Form 1 Draft - Wisconsin Income Tax - 2011 Page 4
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52011
3 of 4
Form 1
Page
Name(s) shown on Form 1
Your social security number
NO COMMAS; NO CENTS
41 Amount from line 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
.00
.00
42 Wisconsin tax withheld . Enclose withholding statements . . . . . . 42
43 2011 estimated tax payments and amount
applied from 2010 return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
.00
44 Earned income credit . Number of qualifying children . . .
Federal
.00
.00
credit . . . . .
x
% = . . . . . . . . . 44
.00
45 Farmland preservation credit . a Schedule FC, line 18 . . . . . . . 45a
.00
b Schedule FC‑A, line 13 . . . . . 45b
.00
46 Repayment credit (see page 31) . . . . . . . . . . . . . . . . . . . . . . . . . 46
.00
47 Homestead credit . Enclose Schedule H or H‑EZ . . . . . . . . . . . . . 47
.00
48 Eligible veterans and surviving spouses property tax credit . . . . 48
.00
49 Other credits from Schedule CR, line 29 .
. . 49
Enclose Schedule CR
.00
50 Add lines 42 through 49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
51 If line 50 is larger than line 41, subtract line 41 from line 50 .
.00
This is the AMOUNT YOU OVERPAID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
.00
52 Amount of line 51 you want REFUNDED TO YOU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
53 Amount of line 51 you want
.00
APPLIED TO YOUR 2012 ESTIMATED TAX . . . . . . . . . . . . . . . 53
54 If line 50 is smaller than line 41, subtract line 50 from line 41 . This is the
.00
AMOUNT YOU OWE . Paper clip payment to front of return . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
55 Underpayment interest . Fill in
55
.00
exception code ‑ See Sch . U
Also include on line 54 (see page 33)
Third
Do you want to allow another person to discuss this return with the department
(see page 34)
?
Yes
Complete the following .
No
Party
Personal
Designee’s
Phone
identification
Designee
(
)
name
no .
number (PIN)
Paper clip copies of your federal income tax return and schedules to this return.
Assemble your return (pages 1-4) and withholding statements in the order listed on page 34.
Sign here
Under penalties of law, I declare that this return and all attachments are true, correct, and complete to the best of my knowledge and belief.
Your signature
Spouse’s signature (if filing jointly, BOTH must sign)
Date
Daytime phone
(
)
I‑010a
For Department
Mail your return to:
Wisconsin Department of Revenue
Use Only
If tax due .....................................PO Box 268, Madison WI 53790‑0001
C
If refund or no tax due . . . . . . . . . . . . . . . . .PO Box 59, Madison WI 53785‑0001
If homestead credit claimed . . . . . . . .PO Box 34, Madison WI 53786‑0001
Do Not Submit
Photocopies
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Parent category: Financial