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MISSOURI INDIVIDUAL INCOME TAX RETURN AND PROPERTY

2011

FORM MO-1040P

TAX CREDIT CLAIM/PENSION EXEMPTION—SHORT FORM

SOFTWARE

LAST NAME

FIRST NAME

MIDDLE INITIAL

SOCIAL SECURITY NUMBER

DECEASED

VENDOR CODE

2011

__ __ __ - __ __ - __ __ __ __

(Assigned by DOR)

SPOUSE’S LAST NAME

FIRST NAME

MIDDLE INITIAL

SPOUSE’S SOCIAL SECURITY NUMBER

DECEASED

002

2011

__ __ __ - __ __ - __ __ __ __

IN CARE OF NAME (ATTORNEY, EXECUTOR, PERSONAL REPRESENTATIVE, ETC.)

COUNTY OF RESIDENCE

PRESENT ADDRESS (INCLUDE APARTMENT NO. OR RURAL ROUTE)

APT. NUMBER

CITY, TOWN, OR POST OFFICE, STATE, AND ZIP CODE

PLEASE CHECK THE APPROPRIATE BOXES THAT APPLY TO YOURSELF OR YOUR SPOUSE.

AGE 65 OR OLDER

BLIND

100% DISABLED

NON-OBLIGATED SPOUSE

AGE 62 THROUGH 64

YOURSELF

SPOUSE

You may contribute to any one or

all of the trust funds that are listed

Workers

LEAD

eneral

to the right. Place the total amount

evenue

contributed on Line 24. See the

Children’s

Veterans

Elderly Home

Missouri National

Workers’ Memorial

Childhood

Missouri Military

General Revenue

After School

Organ Donor

in s tructions for a list of Trust Fund

Program Fund

Trust Fund

Delivered Meals

Guard Trust

Fund

Lead Testing

Family Relief

Fund

Retreat Fund

Codes.

Trust Fund

Fund

Spouse

Yourself

1. Federal Adjusted Gross Income from your 2011 federal return

(See worksheet on page 8.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 –

–

2. Any state income tax refund included in your 2011 federal adjusted gross income. . . . . . . . . .

3 =

3. Subtract Line 2 from Line 1. This is your Missouri adjusted gross income. . . . . . . . . . . . . . .

4. TOTAL MISSOURI ADJUSTED GROSS INCOME — Add both numbers on Line 3 and enter here. . . . . .

5. Income percentages — Divide Line 3 by Line 4 for both you and your spouse.

(The total of the two must equal 100%. Round to the nearest whole number.) . . . . . . . . . . . . . . . . . . . . .

6. M ark your filing status box below and enter the appropriate exemption amount on Line 6.

E. M arried filing separate (spouse

A. Single — $2,100 (See Box B before checking.)

NOT filing) — $4,200

B. Claimed as a dependent on another person’s federal

tax return — $0.00

F. Head of household — $3,500

C. M arried filing joint federal & combined Missouri — $4,200

G. Qualifying widow(er) with

dependent child — $3,500 . . . .

D. Married filing separate — $2,100

CAUTION!

7. Tax from federal return (Do not

Single—maximum of $5,000;

enter amount from your Forms W-2 —

Married filing combined—maximum

7 +

NOT federal tax withheld.)

of $10,000 . . . . . . . . . . . . . . . . . . . . . . . .

See Page 6,

Line 7.

8. Missouri Standard or Itemized Deduction

Taxpayers Under Age 65

Taxpayers Age 65 or Older

Single . . . . . . . . . . . . . . . . . . . . . . $5,800

Single . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $7,250

If 65 or

Married Filing Combined . . . . . . . $11,600

Married Filing Combined and YOU are Age

older or

Married Filing Separate. . . . . . . . . .$5,800

65 or Older . . . . . . . . . . . . . . . . . . . . . . . . . . $12,750

blind the

Head of Household . . . . . . . . . . . . .$8,500

Married Filing Combined and You and Your

appropriate

boxes must

Qualifying Widow(er). . . . . . . . . . .$11,600

Spouse are BOTH Age 65 or Older. . . . . . . $13,900

be checked

Married Filing Separate. . . . . . . . . . . . . . . . . . . . $6,950

above.

Head of Household . . . . . . . . . . . . . . . . . . . . . . . $9,950

Qualifying Widow(er). . . . . . . . . . . . . . . . . . . . . $12,750

If blind or claimed as a dependent, see your federal return or pages 6 and 7 of the instructions.

8 +

If itemizing, see page 4 of the Form MO-1040P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Do not

include

9. Number of dependents from Federal Form 1040 OR 1040A, Line 6c

yourself

9 +

(DO NOT INCLUDE YOURSELF OR SPOUSE.)

x $1,200 . . . . . . . . . . . . . .

or your

spouse.

10. Pension exemption (Complete worksheet on page 3 of Form MO-1040P.) Attach worksheet

10 +

on page 3, a copy of federal return, Forms W-2P and 1099-R.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 +

11. Long-term care insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 =

12. TOTAL DEDUCTIONS — Add Lines 6 through 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. Missouri Taxable Income — Subtract Line 12 (Total Deductions) from Line 4 (Total Missouri Income)

and enter here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MO 860-2954 (12-2011)

For Privacy Notice, see instructions.

Form Mo-1040p - Missouri Individual Income Tax Return And Property Tax Credit Claim/pension Exemption - Short Form - 2011

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