Form 740-Ez - Kentucky Individual Income Tax Return - For Single Persons With No Dependents - 2004
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1K
I
I
T
R
740-EZ
ENTUCKY
NDIVIDUAL
NCOME
AX
ETURN
For Single Persons With No Dependents
42A740-EZ
2004
Department of Revenue
Your Social Security Number
Name—Last, First, Middle Initial
L
Mailing Address (Number and Street or P.O. Box)
Apartment Number
A
B
E
City, Town or Post Office
State
ZIP Code
L
1
2
3
POLITICAL
Designating $2 will not change your refund or tax due. Mark an X in
PARTY
Box 1 for Democratic, Box 2 for Republican, or Box 3 for No Designation.
FUND
Dollars
Cents
INCOME
1. Enter federal Adjusted Gross Income from Form 1040EZ, line 4.
This is your Kentucky Adjusted Gross Income (If $25,000 or less,
0
0
,
.
see Low Income Credit in instructions.) ..................................................................... 1
1
8
7
0
0
0
,
.
2. Standard deduction ................................................................................................... 2
0
0
,
.
3. Subtract line 2 from line 1. This is your Taxable Income ...................................... 3
0
0
,
.
4. Enter tax from Tax Table or Tax Computation for amount on line 3 ...................... 4
TAX
5.
__ . __ __
__ __ __
0
0
Multiply line 4 by the low income tax credit decimal amount
(
%)
.
5
and enter here ....................................................................................................................
0
0
,
.
6. Subtract line 5 from line 4. This is your Income Tax Liability .............................. 6
0
0
,
.
7. Enter Kentucky Use Tax ........................................................................................... 7
0
0
,
.
8. Add lines 6 and 7. This is your Total Tax Liability ................................................. 8
0
0
9. Enter Kentucky Income Tax withheld as shown on attached
,
.
2004 Form W-2, Wage and Tax Statement(s) ......................................................... 9
0
0
,
.
AMOUNT OVERPAID
10. If line 9 is greater than line 8, enter
(see instructions) . 10
See instructions for a detailed description of funds.
11. a Nature and Wildlife Fund Contribution (Enter amount checked)
0
0
.
$2
$5
$10
Other
................
0
0
b Child Victims' Trust Fund Contribution (Enter amount checked)
.
$2
$4
Other
......................................
0
0
c Bluegrass State Games and U.S. Olympic Committee
.
Fund Contribution .............................................................................
0
0
.
d Veterans' Program Trust Fund Contribution ..................................
0
0
,
.
12. Add amounts contributed on lines 11a, 11b, 11c and 11d .................................... 12
0
0
,
.
REFUND
13. Subtract line 12 from line 10. Amount to be refunded to you .......
13
14. If line 8 is larger than line 9, enter amount you owe. Enclose check
0
0
payable to Kentucky State Treasurer. Write your Social
,
.
OWE
Security number and "KY Income Tax—2004" on the check .......................
14
I, the undersigned, declare under penalties of perjury that I have examined this return, including any accompanying statements, and to
the best of my knowledge and belief, it is true, correct and complete.
Your Signature
Telephone Number (daytime)
Date Signed
Typed or Printed Name of Preparer Other Than Taxpayer
I.D. Number of Preparer
Date
Official Use Only
REFUNDS
Kentucky Department of Revenue, Frankfort, KY 40618-0006.
Mail to:
NT
P B F
R
PAYMENTS
Kentucky Department of Revenue, Frankfort, KY 40619-0008.
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