Montana Short Form 2s - Individual Income Tax Return Full Year Resident - 2004

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MONTANA
Short Form 2S -
Full Year Resident -
Individual Income Tax Return
2004
Last Name
First Name and Middle Initial
Social Security No.
Full Year
Resident
Spouse's Last Name if Different
Spouse's First Name and Middle Initial
Spouse's Social Security No.
ONLY
Filing from a
City
Zip Code + 4
Mailing Address
(Montana Addresses Only)
Montana Address
MT
59
File on or before
Filing Status
1. Single
2. Married Filing
3. Head of Household
For tax due mail to:
Check One
Joint Return
(see Instructions)
April 15, 2005
Dept. of Revenue
PO Box 6308
Exemptions
All filers are entitled to at least one exemption
Helena, MT 59604-6308
Regular
65 or Over
Blind
X
1.
All other returns
1. Yourself ........................
.......................
..........................
................................
Enter number checked
and refunds mail to:
2. Spouse ........................
.......................
..........................
................................
Enter number checked
2.
Dept. of Revenue
3. Dependents
PO Box 6577
Dependent's Name
Dependent's Social Security Number
Relationship
Helena, MT 59604-6577
Do not claim yourself
or spouse
3.
3. Dependents
Round to
nearest dollar.
4.
4. Handicapped Dependent
If no entry
5. Add lines 1, 2, 3 and 4 (if additional dependents, see instructions)
Total Number Exemptions
leave blank
5.
6. Wages, salaries, tips, etc................................................................................................................................Attach W-2(s)
6.
7. Taxable interest income.........................................................................................Attach Federal Schedule if over $1,500
7.
8. Dividend income.................................................................................................... Attach Federal Schedule if over $1,500
8.
REPORT
9. Federal taxable pensions, IRA distributions, annuities ...............................................................................Attach 1099R's
9.
YOUR
10. Unemployment, alimony, state refund, etc. specify_____________________________________________________
10.
INCOME
11.
Total
Total of lines 6 thru 10
11.
. ........................................................................................................................................................................
12. Adjustments: moving expense, IRA, alimony, student loan interest, etc., specify______________________________
12.
Total
13. Federal adjusted gross income (subtract line 12 from line 11)..............................................................................
13.
14.
Add: Interest on state and county municipal bonds (non-Montana) and/or federal refund
(see instructions)
14.
Subtract:
................................................................
15.
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, etc.) Refer to page 5 of instructions
..............................................................
19.
......................................................................... Total
20. Total adjustments decreasing income (add lines 15 thru 19)
20.
.....................................................
Total
21.
21.
Montana adjusted gross income (add lines 13 and 14 subtract line 20)
22.
a. Standard deduction-see Worksheet V, page 13.
a.
......................................
(A) Standard deduction - see Worksheet V, page 13
22a.
or
or
or
......................................
b. Federal income taxes paid or withheld in 2004.
b.
22b.
23. Multiply $1,840 times the number of exemptions in Box 5 above..............................................
23.
.
......................................................................................................
Total
24. Add lines 22a or 22b and line 23
24.
Total
25.
25. Taxable income. Subtract line 24 from 21 (If less than zero enter zero).......................................................
26. Tax on amount on line 25 from tax table on back of this form................................................................................................
26.
In boxes below, enter any amount you and your spouse would like to contribute. See instructions.
Child Abuse Prevention
Nongame Wildlife Program
Agriculture in MT Schools
27.
28.
29.
Total
Enter amounts in boxes.....
30.
Total
31.
31.
Total tax - add lines 26 and 30.................................................................................................................................
32.
Montana tax withheld................................Attach withholding statements W-2(s), 1099(s) etc. 32.
33.
Elderly Homeowner/Renter Credit....................................................................Attach Form 2EC 33.
34.
Total
34.
Add lines 32 and 33.....................................................................................................................................................
efund
35. If line 34 is larger than line 31 enter difference (refunds of more than $1.00 will be issued)............ R
35.
If you wish to use direct deposit enter your RTN# and ACCT# below. See instructions
Checking
Savings
RTN#
ACCT#
Tax Due
36. If line 31 is larger than line 34 enter difference...................................................................................
36.
If you chose to pay your tax due by credit card visit our website at
and enter your confirmation number here.________________________________ See instructions on page 11.
37. Penalty and interest (see instructions for calculation of penalty and interest)
Total of Boxes
Underpayment
Late File
Late Pay
Interest
37.
38. Add lines 36 and 37. Attach check or money order for full amount if $1.00 or more.
38.
Total Due
Payable to the Department of Revenue.........................................................................................
Include your payment with the payment coupon provided in this booklet.
Check box if you do not need state
May the DOR discuss this return with the preparer shown?
income tax forms and instructions
Name, address and telephone number of preparer
Yes
No
mailed to you next year.
SIGN
X
X
YOUR
RETURN
Your signature is required
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
I

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