Form D-40 - Individual Income Tax Return - 2011
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Clear Form
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*110400110002*
2011
D-40 Individual
Government of the
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District of Columbia
Income Tax Return
This is a FILL-IN format. Please do not handwrite
any data on this form other than your signature.
s
OFFICIAL USE ONLY
Personal information
Fill in
if: Filing an amended return. See page 5.
Vendor ID#0002
Fill in
if: Filing for a deceased taxpayer See page 17.
Your social security number (SSN)
Spouse’s/registered domestic partner’s SSN
Your daytime telephone number
Your first name
M.I.
Last name
Spouse’s/registered domestic partner’s first name
M.I.
Last name
Home address (number, street and apartment number if applicable)
City
State
Zip Code +4
Filing status
Single,
Married filing
jointly,
Married filing
separately,
Dependent claimed by someone else
1
Fill in only one:
Married filing separately on same return
Enter combined amounts for Lines 4–42. See instructions, page 6.
Registered domestic partners filing jointly
or
filing separately on same return
Head of household
Enter qualifying dependent and/or non-dependent information on Schedule S.
2
Part-year resident in DC from
(month) to
(month); number of months in DC
Fill in if you are:
See page 18.
Complete your federal return first – Enter your dependents’ information on DC Schedule S
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Income Information
Round cents to nearest dollar. If zero, leave the line blank.
.
$
00
a
a
Wages, salaries, unemployment compensation and/or tips,
see instructions, page 19.
.
$
00
b
b
Business income or loss,
Fill in if loss
see instructions, page 19.
.
$
00
c
c
Capital gain (or loss).
Fill in if loss
.
$
00
d
d
Rental real estate, royalties, partnerships, etc.
Fill in if loss
Computation of DC Gross and Adjusted Gross Income
.
$
00
Fill in if loss
3
3
Federal adjusted gross income.
1040, Line 37; 1040A, Line 21;
1040EZ, Line 4; 1040NR, Line 36 plus Sch NEC, Line 13; 1040NR-EZ, Line 10
Additions to DC Income
.
$
00
4
4
Franchise tax deducted on federal forms,
see instructions.
.
$
00
5
5
Other additions from DC Schedule I, Calculation A, Line 8.
.
$
00
Fill in if loss
6
6
Add Lines 3, 4 and 5.
Subtractions from DC Income
.
$
00
7
Part year residents, enter income received during period of nonresidence,
7
see pg 20.
.
$
00
8
Taxable refunds, credits or offsets of state and local income tax.
8
.
$
00
9
Taxable amount of social security and tier 1 railroad retirement
9
Forms 1040, Line 20b or 1040A, Line 14b.
.
$
00
10 Income reported and taxed this year on a DC franchise or fiduciary return.
10
.
$
00
11 DC and federal government pension and annuity limited exclusion,
11
see page 20.
Fill in
if you are 62 or older
if your spouse/domestic partner is 62 or older
.
$
00
12 DC and federal government survivor benefits,
12
see page 20.
.
$
00
13 Other subtractions from DC Schedule I, Calculation B, Line 16.
13
.
$
00
14 Total subtractions from DC income,
14
Lines 7-13.
.
$
00
15 DC adjusted gross income,
15
Line 6 minus Line 14.
Fill in if loss
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2011 D-40 P1
Revised 09/11
Individual Income Tax Return page 1
File order 1
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