Form 40n - Oregon Individual Income Tax Return For Nonresidents - 2012 Page 2
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2Page 2 — 2012 Form 40N
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40 Amount from front of form, line 38S (Oregon amount) ...................................................................................... 40
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41 Itemized deductions from federal Schedule A, line 29 .........................................
41
DEDUCTIONS
AND
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42 State income tax claimed as itemized deduction .................................................
42
MODIFICATIONS
EITHER,
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43 Net Oregon itemized deductions. Line 41 minus line 42 ......................................
43
NOT BOTH
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44 Standard deduction from page 25 ........................................................................
44
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45 2012 federal tax liability ($0–$6,100; see instructions for the correct amount) ....
45
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46y $
46 Other deductions and modifications. Identify:
46x
46z
46
Schedule
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47 Deductions and modifications X Oregon percentage. See page 27 .....................
47
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4 8 Deductions and modifications not multiplied by the Oregon percentage. See page 27
48
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49 Total deductions and other modifications. Add lines 47 and 48 ....................................................................
49
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50 Oregon taxable income. Line 40 minus line 49 ...............................................................................................
50
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51 Tax. See page 27 for instructions. Enter tax here ................................................
51
OREGON
TAX
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Check if tax is from: 51a
Tax charts or
51b
Form FIA-40N or
51c
Worksheet FCG
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52 Interest on certain installment sales ......................................................................
52
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53 Total tax before credits. Add lines 51 and 52 ................................................................... OREGON TAX
53
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54 Exemption credit. See instructions, page 28 ......................................................
54
NONREFUNDABLE
CREDITS
ADD TOGETHER
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55 Credit for income taxes paid to another state. State:
55y
55z
55
Schedule
Include proof
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56y $
56 Other credits. Identify:
56x
56z
56
Schedule included
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57 Total non-refundable credits. Add lines 54 through 56 ..................................................................................
57
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58 Net income tax. Line 53 minus line 57. If line 57 is more than line 53, enter -0- ............................................
58
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59 Oregon income tax withheld from income. Include Forms W-2 and 1099 .........
59
PAYMENTS AND
REFUNDABLE
.00
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60 Estimated tax payments for 2012 and payments made with your extension .......
60
CREDITS
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60a
Wolf depredation
60b
Claim of right
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61 Tax payments from pass-through entity and real estate transactions ..................
61
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ADD TOGETHER
62 Earned income credit. See instructions, page 34 .................................................
62
Include Schedule
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WFC-N/P if you
63
Working family child care credit
from WFC-N/P, line 21 ..................................
63
claim this credit
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64 Mobile home park closure credit. Include Schedule MPC ....................................
64
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65 Total payments and refundable credits. Add lines 59 through 64 ..................................................................
65
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Overpayment.
Is line 58 less than line 65? If so, line 65 minus line 58 ...................
OVERPAYMENT
66
66
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Is line 58 more than line 65? If so, line 58 minus line 65 ...............................
TAX TO PAY
67
Tax to pay.
67
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68 Penalty and interest for filing or paying late. See instructions, page 34 .................. 68
ADD TOGETHER
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69 Interest on underpayment of estimated tax. Include Form 10 and check box
...
69
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Exception # from Form 10, line 1
Check box if you annualized
69a
69b
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70 Total penalty and interest due. Add lines 68 and 69 ......................................................................................... 70
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Amount you owe.
.................................................................AMOUNT YOU OWE
71
Line 67 plus line 70
71
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Is line 66 more than line 70? If so, line 66 minus line 70 ............................................
REFUND
72
Refund.
72
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73
Estimated tax.
Fill in the part of line 72 you want applied to 2013 estimated tax
73
CHARITABLE
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74
75
Prevent Child Abuse
Alzheimer’s Disease Research
CHECkOFF
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76
77
Stop Dom. & Sexual Violence
Habitat for Humanity
DONATIONS,
These will
PAGE 35
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78
79
OR Head Start Association
OR Military Financial Assist.
reduce
I want to donate
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your refund
80
81
Oregon Historical Society
Oregon Food Bank
part of my tax
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82
83
Albertina Kerr Kid’s Crisis Care
American Red Cross
refund to the
following fund(s)
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84a
84b
85a
85b
Charity code
Charity code
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86 Total Oregon 529 College Savings Plan deposits. See instructions, page 35 ......
86
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87 Total. Add lines 73 through 86. Total can’t be more than your refund on line 72 ..........................................
87
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88
NET REFUND.
Line 72 minus line 87. This is your net refund
.........................................NET REFUND
88
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DIRECT
89 For direct deposit of your refund, see instructions, page 35.
Type of account:
Checking or
Savings
DEPOSIT
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Routing No.
Account No.
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Will this refund go to an account outside the United States?
Yes
Important: Include a copy of your federal Form 1040, 1040A, 1040EZ, or 1040NR.
Under penalty for false swearing, I declare that the information in this return is true, correct, and complete.
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Your signature
Date
Signature of preparer other than taxpayer
License No.
X
X
Address
Telephone No.
Spouse’s/RDP’s signature (if filing jointly, BOTH must sign)
Date
X
150-101-048 (Rev. 12-12)
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