Form 40 - Alabama Individual Income Tax Return - 2011 Page 2
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1
211000240
Form 40 (2011)
Page 2
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00
P RT I
1
1 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
00
2 Business income or (loss) (attach Federal Schedule C or C-EZ) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
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00
3 Gain or (loss) from sale of Real Estate, Stocks, Bonds, etc. (attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
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•
00
00
4a Total IRA distributions
4a
4b Taxable amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . .
4b
Other
•
•
00
00
5a Total pensions and annuities
5a
5b Taxable amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . .
5b
Income
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00
6 Rents, royalties, partnerships, estates, trusts, etc. (attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
(See page 12)
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00
7 Farm income or (loss) (attach Federal Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
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8 Other income (state nature and source — see instructions)
8
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9 Total other income. Add lines 1 through 8. Enter here and also on page 1, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
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P RT II
1a Your IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1a
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00
b Spouse’s IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
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00
2 Payments to a Keogh retirement plan and self-employment SEP deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
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3
3 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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4 Alimony paid. Recipient’s last name
Social security no.
4
Adjustments
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5 Adoption expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
to Income
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00
6 Moving Expenses (Attach Federal Form 3903) to City
State
ZIP
6
(See page 15)
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00
7 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
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8
8 Payments to Alabama PACT Program or Alabama College Education Savings Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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00
9 Health insurance deduction for small employer employee (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
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00
10 Costs to retrofit or upgrade home to resist wind or flood damage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
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11 Total adjustments. Add lines 1 through 10. Enter here and also on page 1, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
P RT III
(4) Did you provide
Dependents:
(2) Dependent’s social security
1a
(3) Dependent’s
more than one-half
(1) First name
Last name
number.
relationship to you.
dependent's support?
•
Dependents
•
Do not include
•
yourself or
•
your spouse
•
b Total number of dependents claimed above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 15)
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Enter amount here and on page 1, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
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•
P RT IV
1 Residency Check only one box
Full Year
Part Year
From
2011 through
2011.
2 Did you file an Alabama income tax return for the year 2010?
Yes
No If no, state reason
3 Give name and address of present employer(s). Yours
General
Your Spouse’s
Information
•
•
4 Enter the Federal Adjusted Gross Income
$
and Federal Taxable Income
$
as reported on your 2011 Federal
Individual Income Tax Return.
All Taxpayers
Must 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)
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00
Source
Amount
(See page 15)
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00
Source
Amount
•
I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.
Sign Here
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
In Black Ink
true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature
Date
Daytime telephone number
Your occupation
Keep a copy
(
)
of this return
for your records.
Spouse’s signature (if joint return, BOTH must sign)
Date
Daytime telephone number
Spouse’s occupation
(
)
Date
Preparer’s SSN or PTIN
Preparer’s
Paid
Check if
•
signature
self-employed
Preparer’s
Firm’s name (or yours
Daytime telephone no. (
)
E.I. No.
Use Only
if self-employed)
ZIP Code
and address
If an addressed envelope came with your return, please use it and follow the instructions on the envelope. If you do not have one, mail your return to one of the addresses below.
If you are not making a payment, mail your return to:
If you are making a payment, mail your return, Form 40V, and payment to:
WHERE TO
Alabama Department of Revenue
Alabama Department of Revenue
FILE
P. O. Box 154
P. O. Box 2401
FORM 40
Montgomery, AL 36135-0001
Montgomery, AL 36140-0001
Mail only your 2011 Form 40 to one of the above addresses. Prior year returns, amended returns, and all other correspondence should be mailed to
Alabama Department of Revenue, P.O. Box 327464, Montgomery, AL 36132-7464.
ADOR
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