Form It-40 Schedule 3 & 4 Draft - Exemptions - 2009
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1Schedules 3 & 4
Schedule 3: Exemptions
Enclosure
2009
Form IT-40,
State Form
Sequence No. 03
(Schedule 4 begins after line 5 below)
(9-09)
Name(s) shown on Form IT-40
Your Social Security Number
Round all entries
00
1.
Number of exemptions claimed on your federal return
x $1,000 ...........................................
1
●
(If no federal return was fi led, enter $1,000 per qualifying person)
2.
Claim an additional exemption for each dependent child
•
who is a son, stepson, daughter, stepdaughter and/or foster child,
•
who was under the age of 19 by Dec. 31, 2009, or a full-time student
who was under the age of 24 by Dec. 31, 2009, and
•
who you are eligible to claim as a dependent on your federal tax return.
00
Enter number you are eligible to claim
x $1,500 ....................................................................
2
●
3.
Place “X” in box(es) below if, by December 31, 2009
You were age 65 or older
and/or blind
Spouse was 65 or older
and/or blind
00
Total number of boxes with Xs
x $1,000 ............................................................................
3
●
4.
If age 65 or older, enter amount from Form IT-40, line 1 $ ______________ .
If this amount is less than $40,000, place “X” in box(es) below if:
You were age 65 or older
Spouse was 65 or older
00
Total number of boxes with Xs
x $500 ................................................................................
4
●
00
5.
Add lines 1, 2, 3 and 4. Enter here and on Form IT-40, line 6................................ Total Exemptions
5
●
Schedule 4: Other Taxes
Instructions begin on page XX
00
1.
Use tax on out-of-state purchases from line 4 of Sales/Use Tax Worksheet .......................................
1
●
00
2.
Household employment taxes. Attach Schedule IN-H..........................................................................
2
●
00
3.
Indiana advance earned income credit payments from W-2s ..............................................................
3
●
00
4.
Recapture of Indiana’s CollegeChoice 529 credit. Attach Schedule IN-529R ......................................
4
●
00
5.
Add lines 1 through 4. Enter here and on Form IT-40, line 10 ........................................ Other Taxes
5
●
230091101
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