Filing status: Single, Married filing jointly, Registered domestic partners filing jointly, Your telephone number

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1 STAPLE OTHER DOCUMENTS IN UPPER LEFT IN BACK STAPLE W-2s AND ANY OTHER WITHHOLDING STATEMENTS HERE Government of the District of Columi Print in CAPITAL letters using lck ink D-40EZ Income Tx Return for Single nd Joint Filers with No Dependents 1 Totl wges, slries, tips, unemployment compenstion, etc. 2 Txle interest nd ordinry dividends. (If more thn $1500, file form D-40.) 3 DC djusted gross income. Add Lines 1 nd 2. 4 Stndrd deduction plus exemption. If single, enter $5775. If filing jointly, enter $7450, or if climed s dependent on nother s tx return, enter $ DC txle income. Line 3 minus Line 4. If Line 4 is equl to or more thn Line 3, mke no entry. If more thn $100,000 file form D Tx. Use the tx tles on pges to find the tx on the Line 5 mount. 7 DC Low Income Credit. Use Clc. LIC/EITC to see if LIC or EITC is greter enefit. See instructions. 7 Enter numer of exemptions climed on your federl return 7 8 Net tx. Sutrct Line 7 from Line 6. If Line 7 is equl to or more thn Line 6, mke no entry. 9 Contriution to Pulic Fund for Drug Prevention nd Children t Risk. 9 Contriution to DC Sttehood Delegtion Fund. 9c Contriution to Ancosti River Clenup nd Protection Fund. 9d RESERVED 10 Tx nd/or contriution(s). Add Lines 8, 9, 9, 9c nd 9d. 11 Totl DC income tx withheld, shown on Forms W-2 nd 1099 ttch these forms. * * Personl informtion Filing sttus: Single, Mrried filing jointly, Registered domestic prtners filing jointly, Your telephone numer Dependent climed y someone else Fill in if mended return Your socil security numer (SSN) nd Dte of Birth (MMDDYYYY) Spouse's/registered domestic prtner's SSN nd Dte of Birth (MMDDYYYY) Your first nme M.I. Lst nme Spouse s/registered domestic prtner s first nme M.I. Lst nme Home ddress (numer, street nd prtment numer if pplicle) City Stte Zip Code Tx pid with extension of time to fi le or with originl return if this is n mended return. 13 DC Erned Income Tx Credit. Enter your federl erned income credit Use Clc. LIC/EITC to see if EITC is greter. Leve lnk if you took Line 7 LIC credit. $ 13 Enter numer of qulifi ed EITC children 13 x.40 = 14 Totl tx pyments nd credits. Add lines Refund. If Line 14 is the lrger, sutrct Line 10 from Line Amount owed. If Line 10 is the lrger, sutrct Line 14 from Line 10. See pyment options in instructions. 17 Penlty $ Interest $ See instructions. Enter results 18 TOTAL AMOUNT DUE. Add lines 16 nd TOTAL REFUND. Sutrct Line 17 (results) from Line 15 nd enter here. Will the refund you requested go to n ccount outside of the US? Yes No See instructions. OFFICIAL USE ONLY Vendor ID# $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ 8 $ 9 $ 9 $ 9c $ 9d $ 10 $ 11 $ 12 $ 13 $ 14 $ 15 $ 16 $ 17 $ 18 $ 19 $ Refund Options: For informtion on the tx refund crd nd progrm limittions, visit our wesite otr.dc.gov/refundprepidcrds. Mrk one refund choice: Direct deposit Tx refund crd Pper check Direct Deposit. To hve your refund deposited to your checking OR svings ccount, fill in ovl nd enter nk routing nd ccount numers. See instructions. Routing Numer Account Numer Third prty designee To uthorize nother person to discuss this return with OTR, fill in here Designee s nme nd enter the nme nd phone numer of tht person. See instructions. Phone numer Signture Under penlties of lw, I declre tht I hve exmined this return nd, to the est of my knowledge, it is correct. Declrtion of pid preprer is sed on informtion ville to the preprer. Your signture Dte Preprer s signture Dte Spouse s/domestic prtner s signture if filing jointly Dte Preprer's Tx Identifiction Numer (PTIN) PTIN telephone numer Revised 09/ D-40EZ Income Tx Return

2 Personl informtion (SSN, nme, ddress, telephone numer) Refer to pge 8 of the Generl Instructions to prepre personl informtion. Filing sttus Refer to pge 8 of the Generl Instructions regrding filing sttus, nd fill in the pproprite filing sttus. Line 1 Totl wges, slries, tips, unemployment compenstion, etc. Enter mount from 1040, 1040A, 1040EZ, 1040NR, or 1040NR-EZ. Line 2 Txle interest nd ordinry dividends. If more thn $1,500, file the Form D-40. Txle interest should e shown on your Forms 1099-INT, 1099-OID, or sustitute sttements. Include interest from series EE, HH nd I US svings onds. Do not report ny tx-exempt interest from ox 8 or 9 of Form 1099-INT. Report on Line 2: If