Form 40 - Individual Income Tax Return - 2016 Page 2
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21Form 40 (2016)
Page 2
16000240
ADOR
PART I
1 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
•
2 Business income or (loss) (attach Federal Schedule C or C-EZ) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
•
3 Gain or (loss) from sale of Real Estate, Stocks, Bonds, etc. (attach Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
GO TO SCHEDULE D
•
4a Total IRA distributions
4a
4b Taxable amount (see instructions) . . . . . . . . . . . .
4b
Other
•
•
5a Total pensions and annuities 5a
5b Taxable amount (see instructions) . . . . . . . . . . . .
5b
Income
•
•
6 Rents, royalties, partnerships, estates, trusts, etc. (attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
GO TO SCHEDULE E
•
7 Farm income or (loss) (attach Federal Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
(See page 13)
•
8 Other income (state nature and source — see instructions)
8
•
9 Total other income. Add lines 1 through 8. Enter here and also on page 1, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
•
PART II
Return to Page 1
1a
1a Your IRA deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
1b
b Spouse’s IRA deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
2
2 Payments to a Keogh retirement plan and self-employment SEP deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
3
3 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
4
4 Alimony paid. Recipient’s last name
SSN
•
•
5
5 Adoption expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
6 Moving Expenses (Attach Federal Form 3903) to:
Adjustments
to Income
6
City
State
ZIP
•
7
7 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(See page 16)
•
8
8 Payments to Alabama College Counts 529 Fund or Alabama PACT Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
9
9 Health insurance deduction for small employer employee (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
10
10 Costs to retrofit or upgrade home to resist wind or flood damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
11
11 Deposits to a catastrophe savings account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
12
12 Total adjustments. Add lines 1 through 11. Enter here and also on page 1, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Return to Page 1
•
PART III
(4) Did you provide
1a
(3) Dependent’s
Dependents:
(2) Dependent’s
more than one-half
Relationship to You
(1) First name
Last name
Social Security Number
dependent's support?
Dependents
•
•
Do not include
yourself or
•
your spouse
•
b Total number of dependents claimed above. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
•
2 Amount allowed. (Multiply the total number of dependents claimed on line 1b by the amount from the dependent chart on page 10.)
(See page 17)
Enter amount here and on page 1, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
•
PART IV
Return to Page 1
1 Residency Check only one box
Full Year
Part Year
From
2016 through
2016.
•
•
2 Did you file an Alabama income tax return for the year 2015?
Yes
No If no, state reason
General
3 Give name and address of present employer(s). Yours
Information
Your Spouse’s
4 Enter the Federal Adjusted Gross Income
$
and Federal Taxable Income
$
as reported on your
All Taxpayers
•
•
Must
2016 Federal Individual Income Tax Return.
Complete
5 Do you have income which is reported on your Federal return, but not reported on your Alabama return (other than your state tax refund)?
Yes
No
This
Section.
If yes, enter source(s) and amount(s) below: (other than state income tax refund)
Source
Amount
•
(See page 17)
Source
Amount
•
PART V
For Direct Deposit of your refund, complete 1, 2, 3, and 4 below. (See Page 17 of instructions to see if you qualify.)
1 Routing Number:
2 Type:
Checking
Savings
3 Account Number:
Direct
Deposit
4 Is this refund going to or through an account that is located outside of the United States?
Yes
No
Drivers
DOB
Iss date
Exp date
(mm/dd/yyyy)
Your state
DL#
(mm/dd/yyyy)
(mm/dd/yyyy)
License Info
•
•
•
•
•
DOB
Iss date
Exp date
(mm/dd/yyyy)
Spouse state
DL#
(mm/dd/yyyy)
(mm/dd/yyyy)
•
•
•
•
•
I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.
•
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and com-
If no driver's license, check the box.
Spouse's
plete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign Here
Your Signature
Date
Daytime Telephone Number
Your Occupation
In Black Ink
Keep a copy
of this return
Spouse’s Signature (if joint return, BOTH must sign)
Date
Daytime Telephone Number
Spouse’s Occupation
for your
records.
Preparer’s Signature
Date
Check if Self-employed
Preparer’s SSN or PTIN
E.I. Number
Paid
•
Preparer’s
Firms’s Name (or yours
Daytime
ZIP
Use Only
if self employed)
Telephone No.
Code
Address
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