Form Ia 1040 - Iowa Individual Income Tax Form - 2015

2015 IA 1040 Iowa Individual Income Tax Form

For fiscal year beginning ____/____ 2015 and ending ____/____ /____

Step 1: Fill in all spaces. You must fill in your Social Security Number (SSN).

Your last name

Your first name/middle initial

Spouse’s last name

Spouse’s first name/middle initial

Current mailing address (number and street, apartment, lot, or suite number) or PO Box

City, State, ZIP

•

•

Email Address:

Spouse SSN

Your SSN

•

Step 2 Filing Status: Mark one box only.

Check this box if you or your spouse were 65 or older as of 12/31/15.

•

•

▲

Single: Were you claimed as a dependent on another person’s Iowa return?

1

Yes

No

Residence on 12/31/15: County No.

School District No.

Dependent children for whom an exemption is claimed in Step 3

2

Married filing a joint return. (Two-income families may benefit by using status 3 or 4.)

How many have health care coverage?(including Medicaid or hawk-i) _____ •

How many do not have health care coverage? _____ •

3

Married filing separately on this combined return. Spouse use column B.

▲

4

Married filing separate returns.

Spouse's name:

Net Income: $

SSN:

Head of household with qualifying person. If qualifying person is not claimed as a dependent on this return, enter the person’s name and SSN below.

5

6

Qualifying Widow(er) with dependent child.

Name:

SSN:

Step 3 Exemptions

B. Spouse (Filing Status 3 ONLY)

A. You or Joint

▲

▲

a.

$

$

Personal Credit: Col. A: Enter 1 (enter 2 if filing status 2 or 5); Col. B: Enter 1 if filing status 3

X $ 40 =

X $ 40 =

▲

▲

b.

$

$

Enter 1 for each taxpayer who is 65 or older and/or 1 for each taxpayer who is blind

X $ 20 =

X $ 20 =

▲

▲

c.

Dependents: Enter 1 for each dependent

X $ 40 =

$

X $ 40 =

$

d.

Enter first names of dependents here

e. Total

$ ____________

e. Total

$ _____________

B. Spouse/Status 3 ▲

A. You or Joint ▲

Step 4 Reportable Social Security Benefits as calculated on line 11 of Iowa social security worksheet

B. Spouse/Status 3

A. You or Joint

B. Spouse/Status 3

A. You or Joint

Step 5

1.

Wages, salaries, tips, etc ..................................................................................

1.

.00

.00

Gross

2.

Taxable interest income. If more than $1,500, complete Sch. B......................

Income

2.

.00

.00

3.

Ordinary dividend income. If more than $1,500, complete Sch. B ...................

3.

.00

.00

Alimony received ...............................................................................................

4.

4.

.00

.00

NOTE: Use only

Business income/(loss) from federal Schedule C or C-EZ ...............................

5.

5.

.00

.00

blue or black

Capital gain/(loss), federal Sch. D if required for federal purposes .......

6.

6.

.00

.00

ink, no pencils

or red ink.

Other gains/(losses) from federal form 4797 ....................................................

7.

7.

.00

.00

Taxable IRA distributions ..................................................................................

8.

8.

.00

.00

Taxable pensions and annuities .......................................................................

9.

9.

.00

.00

Rents, royalties, partnerships, estates, etc .......................................................

10.

10.

.00

.00

Farm income/(loss) from federal Schedule F ...................................................

11.

11.

.00

.00

Unemployment compensation. See instructions ..............................................

12.

12.

.00

.00

Gambling winnings ............................................................................................

13.

13.

.00

.00

Other income, bonus depreciation, and section 179 adjustment ....................

14.

14.

.00

.00

Gross Income. Add lines 1-14 .............................................................................................................................................

15.

▲

15.

__________________ .00

_______________ .00

Step 6

16.

Payments to an IRA, Keogh, or SEP ................................................................

16.

.00

.00

Adjust-

ments to

17.

Deductible part of self-employment tax. ...........................................................

17.

.00

.00

Income

Health insurance deduction ..............................................................................

18.

18.

.00

.00

Penalty on early withdrawal of savings .............................................................

19.

19.

.00

.00

Alimony paid ......................................................................................................

20.

20.

.00

.00

Pension/retirement income exclusion ...............................................................

21.

▲

21.

.00

.00

Moving expense deduction from federal form 3903 .........................................

22.

22.

.00

.00

Iowa capital gain deduction; certain sales only. Include IA 100 .......................

23.

▲

23.

.00

.00

Other adjustments .............................................................................................

24.

24.

.00

.00

Total adjustments. Add lines 16-24 ...................................................................................................................................

25.

▲

25.

.00

.00

Net Income. Subtract line 25 from line 15 ............................................................................................................................................................................................................................

26.

▲

26. __________________

.00

_______________ .00

Step 7

27.

Federal income tax refund/overpayment received in 2015 .............................

▲

27.

.00

.00

Federal

Tax

28.

Self-employment/household employment/other federal taxes .........................

▲

28.

.00

.00

Addition

29.

Addition for federal taxes. Add lines 27 and 28 ....................................................................................................................................................................................................................

and

29.

.00

.00

Deduc-

Total. Add lines 26 and 29 ....................................................................................................................................................................................................................................................

30.

tion

30.

.00

.00

Federal tax withheld .........................................................................................

31.

▲

31.

.00

.00

Federal estimated tax payments made in 2015 ...............................................

32.

▲

32.

.00

.00

Additional federal tax paid in 2015 for 2014 and prior years ...........................

33.

▲

33.

.00

.00

Deduction for federal taxes. Add lines 31, 32, and 33 ........................................................................................................

34.

34.

.00

.00

Balance. Subtract line 34 from line 30. Enter here and on line 36, page 2 ........................................................................

35.

▲

35.

.00

.00

41-001 (09/02/15)