you hve ny interest received from seller-finnced mortgge nd the uyer used the property s personl residence; If you hve ccrued interest from ond; If you re reporting originl issue discount (OID) in n mount less thn the mount shown on the IRS Form 1099-OID; If you re reducing your interest income on ond y the mount of the mortized ond premium; If you received interest or ordinry dividends s nominee; or If you hd foreign ccount or you received distriution from, or were grntor of, or trnsferor to, foreign trust. Foreign ccounts. If you own more thn 50% of the stock in ny corportion tht owns one or more foreign nk ccounts; or if ny time during 2013 you hd n interest in or signture or other uthority over finncil ccount in foreign country (such s nk ccount, securities ccount, or other finncil ccount) unless: The comined vlue of the ccounts ws $10,000 or less during the whole yer; The ccounts were with US militry nking fcility operted y US finncil institution; You were n officer or employee of commercil nk tht is supervised y the Comptroller of the Federl Reserve System, or the Federl Deposit Insurnce Corportion; the ccount ws in your employer s nme; nd you did not hve personl finncil interest in the ccount; You were n officer or employee of domestic corportion with securities listed on ntionl securities exchnge or with ssets of more thn $10 million nd 500 or more shreholders of record; the ccount ws in your employer s nme; you did not hve personl finncil interest in the ccount; nd the corportion s chief finncil officer hs given you written notice tht the corportion hs filed current report tht includes the ccount. Report ny income shown in Box 1 of the Forms DIV or sustitute sttements. You my refer to the Generl Instructions for Schedule B Interest nd Ordinry Dividends from Instructions for the D-40EZ DC Low Income Credit or DC Erned Income Tx Credit Clcultion LIC/EITC Tke only one of these credits. (Use this clcultion to determine which is etter for you to clim) Tx from D-40EZ, Line 6 Low income credit c Enter the lesser of Line or Line d Federl Erned Income Credit climed on 1040, 1040A, 1040EZ. e DC Erned Income Tx Credit rte f DC Erned Income Tx Credit Multiply Line d y Line e (round to the nerest dollr). Compre Line c to Line f. If Line c mount is greter thn or equl to Line f, enter it on D-40EZ, Line 7. If Line f mount is greter thn line c, enter it on D-40EZ, Line Line 3 DC Adjusted Gross Income. Add Lines 1 nd 2. Line 4 Stndrd deduction plus exemption. Refer to pge 9 of the Generl Instructions regrding stndrd deduction nd personl exemptions. Line 5 DC txle income. Line 3 minus Line 4. If Line 4 is equl to or more thn Line 3, mke no entry. If more thn $100,000, file the Form D-40. Refer to pge 10 of the Generl Instructions. Line 6 Tx. Refer to pge 10 of the Generl Instructions. Line 7 DC Low Income Credit. Refer to pge 9 of the Generl Instructions. Line 7 Numer of exemptions climed on federl return. Enter the numer of federl exemptions. Line 8 Net Tx. Sutrct Line 7 from Line 6. If Line 7 is equl to or more thn Line 6, mke no entry. Lines 9, 9 nd 9c Refer to pge 10 of the Generl Instructions. Line 9d RESERVED Line 10 Tx nd/or contriutions. Add Lines 8, 9, 9, 9c, nd 9d (if pplicle) Line 11 Totl DC income tx withheld. Refer to pge 8 of the Generl Instructions. Line 12 Tx pid with extension of time to file or with originl return if this is n mended return. Refer to pge 10 of the Generl Instructions. Line 13 DC Erned Income Tx Credit. Refer to pge 10 of the Generl Instructions. Line 13 Numer of Qulified EITC Children. Enter the numer of qulified children s defined on pge 10 of the Generl Instructions. Line 14 Totl tx pyments nd credits. Add lines Line 15 Refund. If Line 14 is the lrger, sutrct Line 10 from Line 14. Include contriutions. Answer the IAT question; refer to pge 11 of the Generl Instructions. Line 16 Amount Owed. If Line 10 is the lrger, sutrct Line 14 from Line 10. Refer to pyment options on pge 6 of the Generl Instructions. Line 17 Penlty nd interest. Enter ny underestimted penlty nd interest owed in the pproprite oxes. Refer to pge 7 of the Generl Instructions. Line 18 Totl mount due. Add lines 16 nd 17. Line 19 Totl refund. Sutrct Line 17 (results) from Line 15. c d e f x.40 Refund Options. Refer to pge 10 of the Generl Instructions. Third Prty Designee. Refer to pge 11 of the Generl Instructions. Signture. Refer to pge 11 of the Generl Instructions. PTIN. Refer to pge 11 of the Generl Instructions.

