IT-40EZ
Indiana Income Tax Return for Full-Year
2013
State Form 48438
Due April 15, 2014
Indiana Resident Filers With No Dependents
(R12 / 9-13)
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, 2013.
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 (if less than zero, leave blank) __________ State Taxable Income
5
00
6. State adjusted gross income tax: multiply line 5 by 3.4% (.034) _________________________
6
00
7. County income tax (see instructions on page 8) _____________________________________
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
00
12. Add lines 10 and 11 _______________________________________________ Total Credits
12
13. If line 12 is more than line 9, subtract line 9 from line 12. This is an
00
overpayment. (If line 9 is more than line 12, skip to line 17.) _______________ Overpayment
13
00
14.
Amount from line 13 to be donated to the Indiana Nongame Wildlife Fund _____________ 14
00
15. Subtract line 14 from line 13. This is your refund _________________________Your Refund 15
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□
Direct
16. a. Routing Number
c.Type
Checking
Savings
Deposit
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(see page 7)
b. Account Number
Hoosier Works MC
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d. Place an “X” in the box if refund will go to an account outside the United States
00
17. If line 9 is more than line 12, subtract line 12 from line 9 _______________________________ 17
00
18. Penalty if fi led after due date (see instructions on page 7) _____________________________ 18
00
19. Interest if fi led after due date (see instructions on page 7) _____________________________ 19
20. Add lines 17, 18 and 19. This is the amount you owe. See page 7 for details on how to
00
make your payment, including credit card options. ___________________ Amount You Owe 20
15413111694