Form It-40ez - Indiana Income Tax Return For Full-Year Indiana Resident Filers With No Dependents - 2012
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1
2IT-40EZ
Indiana Income Tax Return for Full-Year
2012
State Form 48438
Due April 15, 2013
Indiana Resident Filers With No Dependents
(R11 / 9-12)
Your Social
Spouse’s Social
Security Number
Security Number
□
□
Check if applying for ITIN
Check if applying for ITIN
Your fi rst name
Initial
Last name
Suffi x
If fi ling a joint return, spouse’s fi rst name
Initial
Last name
Suffi x
Present address (number and street or rural route)
School Corporation
Number (see pg. 12, 13)
City
State
Zip/Postal code
Foreign country
2-character code
Enter the 2-digit county code numbers (found on the back of Schedule CT-40EZ) for the county where you lived and worked on January 1, 2012.
County where you lived
County where you worked
County where spouse lived
County where spouse worked
Round all entries
00
1. Enter your federal adjusted gross income from federal Form 1040EZ, line 4 _______________
1
00
2. Enter the amount from line 3 of the Indiana Deduction Worksheet on the back of this form ____
2
00
3. Subtract line 2 from line 1 and enter total ___________________________________________
3
00
4. Enter $1,000 if fi ling a single return OR $2,000 if fi ling a joint return ______________________
4
00
5. Subtract line 4 from line 3 ___________________________________ State Taxable Income
5
00
6. State adjusted gross income tax: multiply line 5 by 3.4% (.034) (if less than zero, leave blank)
6
00
7. County income tax (see instructions on page 9) (if less than zero, leave blank) _____________
7
00
8. Use tax due on out-of-state purchases (see instructions on page 6) ______________________
8
00
9. Add lines 6, 7 and 8 __________________________________________________ Total Tax
9
00
10. From W-2s: all Indiana state tax withheld __________________________________________ 10
00
11. From W-2s: all Indiana county tax withheld _________________________________________ 11
12. Automatic Taxpayer Refund credit. See eligibility requirements on page 6.
Enter $111 if you are eligible; enter $222 if joint fi ling and both are eligible; or,
00
enter $111 if joint fi ling but only one is eligible. Leave blank if not eligible ________________ 12
00
13. Add lines 10, 11 and 12 ____________________________________________ Total Credits
13
14. If line 13 is more than line 9, subtract line 9 from line 13. This is an
00
overpayment. (If line 9 is more than line 13, skip to line 18.) _______________ Overpayment
14
00
15.
Amount from line 14 to be donated to the Indiana Nongame Wildlife Fund _____________ 15
00
16. Subtract line 15 from line 14. This is your refund _________________________Your Refund 16
□
□
17. a. Routing Number
c.Type
Checking
Savings
Direct
□
Deposit
b. Account Number
Hoosier Works MC
□
(see page 7)
d. Place an “X” in the box if refund will go to an account outside the United States
00
18. If line 9 is more than line 13, subtract line 13 from line 9 _______________________________ 18
00
19. Penalty if fi led after due date (see instructions on page 8) _____________________________ 19
00
20. Interest if fi led after due date (see instructions on page 8) _____________________________ 20
21. Add lines 18, 19 and 20. This is the amount you owe. See page 8 for details on how to
00
make your payment, including credit card options. ___________________ Amount You Owe 21
15412111694
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