3 Stte Income Tx Return Forms You cn prepre nd efile this tx form on efile.com s prt of your current Federl nd/or Stte Tx Return on from: Erly Jnury until mid Octoer You cn strt, prepre, nd efile your tx return now You will just need to nswer few tx questions nd the efile.com tx preprtion softwre will select the correct tx forms for you. Attention If you missed the mid Octoer efile dedline for the current tx yer you hve the following options to prepre nd file your tx return: 1. You cn downlod the Stte Tx form here: stte tx gency list/ 2. Work online on your tx return with n efile Tx Professionl Strt working with LIVE TxPRO 3. Downlod Federl tx forms y tx yer, complete nd mil to the IRS Downlod Federl Tx Forms Free Tx Tools, Clcultors nd Eductors Hed of Household Eductor: hed of household single qulifying person requirement tx tool/ Qulifying Child Dependent Eductor: child test qulified dependent tx tool/ Qulifying Reltive Eductor: reltive test dependent requirement tx tool/ Erned Income Tx Credit Eductor: is the erned income tx credit eitc eic eligiility schedule clcultor/ Child Tx Credit Eductor: to qulify for child tx credit deduction requirements tool/ Got Tx Questions? Contct efile.com!

4 Instructions for the D-40 To complete your D-40 return, you will need to do series of clcultions contined in these instructions nd copy mny of the line items nd totls on your D-40. You my lso need to ttch DC schedules, forms nd worksheets to your D-40 if you complete ny of the DC forms. Unless instructed otherwise, if you complete ny prt of ny Schedules H, I, N, S, or U, ttch it to your return, in the order defined in Generl Instructions, pge 12. Schedule H, Homeowners nd Renter Property Tx Credit. This schedule llows eligile residents to clim property tx credit ginst their DC income tx liility. Totl household gross income cnnot exceed $20,000. Do not clim this credit for n exempt property owned y government, house of worship or non-profit orgniztion. See Schedule H in this ooklet. Note: If you re filing D-40, you must file DC Schedule H with it. If you re not required to file D-40 (or D-40EZ), the DC Schedule H cn e filed y itself. Schedule I, Additions to nd Sutrctions from FAGI. This schedule contins two clcultions, one for dditions nd nother for sutrctions from federl AGI. See Schedule I in this ooklet. If you took the 30% or 50% federl onus deprecition nd/or the dditionl Internl Revenue Code (IRC) Section 179 expenses on your federl return, enter the totl on Schedule I, Clcultion A, Line 3. Schedule N. DC Non-Custodil Prent EITC Clim. Use this schedule to determine whether non-custodil prent mking court-ordered child support pyments my clim the DC EITC. See Schedule N in this ooklet. Schedule S, Supplementl Informtion nd Dependents. If climing exemptions, use Schedule S to list ech dependents nme, socil security numer nd dte of irth. Use Schedule S if reporting dependent or other qulifying dependent, nd hed of household informtion. It contins Clcultion G for use in determining the numer of exemptions you my clim nd Clcultion J to determine the DC tx mount for mrried or registered domestic prtners filing seprtely on the sme return. You my lso use Schedule S for climing dependents nd deductions for eing lind nd/or over 65. You my clim n exemption for ech of your dependents. You my lso clim deduction for eing over 65 or lind. Climing dependents nd deductions for eing lind nd/or over 65 You my clim n exemption for ech of your dependents or other qulifying non-dependent person. If climing exemptions, use Schedule S to list ech dependent's nme, SSN, nd DOB. You my lso clim deduction for yourself or your spouse/registered domestic prtner for eing over 65 or lind. Schedule U, Additionl Miscellneous Credits nd Contriutions. This schedule lists certin dditionl non-refundle nd refundle credits you my e le to clim. It lso lists severl contriutions funds to which you my wish to contriute. See Schedule U in this ooklet. Credit for certin DC Government employees who re DC residents nd first-time DC homeuyers. This credit, originlly limited to DC police officers who re first-time homeuyers in DC, hs een expnded. This $2,000 credit is now ville to ll DC government employees, employees of DC pulic chrter school, nd ny person who hs ccepted n offer to e DC police officer, firefighter, emergency medicl technicin, pulic school techer or techer t DC pulic chrter school. Except for DC police officers, the tx credit is limited to those employees who purchsed their first principl residence in DC on or fter Octoer 1, 2007, nd who re enrolled in the Employer Assisted Housing Progrm (EAHP) offered y the DC Deprtment of Housing nd Community Development. The credit is ville for 5-yer period. Enter $2,000 on Schedule U, Prt 1, Line 1. It includes the mount DC txpyers my clim s credit for individul income tx pid to other stte(s) if