Form Ia 1040 - Iowa Individual Income Tax Form - 2011
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1
22011 IA 1040
Iowa Individual Income Tax Form
/
/
/
or fiscal year beginning
2011 and ending
STEP 1: Fill in all spaces. You MUST fill in your Social Security Number (SSN).
Your last name
Your first name/middle initial
Spouse's last name
Spouse's first name/middle initial
Current mailing address (number and street, apartment, lot, or suite number) or PO Box
City, State, ZIP
•
•
•
Check this box if you or your spouse were 65 or older as of 12/31/11.
Spouse SSN
Your SSN
Residence on 12/31/11
STEP 2 Filing Status: Mark one box only.
•
•
County Number
School District Number
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1
Single: Were you claimed as a dependent on another person's Iowa return?
YES
NO
Dependent children for whom an exemption is claimed in Step 3
Married filing a joint return. (Two-income families may benefit by using status 3 or 4.)
2
•
(including Medicaid or hawk-i)
How many have health care coverage?
•
How many do not have health care coverage?
3
Married filing separately on this combined return. Spouse use column B.
Married filing separate returns.
p
4
SSN:
Income: $
Spouse's name:
5
Head of household with qualifying person. If qualifying person is not claimed as a dependent on this return, enter the person's name and SSN below.
6
Qualifying widow(er) with dependent child.
Name:
SSN:
STEP 3 Exemptions
A.
B. Spouse (Filing Status 3 ONLY)
You or Joint
Personal Credit:
a.
X $ 40 = $
X $ 40 = $
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p
Col. A: Enter 1 (enter 2 if filing status 2 or 5); Col. B: Enter 1 if filing status 3 . . .
Enter 1 for each person who is 65 or older and/or 1 for each person who is blind
b.
X $ 20 = $
X $ 20 = $
p
p
. . . . . .
c.
Dependents: Enter 1 for each dependent
X $ 40 = $
X $ 40 = $
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p
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d.
Enter first names of dependents here:
$
e.
TOTAL $
B.
Spouse/Status 3
A.
You or Joint
B.
Spouse/Status 3
A.
You or Joint
i
STEP 4
1.
Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
Gross
2.
Taxable interest income. If more than $1,500, complete Sch. B. . .
2.
Income
Ordinary dividend income. If more than $1,500, complete Sch. B.
3.
3.
. . . .
4.
Alimony received
4.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
Business income/(loss) from federal Schedule C or C-EZ . . . . . . .
5.
NOTE: Use only
Capital gain/(loss) from federal Sch. D if required for federal purposes
6.
6.
blue or black ink,
7.
Other gains/(losses) from federal form 4797 . . . . . . . . . . . . . . . . . .
7.
no pencils or red ink.
8.
Taxable IRA distributions
8.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
Taxable pensions and annuities . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
10.
Rents, royalties, partnerships, estates, etc.
10.
. . . . . . . . . . . . . . . . . .
11.
Farm income/(loss) from federal Schedule F . . . . . . . . . . . . . . . . . .
11.
12.
Unemployment compensation. See instructions. . . . . . . . . . . . . . . .
12.
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13.
Taxable Social Security benefits . . . . . . . . . . . . . . . . . . . . . . . . . . .
13.
Other income, gambling income, bonus depreciation/sec. 179 adjustment
14.
14.
p
15.
GROSS INCOME. ADD lines 1-14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15.
STEP 5
16.
Payments to an IRA, Keogh, or SEP
16.
. . . . . . . . . . . . . . . . . . . . . . . .
Adjust-
17.
Deductible part of self-employment tax . . . . . . . . . . . . . . . . . . . . . .
17.
ments
18.
Health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.
to
Income
19.
Penalty on early withdrawal of savings
19.
. . . . . . . . . . . . . . . . . . . . . .
20.
Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20.
21.
Pension/retirement income exclusion . . . . . . . . . . . . . . . . . . . . . . .
21.
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22.
Moving expense deduction from federal form 3903 . . . . . . . . . . . . .
22.
Iowa capital gain deduction certain asset sales ONLY (see instructions)
23.
23.
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24.
Other adjustments
24.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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25.
Total adjustments. ADD lines 16-24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25.
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26.
NET INCOME. SUBTRACT line 25 from line 15.
26.
. . . . . . . . . . . .
STEP 6
27.
Federal income tax refund / overpayment received in 2011
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27.
Federal
28.
Self-employment/household employment taxes . . . . . . . . . . . . . . .
28.
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Tax
29.
Addition for federal taxes. ADD lines 27 and 28. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29.
Addition
and
30.
Total. ADD lines 26 and 29. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30.
Deduc-
h
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31.
Federal tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31.
tion
32.
Federal estimated tax payments made in 2011 . . . . . . . . . . . . . . . .
32.
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33.
Additional federal tax paid in 2011 for 2010 and prior years
33.
p
. . . . . .
34.
Deduction for federal taxes. ADD lines 31, 32, and 33. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34.
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35.
BALANCE. SUBTRACT line 34 from line 30. Enter here and on line 36, side 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35.
CS
41-001a (09/21/11)
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