit, enter the computed amount on line 45 ....................................................................

46. Maintaining a home for family member age 65 or older, or developmentally disabled. Include Form 39R ..............

47. Special fuels tax refund ________________

Gasoline tax refund ___________________

Include Form 75

48. Idaho income tax withheld. Include Form(s) W-2 and any 1099(s) that show Idaho withholding ............................

49. 2010 Form 51 payment(s) and amount applied from 2009 return .............................................................................

50. TOTAL PAYMENTS AND OTHER CREDITS. Add lines 45 through 49 ....................................................................

210

TAX DUE or REFUND. See instructions, page 11. If line 44 is more than line 50, GO TO LINE 51. If line 44 is less than line 50 GO TO LINE 54.

51. TAX DUE. Subtract line 50 from line 44 .........................................................................................................

52. Penalty ____________ Interest from the due date

____________

Enter total ..............................................

Check box if penalty is due to an ineligible withdrawal from an Idaho medical savings account ....................

53. TOTAL DUE. Add lines 51 and 52. Make check or money order payable to the Idaho State Tax Commission ........

54. OVERPAID. Line 50 minus lines 44 and 52. This is the amount you overpaid .......................................................

210

55. REFUND. Amount of line 54 to be refunded to you .......................................................................................

210

56. ESTIMATED TAX. Amount of line 54 to be applied to your 2011 estimated tax .......................................................

57. DIRECT DEPOSIT. See instructions, page 12.

Check if final deposit destination is outside the U.S.

Type of

Checking

Routing No.

Account No.

Account:

Savings

AMENDED RETURN ONLY. Complete this section to determine your tax due or refund. See instructions.

58. Total due (line 53) or overpaid (line 54) on this return ...............................................................................................

59. Refund from original return plus additional refunds ...................................................................................................

60. Tax paid with original return plus additional tax paid .................................................................................................

61. Amended tax due or refund. Add lines 58 and 59 and subtract line 60 ....................................................................

Within 180 days of receiving this return, the Idaho State Tax Commission may discuss this return with the paid preparer identified below.

Under penalties of perjury, I declare that to the best of my knowledge and belief this return is true, correct and complete. See instructions.

Your signature

Spouse's signature (if a joint return, BOTH MUST SIGN)

SIGN

HERE

Date

Preparer's EIN, SSN, or PTIN

Daytime phone

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Paid preparer's signature