the income txed y tht stte is derived from tht stte nd is of kind txed y DC. If tx pid to stte is the totl stte tx liility shown on the stte tx return. (It is not the stte withholding shown on your Form W-2.) Complete Clcultion K on pge 19, to determine your out of stte credit. Enter the credit mount on Schedule U, Prt 1, Line 3. If you pid tx to more thn one stte, enter the respective mounts nd other stte codes in the spces provided. No DC credit is llowed for ny other tx imposed y stte, including the following: Corporte frnchise tx; License tx; Excise tx; Unincorported usiness frnchise tx; nd Occuption tx. Personl Informtion. Refer to Generl Instructions, pge 8 for directions on completing n mended return. Filing for decesed txpyer. Fill in the ovl for decesed txpyer t the top of the pge of the D-40. If txpyer died in 2013 or 2014 efore filing return, return must e filed for tht person. Complete D-40 on the correct yer's tx return nd provide the decesed person's informtion, not your own. Do not djust the decesed's income, exemptions or deductions to reflect the dte of deth, unless D-41 is eing filed for the reminder of the yer fter the dte of deth. Tx preprers, other thn the surviving spouse/registered domestic prtner, such s executors, ttorneys, or other personl representtives, must ttch letters of dministrtion. Clcultion K Out-of-stte income tx credit Amount of income tx pid to other stte(s), enter from the other stte(s) return(s). Income suject to income tx in other sttes nd received while resident of DC. c DC djusted gross income from D-40, Line 15. d Divide Line y Line c. (Enter the percent.) e DC Tx from D-40, Line 22. f Mximum out-of-stte credit. Multiply Line e y Line d. g Enter the lesser of Line or Line f. Also enter on Schedule U, Prt 1 Line 3. c d e f g 19

5 If refund is due, ll tx preprers must ttch completed FR-147, Sttement of Persons Climing Refund Due Decesed Txpyer, found on nd copy of the deth certificte. Do not use the federl form to request DC refund. Filing Sttus Refer to Generl Instructions, pge 8. A DC txpyer present in DC for 183 dys or more nd not domiciled in DC during the tx yer is prt-time resident for the period present in DC. Numer of months of DC residency. Divide the numer of dys lived in DC y 30 to determine the numer of months of residency. Any reminder over 15 dys counts s full month. Exmple: 196 dys of residency in DC divided y 30 = 7 months (6 months plus one month due to the 16 dy reminder). Prt-Yer Residents NOTE: A temporry sence (even lengthy one) from your permnent home does not mke you prt-yer resident. If filing s prt-yer resident, you will e given guidnce for completing your D-40 throughout these instructions. You re prt-yer DC resident if, during the yer, you moved out of DC with the intent to permnently leve or moved into DC with the intent to permnently sty. A DC txpyer domiciled in DC during the tx yer, is full-time DC resident unless he or she chnges domicile during the tx yer. In such cse, he or she will e prt-yer resident for the period not domiciled in DC. (Note: Clcultions A nd B re on Schedule I) Clcultion C Stndrd deduction for prt-yer DC residents Your stndrd deduction. Mrried or registered domestic prtner filing seprtely enter $2,050. All others enter $4,100. Numer of months you lived in DC from D-40, Line 2. c Divide Line y the numer 12. d Prt-yer DC stndrd deduction. Multiply Line c y Line, enter here nd on D-40, Line 17. Clcultion D DC Itemized deductions for prt-yer DC residents. "Domicile" is where person hs his or her permnent home. To chnge domicile, you hve to ndon the previous domicile nd estlish new one in nother stte with the intent to remin. If you resided in DC for only prt of 2013, llocte your DC income nd deductions ttriutle to the time of your DC residency. Also prorte your exemptions nd credits. If DC ws your home or permnent residence for less thn yer, fill in the ovl on Line 2 of the D-40, complete the pplicle months in the "from" nd "to" oxes, nd enter the numer of months in DC. Complete Clcultion C for stndrd deduction nd Clcultion D for DC itemized deductions showing the type nd mount of income received: During the time you resided in DC; During the time you were non-resident; nd The totl income reported on your federl return. Before completing the D-40, clculte the following: Income received when you were resident of DC, nd when you resided outside of DC; nd c d Totl Itemized Deductions from Form 1040 Schedule A, Form 1040NR. Portion of Line tht pplies to the time you were DC resident. c Portion of your stte nd locl tx or stte nd locl sles tx deduction from Schedule A, Line 5; or 1040NR, Schedule A, Line 1, tht ws pid to DC. c d DC itemized deductions Sutrct Line c from Line. If your District AGI is equl to or less thn $200,000 ($100,000 if Mrried filing seprtely) stop here nd enter this mount on Line 17 