Fillable 2015 Tc-40 - Utah Individual Income Tax Return (Page 3 of 3) in pdf

Utah Individual Income Tax Return (continued)

TC-40

Pg. 3

40503

2015

SSN

Last name

USTC ORIGINAL FORM

Part 1 - Deceased Taxpayer Information

If the taxpayer shown on page 1 is deceased, enter the date of death here:

•

mm/dd/yy

If the spouse shown on page 1 is deceased, enter the date of death here:

•

mm/dd/yy

If you are claiming a refund for a deceased taxpayer and are not the surviving spouse, enter “X”:

•

You must complete and attach form TC-131 to the return.

Part 2 - Fiscal Year Filer

If filing a fiscal year return (a year other than January 1 through December 31), enter the fiscal year end (mm/yy)

•

mm/yy

See incometax.utah.gov/topics/fiscal-year-filing.

Part 3 - Federal Form 8886 filed

If you filed federal form 8886, Reportable Transaction Disclosure Statement, enter “X”:

•

Get form and instructions at irs.gov.

Part 4 - Voluntary Contributions (write the code and amount of each voluntary contribution)

See explanation of each contribution at incometax.utah.gov/contributions and/or the TC-40 instructions

Sch Dist

02 Pamela Atkinson Homeless Account

Code

Amount

Code

03 Kurt Oscarson Children’s Organ Transplant Account

.00

05 School District and Nonprofit School District Foundation - enter school district code

•

See codes at incometax.utah.gov/contributions/school-district-contributions

.00

09 Cat and Dog Community Spay and Neuter Program

•

11 Canine Body Armor Account

.00

12 Invest More for Education Account

•

13 Youth Development Organization Account

.00

14 Youth Character Organization Account

•

.00

Total voluntary contributions (enter the total here and on TC-40, page 2, line 28)

Part 5 - Utah Educational Savings Plan - Refund Application

To deposit your total refund into your Utah Educational Savings Plan (UESP) account(s), enter “X”:

•

Partial refunds are not allowed. UESP will divide your refund equally between all your accounts. If you do

not have a UESP individual account, UESP will send you information about how to open an account and also

return your refund without interest or earnings.

See , or call 801-321-7188 or 1-800-418-2551.

Part 6 - Direct Deposit to Foreign Account

If you choose to direct deposit your refund to an account outside the United States and its territories, enter “X”:

•

The Tax Commission cannot transfer a refund to an account outside the United States and its territories.

By checking this box, your refund will not be direct deposited but will be sent to you by check.

Part 7 - Property Owner’s Residential Exemption Termination Declaration

If you are a Utah residential property owner and declare you no longer qualify to receive a residential exemption

•

Enter “X”

authorized under UC §59-2-103 for your primary residence, enter “X” and enter the county code where the

residence is located (see instructions for county codes and additional information).

•

Enter code

Mail

Utah State Tax Commission

Mail

Utah State Tax Commission

RETURNS WITH

210 N 1950 W

ALL OTHER

210 N 1950 W

PAYMENTS to:

Salt Lake City, UT 84134-0266

RETURNS to:

Salt Lake City, UT 84134-0260

Submit page ONLY if data entered.

Attach completed schedule to your Utah Income Tax return.

2015 Tc-40 - Utah Individual Income Tax Return Page 3

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