Short Form 2s - Individual Income Tax Return - Full Year Resident - 2001
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1MONTANA
Short Form 2S -
Full Year Resident -
Individual Income Tax Return
2001
Full Year
Last Name
Your First Name & Middle Initial
Your Social Security No.
Resident
ONLY
Spouse's Last Name if Different
Spouse's First Name & Middle Initial
Spouse's Social Security No.
Filing from a
Montana Address
City
Zip Code + 4
Mailing Address
(Montana Addresses Only)
MT
59
All Other Returns
For Tax Due mail to:
Dept. of Revenue
and Refunds Mail to:
Filing Status
1. Single
2. Married filing
3. Head of Household
Check One
joint return
(see Instructions)
Dept. of Revenue
PO Box 6308
PO Box 6577
Helena, MT 59604-6308
Exemptions
Regular
65 or Over
Blind
Helena, MT 59604-6577
All filers are entitled to at least one exemption
X
1. Yourself ........................
.......................
..........................
...................
Enter number checked
1.
File on or Before
April 15, 2002
2. Spouse ........................
.......................
..........................
...................
Enter number checked
2.
April 2002
3. Dependents
Name
check if
If age one or over, dependents Relationship
.
3. Dependents ......................
3
Do Not Claim Yourself or Spouse
under age 1
social security number
1 2
3 4 5
6
4.
4. Handicapped Dependent
8
9 10 11 12 13
7
Attach Doctor's Certification
14
15 16 17 18 19 20
21
22 23 24 25 26 27
30
28
29
5. Add lines 1, 2, 3 and 4 (if additional dependents, see instructions)
Total Number Exemptions
5.
6. Wages, salaries, tips, etc. ......................................................................... Attach W-2 (s)
6.
ROUND TO
7. Taxable interest income .......................................... Attach Federal Schedule if over $400
7.
NEAREST DOLLAR
8. Dividend income ..................................................... Attach Federal Schedule if over $400
8.
REPORT
9. Federal taxable pensions, IRA Distributions, annuities .............................. Attach 1099R's
9.
If no entry leave blank
YOUR
INCOME
10. Unemployment, alimony, state refund, etc, specify_______________________
10.
11.Total of lines 6 thru 10 ................................................................................................................. Total
11.
12. Adjustments: moving expense, IRA, alimony, student loan interest, etc., specify______________________________
12.
13. Federal Adjusted Gross Income (Subtract line 12 from line 11) .............................................................................
13.
14.
Add
Interest on state & county municipal bonds (non-Montana) and/or federal refund
14.
(see instructions)
15.Subtract
Exempt pension and annuity income - see Worksheet IV, page 13...................
15.
16.
Interest exclusion for elderly. .....................................................................
16.
17.
Interest exclusion for savings bonds, etc. (specify)_________________
17.
18.
Unemployment .........................................................................................
18.
19.
Other reductions (including tips, medical savings account,
family education savings account , etc. specify)____________________
19.
20. Total adjustments decreasing income (add lines 15 thru 19) ........................................................ Total 20.
21.
Montana adjusted gross income (add lines 13 and 14, subtract line 20) ..................................................................
21.
}
}
22.
(A) Standard deduction - see Worksheet V, page 13
(A)
22.
22. (A) Standard deduction - see Worksheet V, page 13
(A)
22.
or
or
(B)
(B)
(B) Federal income taxes paid or withheld in 2001.
(B) Federal income taxes paid or withheld in 2001.
(B)
(B1) Federal Advance Payment-Subtract (B1) from (B). Enter amount on line22....
(B1)
NEW
23. Multiply $1,670 times the number of exemptions in Box 5 above ......................................... 23.
23. Multiply $1,720 times the number of exemptions in Box 5 above ............................................ 23.
24. Add lines 22 and 23 ................................................................................................................... Total
24.
24. Add lines 22 and 23 ................................................................................................................... Total
25. Taxable income. Subtract line 24 from 21 (If less than zero enter zero) ...................................................................
25.
26. Tax on amount on line 25 from tax table on back of this form ...................................................................................
26.
27. In boxes below, enter any amount you and your spouse would like to contribute. See instructions.
Nongame Wildlife Program
Child AbusePrevention
Agriculture in MT Schools
Enter total amounts in boxes........ 27.
28.
29.
30.
Total Tax — Add lines 26 and 27......................................................................................................................
31.
31.
32.
Montana tax withheld.................Attach withholding statements W-2(s), 1099(s) etc.
32.
33.
Elderly Homeowner/ Renter Credit- Attach Form 2EC with your receipts.
33.
34. Add lines 32 and 33...............................................................................................................
34.
35. If line 34 is larger than line 31 enter difference (refunds of more than $1.00 will be issued) ............. Refund 35.
If you wish to use direct deposit enter your RTN# and ACCT# below. See instructions
Checking
Savings
RTN#
ACCT#
36. If line 31 is larger than line 34 enter difference ............................................................................. Tax Due 36.
37. Penalties (see instructions for calculation of penalties)
37.
Under Pay Pen.
Late File
Late Pay
Interest
Total of Boxes
38. TOTAL DUE Add lines 36 & 37. Attach check or money order for full amount if $1.00 or more.
Payable to the Department of Revenue. .............................................................................................. 38.
Include your payment with the payment coupon provided in this booklet.
SIGN
YOUR
My/our initials authorize the State to contact the
If you do not need state income
RETURN
preparer regarding this return. I/we waive my/our
tax forms and instructions mailed
Name, Address & Telephone Number of Preparer
constitutional right of privacy for this limited purpose.
to you next year, check box.
X
X
Your Signature
Date
Telephone Number
Spouse Signature (if filing jointly, both must sign)
Date
I declare under penalty of false swearing that the information in this return and attachments is true, correct and complete.
104
Questions? Please call (406) 444-6900 or TDD (406) 444-2830 for hearing impaired.
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