of the D-40. d Note: If your District AGI is greter thn $200,000 ($100,000 if Mrried filing seprtely) continue elow to Note: If your District AGI is greter thn $200,000 ($100,000 if Mrried filing seprtely) continue elow to determine the llowle itemized deductions determine the llowle itemized deductions e Enter the sum of Form 1040 Schedule A Lines 4, 14&20 llocle to the time you were DC resident f Sutrct mount on Line e from the mount on Line d g Enter the mount of DC AGI h Enter $200,000 (or $100,000 if MFS) i Sutrct Line h entry from Line g entry j Multiply Line i entry y 5% k Sutrct mount on Line j from mount on Line f (If < 0, enter 0) l Add the mounts on Lines e nd k (enter this on Line 17 of the D-40) e f g h i j k l 20

6 Deductile expenses pid when you resided in DC nd when you resided outside of DC. The sme lloction is required for exemptions, credits, nd other deductions. If you received stte income tx refund while not resident of DC; do not include it in DC income. If you climed itemized deductions on your federl income tx return, include, for DC purposes, only those relting to the time you were DC resident. Your federl worksheet will ssist you in completing Schedule I (Clcultions A nd B) nd Clcultion D (if pplicle). Keep copy of your worksheet, copy of your tx return nd ll clcultions. If you resided in DC for only prt of 2013, llocte your DC income nd deductions ttriutle to the time of your DC residency. Also prorte your exemptions nd credits. Stndrd deduction for prt-yer DC residents. Adjust your stndrd deduction to reflect the numer of months you were DC resident. Complete Clcultion C on pge 20. Itemized deductions for prt-yer DC residents. If your DC AGI is $200,000 or less nd you were prt-yer resident, complete Clcultion D on pge 20. Effective Jnury 1, 2011, DC Officil Code (-4) provides tht certin DC itemized deductions of DC txpyers with over $200,000 of DC AGI ($100,000 for seprte return filed y mrried individul) will e limited. Reduce the DC itemized deduction mount y 5% of DC AGI in excess of $200,000 ($100,000 for seprte return filed y mrried individul). The itemized deductions tht re not suject to the 5% limittion re medicl nd dentl expenses, expenses incurred in the production of investment interest nd csulty or theft loss deduction. If your DC deductions re limited nd you were prt-yer DC resident, complete Clcultion D on pge 20. Numer of exemptions for prt-yer DC residents. Reduce the full exemption mount to reflect the numer of months you were DC resident. Complete Clcultion E on pge 21. NOTE: Clcultion G - Numer of exemptions is on Schedule S - Supplementl Informtion nd Dependents. Credit for child nd dependent cre expenses for prt-yer DC residents. Complete the DC Form D-2441 nd enter the mount from Line 5 on Line 23 of the D-40. Attch copy of your DC Form D Do not include income tx withheld for other sttes in the DC tx withheld, Line 31, D-40. Income Informtion Section Copy Line through d from the pproprite federl return. Do not reclculte ny mounts or totls. Not ll items will pply to you. Fill in only those tht do. If the mount is zero, leve the line lnk. If you hd loss for Lines, c, d, 3, 6, 15 or 21, fill in the "Fill in if loss" ovl to indicte tht the figure entered is negtive one. Do not enter minus sign or rckets in the oxes. Line Wges, slries, unemployment compenstion, nd/or tips Enter the mount from your federl 1040,1040, 1040EZ, 1040NR, or 1040NREZ, plus ny unemployment compenstion received. All unemployment compenstion received in 2013 is txle. Clcultion E DC exemption mount for prt-yer DC residents Numer of exemptions from D-40 Line 18. Exemption mount per month x $ ($1,675 divided y 12). c Multiply Line y Line. d Numer of months you lived in DC from D-40, Line 2. e Exemption mount Multiply Line c y Line d. Enter here nd on D-40, Line 19. Line Business income or loss Enter the mount from your 1040 or 1040NR. Line c Cpitl gins or losses Enter the mount from your 1040 or 1040NR. The mximum llowle nnul cpitl loss clim is $3000 ($1500 if mrried or registered domestic prtner filing seprtely). If you hd frm income or loss, enter on Line c the mount on Line 18 of your 1040 or Line 19 of your 1040NR in the mount entered on Line c. If loss, fill in the ovl. For DC tx purposes, upon disposing of n sset not fully deprecited, compute the cpitl gin/loss reported on your federl return for the yer of disposition excluding ny onus deprecition. Line d Rentl rel estte, roylties, S corportions, trusts, etc Enter the mount from your 1040 or 1040NR. If you hd gross income, from DC sources, of more thn $12,000 from non-incorported usiness or usiness ctivity, including rents nd roylties, do not include on D-40. You re required to file D-30 return. File DC Form D-30, Unincorported Frnchise Tx Return if cpitl is mteril income producing fctor. An S Corportion must file D-20, Corporte