Form 40 - Oregon Individual Income Tax Return - 2012
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1
2Clear Form
Amended Return
OREGON
2012
For office use only
Form
40
INDIVIDUAL INCOME TAX RETURN
Full-Year Residents Only
Fiscal year ending
K
F
P
J
W
Last name
First name and initial
Date of birth
(mm/dd/yyyy)
Social Security No. (SSN)
–
–
Deceased
Spouse’s/RDP’s last name if joint return
Spouse’s/RDP’s first name and initial if joint return
Spouse’s/RDP’s SSN if joint return
Date of birth
(mm/dd/yyyy)
–
–
Deceased
Current mailing address
Telephone number
(
)
City
State
ZIP code
Country
If you filed a return last year, and your
name or address is different, check here
•
Filing
1
Exemptions
Single
Status
•
•
2a
Married filing jointly
Total
2b
Registered domestic partners (RDP) filing jointly
Check
6a
6a
Yourself ...........
Regular
...... Severely disabled
....
only
3a
Married filing separately:
one
6b
b
Spouse/RDP ...
Regular
...... Severely disabled
......
Spouse’s name _____________________________ Spouse’s SSN ___________________
box
3b
•
Registered domestic partner filing separately:
6c
c
All dependents
First names __________________________________
Partner’s name _____________________________ Partner’s SSN ___________________
•
6d
d
Disabled
First names __________________________________
4
Head of household:
Person who qualifies you ________________________________
children only
•
Total
6e
5
Qualifying widow(er) with dependent child
(see instructions)
•
•
•
•
•
7a
7b
You
7c
You have
7d
Someone else
You were:
65 or older
Blind
Check all that apply
➛
filed an
federal
can claim you
Spouse/RDP was:
65 or older
Blind
extension
Form 8886
as a dependent
Round to the nearest dollar
8 Federal adjusted gross income. Federal Form 1040, line 37; 1040A, line 21; 1040EZ, line 4;
•
.00
1040NR, line 36; or 1040NR-EZ, line 10. See instructions, page 13 ...........................................................
8
•
.00
9 Interest and dividends on state and local government bonds outside of Oregon ...
9
ADDITIONS
•
.00
•
•
10y $
10 Other additions. Identify:
10x
10z
10
Schedule included
•
.00
11 Total additions. Add lines 9 and 10 .............................................................................................................
11
•
.00
12 Income after additions. Add lines 8 and 11 .................................................................................................
12
•
.00
13 2012 federal tax liability ($0–$6,100; see instructions for the correct amount) .....
13
SUBTRACTIONS
•
.00
Include
14 Social Security included on federal Form 1040, line 20b; or Form 1040A, line 14b ...
14
proof of
•
.00
15 Oregon income tax refund included in federal income ............................................
15
withholding
•
.00
16 Interest from U.S. government, such as Series EE, HH, and I bonds .....................
16
(W-2s,
•
.00
% ...
% 17b
1099s),
17 Federal pension income. See instructions, page 15. 17a
17
payment,
•
•
•
.00
18y $
18 Other subtractions. Identify:
18x
18z
18
Schedule included
and payment
•
.00
19 Total subtractions. Add lines 13 through 18 ................................................................................................
19
voucher
•
.00
20 Income after subtractions. Line 12 minus line 19 ........................................................................................
20
If you are claiming itemized deductions, fill in lines 21–25. If you are claiming the standard deduction, fill in line 26 only.
DEDUCTIONS
•
.00
21 Itemized deductions from federal Schedule A, line 29 ............................................
21
•
.00
22 Special Oregon medical deduction (age restricted, see instructions, page 17) ......
22
•
.00
23 Total Oregon itemized deductions. Add lines 21 and 22 .........................................
23
•
.00
24 State income tax claimed as an itemized deduction ..........................................
24
•
.00
25 Net Oregon itemized deductions. Line 23 minus line 24.........................................
25
Either line 25 or 26
OR
•
.00
26 Standard deduction from page 17 ...........................................................................
26
•
.00
27 Total deductions. Line 25 or line 26, whichever is larger .........................................................................
27
•
.00
28 Oregon taxable income. Line 20 minus line 27. If line 27 is more than line 20, enter -0- .........................
28
•
.00
TAX
29 Tax. See instructions, page 18. Enter tax here ........................................................
29
•
•
Check if tax is from: 29a
Tax tables or charts or
29b
Form FIA-40 or
29c
Worksheet FCG
•
.00
30 Interest on certain installment sales .........................................................................
30
•
.00
31 Total tax before credits. Add lines 29 and 30 ...................................
OREGON TAX BEFORE CREDITS
31
➛
NOW GO TO THE BACK OF THE FORM
150-101-040 (Rev. 12-12)
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