Fillable Form Mo-A - Individual Income Tax Adjustments

Reset Form

Print Form

2012

Attachment Sequence No. 1040-01

MISSOURI DEPARTMENT OF REVENUE

ATTACH TO FORM MO-1040. ATTACH A COPY OF YOUR FEDERAL

INDIVIDUAL INCOME TAX

FORM

RETURN. See information beginning on page 11 to assist you

MO-A

ADJUSTMENTS

in completing this form.

LAST NAME

FIRST NAME

INITIAL

SOCIAL SECURITY NO.

SPOUSE’S LAST NAME

FIRST NAME

INITIAL

SPOUSE’S SOCIAL SECURITY NO.

PART 1 — MISSOURI MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME (SEE PAGE 11).

Y - YOURSELF

S - SPOUSE

ADDITIONS

00 1S

1. Interest on state and local obligations other than Missouri source .....................................................

Partnership;

Fiduciary;

S corporation;

Net Operating Loss (Carryback/Carryforward);

00 2S

Other (description) .........................................................................................................................

3. Nonqualified distribution received from a qualified 529 plan (higher education savings program)

00 3S

not used for qualified higher education expenses ....................................................................................

00 4S

4. Food Pantry contributions included on Federal Schedule A ...............................................................

00 5S

5. Nonresident Property Tax ...................................................................................................................

6. TOTAL ADDITIONS — Add Lines 1, 2, 3, 4, and 5. Enter here and on Form MO‑1040, Line 2........

00 6S

SUBTRACTIONS

7. Interest from exempt federal obligations included in federal adjusted gross income (reduced by

00 7S

related expenses if expenses were over $500). Attach a detailed list or all Federal Forms 1099.

00 8S

8 . Any state income tax refund included in federal adjusted gross income .............................................

Partnership;

Fiduciary;

S corporation;

Railroad retirement benefits;

Net Operating Loss;

Military (nonresident);

Build America and Recovery Zone Bond Interest

Combat pay included in federal adjusted gross income;

MO Public‑Private Transportation Act

00 9S

Attach supporting documentation ......

Other (description)

10Y

00 10S

10. Exempt contributions made to a qualified 529 plan (higher education savings program) ...................

11Y

00 11S

11. Qualified Health Insurance Premiums. ................................................................................................

12. Missouri depreciation adjustment (Section 143.121, RSMo)

12Y

00 12S

Sold or disposed property previously taken as addition modification .............................................

13Y

00 13S

13. Home Energy Audit Expenses .............................................................................................................

14Y

00 14S

14. TOTAL SUBTRACTIONS — Add Lines 7, 8, 9, 10, 11, 12 and 13. Enter here and on Form MO‑1040, Line 4. .

PART 2 — MISSOURI ITEMIZED DEDUCTIONS — Complete this section only if you itemize deductions on your federal

return. Attach a copy of your Federal Form 1040 (pages 1 and 2) and Federal Schedule A.

1. Total federal itemized deductions from Federal Form 1040, Line 40 ............................................................................................

2. 2012 (FICA) — yourself — Social security $

+ Medicare $ ........................................................

3. 2012 (FICA) — spouse — Social security $

+ Medicare $ ........................................................

4. 2012 Railroad retirement tax — yourself (Tier I and Tier II) $

+ Medicare $ ..........................................

5. 2012 Railroad retirement tax — spouse (Tier I and Tier II) $

+ Medicare $ ..........................................

6. 2012 Self‑employment tax — See instructions on Page 35. ..........................................................................................................

7. TOTAL — Add Lines 1 through 6. .................................................................................................................................................

8. State and local income taxes — from Federal Schedule A, Line 5. ...............................................

9. Earnings taxes included in Line 8 .....................................................................................................

10. Net state income taxes — Subtract Line 9 from Line 8. ................................................................................................................

11. MISSOURI ITEMIZED DEDUCTIONS — Subtract Line 10 from Line 7. Enter here and on Form MO‑1040, Line 14. ..............

NOTE: IF LINE 11 IS LESS THAN YOUR FEDERAL STANDARD DEDUCTION, SEE INFORMATION ON PAGE 7.

MO-A (12-2012)

For Privacy Notice, see instructions.