Frnchise Tx Return. Computtion of DC Gross nd Adjusted Gross Income Line 3 Federl djusted gross income Enter the mount from 1040, 1040A, 1040EZ, 1040NR, or 1040NR. Include your txle portion of pension/nnuity in your federl djusted gross income. NOTE: Any grnts nd stipends received y certin DC pulic or chrter school techers under the Housing Support for Techers Act of 2007 re suject to oth federl nd DC income tx. Additions to DC Income Line 4 Frnchise Tx Enter ny frnchise tx deducted on federl usiness tx return, from federl Forms 1065 or 1120S. Line 5 Other dditions from DC Schedule I Enter the mount from Line 8 of Clcultion A, Schedule I. Line 6 Add Lines 3, 4 nd 5 Add federl djusted gross income, frnchise tx deducted nd dditions to DC income. Fill in ovl if loss. 21

7 Clcultion F DC Itemized deductions for full-yer DC residents Totl itemized deductions from Form 1040, 1040NR, 1040NR-EZ. Stte nd locl income tx or stte nd locl generl sles tx deduction from 1040, or 1040NR. c DC itemized deductions. Sutrct Line from Line, If your District AGI is equl to or less thn $200,000 ($100,000 if Mrried filing seprtely), stop here nd enter this mount on Line 17 of the D-40. c Note: If your District AGI is greter thn $200,000 ($100,000 if Mrried filing seprtely) continue elow to determine the llowle itemized deductions d Enter the sum of Form 1040 Schedule A Lines 4, 14&20 d e Sutrct mount on Line d from the mount on Line c e f Enter the mount of DC AGI f g Enter $200,000 (or $100,000 if MFS) g h Sutrct Line g entry from Line f entry h i Multiply Line h entry y 5% i j Sutrct mount on Line i from mount on Line e (if < 0, enter 0) j k Add the mounts on Lines d nd j (enter this on Line 17 of the D-40) k Note: Clcultion G Numer of exemptions is on Schedule S Supplementl Informtion nd Dependents. Sutrctions from DC Income Line 7 Income received during period of non-residence For ech type of income reported on your federl 1040, determine the mount you received when you resided in DC. Sutrct tht mount from your totl income nd enter the results on Line 7. Line 8 Txle refunds, credits or offset of stte nd locl income tx Enter the mount from your 1040, or 1040NR. Line 9 Txle mount of socil security nd tier 1 rilrod retirement Enter the mount from 1040 or 1040A. Line 10 Income reported nd txed this yer on DC frnchise or fiduciry return (D-20, D-30 or D-41) If the income reported on your 1040 included income reported nd txed on DC frnchise or DC fiduciry return, enter tht mount here. Provide the, FEIN or SSN, nd your shre of the income reported. Refer to Generl Instructions, pge 7 regrding TINs. Include the FEIN/SSN on pge 2 of the Schedule S. Line 11 DC nd federl government pension nd nnuity limited exclusion You must e 62 yers of ge or older s of Decemer 31, 2013, to clim this exclusion. Enter the lesser of $3,000 or the txle income you received from militry retired py, pension income or nnuity income from the DC or federl government during the yer. The mximum nnul exclusion is $3,000 per person. The remining mount of the pension/nnuity is txle nd must 22 e reported on your return. Attch copy of your federl Form 1099R. Line 12 DC nd federl government survivor enefits If you re n nnuitnt's survivor nd 62 yers of ge or older s of Decemer 31, 2013, enter the totl survivor enefits (do not include Socil Security survivor enefits). Line 13 Other sutrctions from DC Schedule I Line 14 Totl sutrctions from DC Income Add Lines 7-13 DC Adjusted Gross Income Line 15 DC djusted gross income Line 6 minus Line 14. DC Txle Income Line 16 Deduction type Indicte which type of deduction (itemized or stndrd) you re tking y filling in the pproprite ovl. You must tke the sme type of deduction on your DC return s you took on your federl return. Line 17 DC deduction mount Do not copy the mount from your federl return. DC mounts re different from those llowed on your federl return. Stndrd deduction. Reference pge 9 of the Generl Instructions. Prt-yer DC residents, reference pge 20.

8 Clcultion I/Tx Rte Schedule If your txle income from D-40, Line 21 is: 0 ut not over $10,000, your tx rte is 4% At lest $10,000, ut not over $40,000, your tx is $ % of excess over $10,000 At lest $40,000, ut not over $350,000, your tx is $2, % of excess over $40,000 Over $350,000, your tx is $28, % of excess over $350,000. Itemized deductions. Do not copy the mount from your federl return. DC mounts re different from those llowed on your federl return. If your DC AGI is $200,000 or less, complete Clcultion F on pge 22. DC income txes pid re not deductile on your DC return. Therefore, reduce your federl itemized deductions mount y those txes efore entering the totl on your DC return. Effective Jnury 1, 2011, DC Officil Code (-4) provides tht certin DC itemized deductions of DC txpyers with over $200,000 of DC AGI ($100,000 for seprte return filed y mrried