Form 40 - Individual Income Tax Return - 2016 Page 4
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2116000540
Sch. A, B, & DC
(Form 40) 2016
Page 2
Name(s) as shown on Form 40 (Do not enter name and social security number if shown on other side)
Your social security number
SCHEDULE B – Interest And Dividend Income
Reset Schedule B
If you received more than $1500 of interest and dividend income, you must complete Schedule B. See instructions on page 21.
B
A
List Payers and Amounts
Taxable Interest
Exempt Interest
and Dividends
00
00
1
00
00
I
00
00
N
T
00
00
E
00
00
1
1
R
E
00
00
S
00
00
T
00
00
00
00
00
2
00
D
I
00
V
00
I
D
00
2
E
00
N
D
00
S
00
00
3
TOTAL TAXABLE INTEREST AND DIVIDENDS
Return to Page 1
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00
3
Enter here and on Form 40, page 1, line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SCHEDULE DC – Donation Check-Offs
Reset Schedule DC
1 You may donate all or part of your overpayment. (Enter the amount in the appropriate boxes.)
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•
00
00
a Senior Services Trust Fund . . . . . . . . . . . . . . . . . . . . . . .
k Alabama Breast & Cervical Cancer Program . . . . . . . . . . . . . . .
•
•
00
00
b Alabama Arts Development Fund . . . . . . . . . . . . . . . . . .
l Victims of Violence Assistance . . . . . . . . . . . . . . . . . . . . . . . .
•
•
00
00
c Alabama Nongame Wildlife Fund . . . . . . . . . . . . . . . . . .
m Alabama Military Support Foundation . . . . . . . . . . . . . . . . . . . . .
•
00
d Child Abuse Trust Fund. . . . . . . . . . . . . . . . . . . . . . . . . . .
n Alabama Veterinary Medical Foundation
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•
00
00
e Alabama Veterans Program . . . . . . . . . . . . . . . . . . . . . . .
Spay-Neuter Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
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00
00
f Alabama State Historic Preservation Fund . . . . . . . . . .
o Cancer Research Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
•
00
00
g Archives Services Fund. . . . . . . . . . . . . . . . . . . . . . . . . . .
p Alabama Association of Rescue Squads. . . . . . . . . . . . . . . . . . .
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00
00
h Foster Care Trust Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
q USS Alabama Battleship Commission. . . . . . . . . . . . . . . . . . . . .
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00
00
i Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
r Children First Trust Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
00
j Alabama Firefighters Annuity and Benefit Fund . . . . . .
Return to Page 1
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2 Total Donations. Add lines 1a, b, c, d, e, f, g, h, i, j, k, l, m, n, o, p, q, and r. Enter here and on Form 40, page 1, line 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ADOR
Schedules B, & DC (Form 40) 2016
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