individul) will e limited. Reduce the DC itemized deduction mount y 5% of DC AGI in excess of $200,000 ($100,000 for seprte return filed y mrried individul). The itemized deductions tht re not suject to the 5% limittion re medicl nd dentl expenses, expenses incurred in the production of investment interest nd csulty or theft loss deduction. _ If your DC deductions re limited, complete Clcultion F on pge 22. _ Line 18 Numer of exemptions Reference pge 9 of the Generl Instructions. Line 19 Exemption mount Reference pge 9 of the Generl Instructions. Line 20 Add Line 17 nd 19. Line 21 DC txle income Sutrct Line 20 from Line 15. Enter the result, if it is minus, fill in the ovl. Line 22 Tx If Line 21 is $100,000 or less, use the tx tles on pges to determine your tx. If Line 21 is more thn $100,000, use Clcultion I on pge 23 to determine your tx. Mrried or registered domestic prtners filing seprtely on the sme return Before completing Clcultion J, the tx computtion, on Schedule S, you must determine ech person's seprte federl AGI, dditions to income, sutrctions from income, deductions nd exemptions. You must comine the seprte mounts for ech person efore mking entries on Lines of the D-40. DC tx, credits, nd pyments The credits climed on Lines 23, 24 nd 25 re non-refundle, which mens they cn reduce the txes you owe, ut they will not result in tx refund. The credits you clim on Lines 28, 29 nd 30 re refundle credits, which mens if these credits plus ny tx pyments re greter thn your totl tx due, you my receive refund. Line 23 Credit for child nd dependent cre expenses Do not clim this credit if your filing sttus is mrried filing seprtely. If your sttus is mrried or registered domestic prtner filing seprtely on the sme return, you my clim the credit nd divide it etween spouses/ domestic prtners ny wy you wish. If you were full-yer DC resident, to figure your DC credit, multiply y.32, the mount from federl Form 2441, Line 9. Enter the result on Line 23 of the D-40. (Do not use the DC Form D-2441.) If you were eligile for the Child nd Dependent Cre Credit ut did not clim it for federl purposes, complete the DC Form D-2441, multiply the result y.32 nd clim the DC credit for child nd dependent cre expenses. Line 24 Non-refundle credits from DC Schedule U This entry is the totl of non-refundle mounts from DC Schedule U, Prt 1, Line 6. Clcultion L - comprison of DC Low Income Credit nd the DC Erned Income Tx Credit. DO NOT TAKE BOTH Child nd dependent cre credit from D-40, Line 23. DC Schedule U, Line 6 (nonrefundle credits). c Add Line nd Line. c d Tx from D-40, Line 22. d e Sutrct Line c mount from Line d mount. e f DC Low Income Credit from tle on pge 13. f g Enter the lesser of Line e or Line f mounts. g X.40 h Federl Erned Income Credit from Federl Form 1040, 1040A, h or 1040EZ. i DC Erned Income Tx Credit Rte 40% of Federl credit. i x.40 j DC Erned Income Tx Credit. Multiply Line h y Line i. j If Line g mount exceeds Line j mount, enter it on D-40, Line 25. If Line j mount exceeds Line g mount, enter it on D-40, Line 28. Note: Prt-yer residents my not tke the full mount of either credit. See pge 20 of the instructions to determine the reduced mount. 23

9 STAPLE OTHER DOCUMENTS IN UPPER LEFT IN BACK Government of the District of Columi 2013 D-40 Individul Income Tx Return Print in CAPITAL letters using lck ink. Leve lines lnk tht do not pply. Personl informtion Your telephone numer * * Fill in Fill in if: Filing n mended return. See instructions. if: Filing for decesed txpyer See instructions. Your socil security numer (SSN) nd Dte of Birth (MMDDYYYY) Spouse s/registered domestic prtner s SSN nd Dte of Birth (MMDDYYYY) Your first nme M.I. Lst nme Spouse s/registered domestic prtner s first nme M.I. Lst nme Home ddress (numer, street nd prtment numer if pplicle) City Stte Zip Code +4 OFFICIAL USE ONLY Vendor ID#0000 STAPLE W-2s AND ANY OTHER WITHHOLDING STATEMENTS HERE Filing sttus Single, Mrried filing jointly, Mrried filing seprtely, Dependent climed y someone else 1 Fill in only one: Mrried filing seprtely on sme return Enter comined mounts for Lines See instructions. Registered domestic prtners filing jointly or filing seprtely on sme return Complete your federl return first Enter your dependents informtion on DC Schedule S Income Informtion Round cents to nerest dollr. If zero, leve the line lnk. Wges, slries, unemployment compenstion nd/or tips, $ see instructions. Business income or loss, see instructions. Fill in if loss $ c Cpitl gin (or loss). Fill in if loss c $ d Rentl rel estte, roylties, prtnerships, etc. Fill in if loss d $ Revised 09/13 Hed of household Enter qulifying dependent nd/or non-dependent informtion on Schedule S. 2 Fill in if you re: Prt-yer resident in DC from (month) to (month); numer of months in DC See instructions. Computtion of DC Gross nd Adjusted Gross Income 3 Federl djusted gross income. From djusted gross income lines on Federl Forms 1040, 1040A, 1040EZ, 1040NR, or 1040NR-EZ Additions to DC Income 4 Frnchise tx deducted on federl forms, see instructions. 5 Other dditions from DC Schedule I, Clcultion A, Line 8. 6 Add Lines 3, 4 nd 5. Sutrctions from DC Income 7 Prt yer residents, enter income received during period of nonresidence, see instructions. 8 Txle refunds, credits or offsets of stte nd locl income tx. 9 Txle mount of socil security nd tier 1 rilrod retirement From Federl Forms 1040 or 1040A. 10 Income reported nd txed this yer on DC frnchise or fiduciry return. 11 DC nd federl government pension nd nnuity limited exclusion, see instructions. Fill in if you re 62 or older if your spouse/domestic prtner is 62 or older 12 DC nd federl government survivor enefits, see instructions. 13 Other sutrctions from DC Schedule I, Clcultion B, Line Totl sutrctions from DC income, Lines DC djusted gross income, Line 6 minus Line 14. Fill in if loss Fill in if loss Fill in if loss 2013 D-40 P1 Individul Income Tx Return pge 1 File order 1 3 $ 4 $ 5 $ 6 $ 7 $ 8 $ 9 $ 10 $ 11 $ 12 $ 13 $ 14 $ 15 $

10 D-40 PAGE 2 Enter your lst nme. Enter your SSN. * * 16 Deduction type. Tke the sme type s you took on your federl return. Fill in which type: Stndrd or Itemized See instructions for mount to enter on Line DC deduction mount. Do not copy from federl return. For mount to enter, see instructions. 18 Numer of exemptions. If more thn 1 (more thn 2 if filing jointly), or if you or your 18 spouse/domestic prtner re over 65 or lind, ttch completed Clcultion G, Schedule S. 19 Exemption mount. Multiply $1,675 y numer on line 18. Prt-yer DC residents see Clcultion E, see instructions. 20 Add Lines 17 nd DC txle income. Sutrct Line 20 from Line 15. Enter result. Fill in if loss 17 $ 19 $ 20 $ 21 $ DC tx, credits nd pyments 22 Tx. If Line 21 is $100,000 or less, use tx tles to find the tx, If more, use Clcultion I in instructions. Fill in if filing seprtely on sme return. Complete Clcultion J on Schedule S. 23 Credit for child nd dependent cre expenses $ X.32 Enter result > From Federl form 2441; if prt-yer DC resident, from Line 5, DC Form Non-refundle credits from DC Schedule U, Prt 1, Line 6. Attch Schedule U. 25 DC Low Income Credit. Use Clc. LIC/EITC to see if LIC or EITC is greter enefit. See instructions. 25 Enter the numer of exemptions climed on your federl return Totl non-refundle credits. Add Lines 23, 24 nd Totl tx. Sutrct Line 26 from Line 22. If Line 22 is less thn Line 26 leve Line 27 lnk. 28 DC Erned Income Tx Credit. Enter your federl EIC. $ X.40 Enter result > 28 Enter the numer of qulified EITC children. 29 Property Tx Credit. From your DC Schedule H; ttch copy. 30 Refundle credits from DC Schedule U, Prt 1, Line 4. Attch Schedule U. 31 DC income tx withheld shown on Forms W-2 nd Attch these forms estimted income tx pyments. 33 Tx pid with extension of time to file or with originl return if this is n mended return. 34 Totl pyments nd refundle credits Add Lines 28, $ 23 $ 24 $ 25 $ 26 $ 27 $ 28 $ 29 $ 30 $ 31 $ 32 $ 33 $ 34 $ Refund Complete if Line 34 is more thn Line Amount you overpid Sutrct Line 27 from Line $ Amount to e pplied to your 2014 estimted tx Fill in the ovl if Form D-2210 is ttched 37 Penlty See instructions 38 Refund Sutrct sum of Lines 36 nd 37 from Line Contriution mount from Sched. U, Prt II, Line 6 Cn not exceed refund mt. on Line 38 Put dditionl mt. on Line Net refund 42 Contriution mount from Sched. U, Prt II, Line 7 Fill in the ovl if Form D-2210 is ttched Sutrct Line 39 from Line 38 Will the refund you requested go to n ccount outside the U.S.? Yes No See instructions. Refund Options: For informtion on the tx refund crd nd progrm limittions, see instructions or visit our wesite otr.dc.gov/refundprepidcrds. Mrk one refund choice: Direct deposit Tx refund crd Pper check Direct Deposit. To hve your refund deposited to your checking OR svings ccount, fill in ovl nd enter nk routing nd ccount numers. See instructions. Routing Numer 36 $ $ $ $ $ 00 Amount owed Complete if Line 34 is equl to or less thn Line Tx due Sutrct Line 34 from Line Penlty $ 43 Interest $ 44 Totl mount due Add Lines Account Numer Enter totl P & I 41 $ 42 $ 43 $ 44 $ Third prty designee To uthorize nother person to discuss this return with OTR, fill in here Designee s nme nd enter the nme nd phone numer of tht person. See instructions. Phone numer Signture Under penlties of lw, I declre tht I hve exmined this return nd, to the est of my knowledge, it is correct. Declrtion of pid preprer is sed on informtion ville to the preprer. Your signture Dte Preprer s signture Dte Spouse s/domestic prtner s signture if filing jointly or seprtely on sme return Dte Preprer's Tx Identifiction Numer (PTIN) PTIN telephone numer 2013 D-40 P2 Individul Income Tx Return pge 2 File order 2