INDIANA 2012 Barcode TEST # IT-40EZ

Transcription

1 Test Scenario 2 OWE U MONEY INDIANA Barcode TEST #2 IT-40EZ Test Scenario 2 Taxpayer: OWE U MONEY SSN: Spouse: TUYOUNG TUDIE SSN: Test Scenario 2 includes the following forms: Form IT 40EZ Schedule CT 40EZ Schedule IN BAR Indiana BC Test 2 Page 1 of 5 10/19/

2 DRAFT 9/5/12 IT-40EZ State Form Indiana Income Tax Return for Full-Year (R11 / 9-12) Indiana Resident Filers With No Dependents Due April 15, 2013 Your Social Spouse s Social Security Number Security Number Check if applying for ITIN Check if applying for ITIN Your rst name Initial Last name Suf x OWE U MONEY If ling a joint return, spouse s rst name Initial Last name Suf x TUYOUNG Present address (number and street or rural route) School Corporation Number (see pg. 8, 9) City State Zip/Postal code Foreign country 2-character code Enter the 2-digit county code numbers (found on the back of Schedule CT-40EZ) for the county where you lived and worked on January 1,. County where you lived TUDIE 520 S MAIN ST 2735 PRINCETON IN County where you worked 26 County where spouse lived 26 County where spouse worked 26 Round all entries 1. Enter your federal adjusted gross income from federal Form 1040EZ, line Enter the amount from line 3 of the Indiana Deduction Worksheet on the back of this form Subtract line 2 from line 1 and enter total Enter $1,000 if ling a single return OR $2,000 if ling a joint return Subtract line 4 from line 3 State Taxable Income State adjusted gross income tax: multiply line 5 by 3.4% (.034) (if less than zero, leave blank) County income tax (see instructions on page 4) (if less than zero, leave blank) Use tax due on out-of-state purchases (see instructions on page 3) Add lines 6, 7 and 8 Total Tax From W-2s: all Indiana state tax withheld From W-2s: all Indiana county tax withheld Automatic Taxpayer Refund credit. See eligibility requirements on page XX. Enter $XXX if you are eligible; enter $XXX if joint ling and both are eligible; or, enter $XXX if joint ling but only one is eligible. Leave blank if not eligible Add lines 10, 11 and 12 Total Credits If line 13 is more than line 9, subtract line 9 from line 13. This is an overpayment. (If line 9 is more than line 13, skip to line 18.) Overpayment Amount from line 14 to be donated to the Indiana Nongame Wildlife Fund Subtract line 15 from line 14. This is your refund Your Refund a. Routing Number c.type Checking Savings b. Account Number Hoosier Works MC d. Place an X in the box if refund will go to an account outside the United States Direct Deposit (see page 3) 18. If line 9 is more than line 13, subtract line 13 from line Penalty if led after due date (see instructions on page 3) Interest if led after due date (see instructions on page 3) Add lines 18, 19 and 20. This is the amount you owe. See page 3 for details on how to make your payment, including credit card options. Amount You Owe Indiana BC Test 2 Page 2 of 5 10/19/ 127

3 Indiana Deduction Worksheet 1.Renter s deduction Address where rented if different from the one on the front page (enter below) Landlord s name and address (enter below) Total amount of rent paid $. 00 Number of months rented Enter the lesser of $3,000 OR total amount of rent paid Enter the amount from line 7 of the unemployment compensation worksheet found on page Total deductions: Add lines 1 and 2. Carry this total to page 1, line Extension of time to file Place X in box if you have led a federal extension of time to le, Form 4868 Place X in box if you have led an Indiana extension of time to le, Form IT-9, or online via e-pay. Date of Death If any individual listed at the top of the IT-40EZ died during, enter date of death below (MMDD). DRAFT 9/5/12 Taxpayer's date of death Spouse s date of death Authorization Under penalty of perjury, I have examined this return and all attachments and to the best of my knowledge and belief, it is true, complete and correct. I understand that if this is a joint return, any refund will be made payable to us jointly and each of us is liable for all taxes due under this return. Also, my request for direct deposit of my refund includes my authorization to the Indiana Department of Revenue to furnish my nancial institution with my routing number, account number, account type, and Social Security number to ensure my refund is properly deposited. I give permission to the Department to contact the Social Security Administration in order to con rm the Social Security number(s) used on this return are correct. Your Signature Date Daytime telephone number Spouse s Signature Date address where we can reach you I authorize the Department to discuss my return with my personal representative (see page 6 ). Paid Preparer: Firm s Name (or yours if self-employed) Yes No If yes, complete the information below. Personal Representative s Name (please print) IN-OPT on le with paid preparer if not ling electronically Telephone number Address City PTIN Address City State Zip Code State Zip Code If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN Keep a copy for your records. Indiana BC Test 2 Page 3 of 5 10/19/

4 Schedule CT-40EZ Form IT-40EZ State Form (R5 / 9-12) County Tax Schedule for Indiana Residents Read instructions on page 4 to see if this schedule needs to be attached to your IT-40EZ Name(s) shown on Form IT-40EZ Your Social Security Number OWE U MONEY & TUYOUNG TUDIE Lake County Residents: Read the Special Instructions for Lake County residents on page 6 if you and/or your spouse lived in Lake County on Jan. 1,. If Lake County adopted an income tax, enter your 4-digit Lake County number(s) below and complete Section 1. If Lake County did not adopt an income tax, do not fi ll in the 4-digit numbers below, and skip to Section 2. Your Lake County 4-digit number. Spouse s Lake County 4-digit number. SECTION 1: To be completed by those taxpayers who were residents of a county that had adopted a county income tax. DRAFT 6/25/12 1. Enter the amount from IT-40EZ, line 5. Note: If both you and your spouse lived in the same county on January 1 (or lived in the same Lake County location on January 1), enter the entire amount from Form IT-40EZ, line 5 on line 1A only. See instructions on page 5 1A B Enter the resident rate from the chart on the back of this Column A - Yourself Column B - Spouse s schedule for the county where you lived on Jan. 1, 2A B. 3. Multiply line 1 by the rate on line 2 3A B Enter total of lines 3A plus 3B. Continue with Section 2 below if you are married fi ling jointly and you/spouse need to complete it. Otherwise, enter this amount on line 7 of Form IT-40EZ SECTION 2: To be completed by those taxpayers who, on Jan. 1,, were residents of a county that had not adopted a county income tax, but worked in an Indiana county that had adopted a county income tax. Column A - Yourself Column B - Spouse s 1. Enter your wages, salaries, tips and/or commission income from your principal employment for the year. This income will be included on Form IT-40EZ, line 1. See instructions on page 6 _ 1A 00 1B Exemption 2A B Line 1 minus line 2 3A 00 3B Enter the nonresident rate from the chart on the back of this schedule for the county where you worked on Jan. 1, 4A. 4B. 5. Multiply the income on line 3A/B by the nonresident rate on Line 4A/B 5A 00 5B Enter total of 5A plus 5B; carry to Form IT-40EZ, line 7. (If you have an amount on Section 1, line 4 above, combine that with the amount on line 6 and enter total on Form IT-40EZ, line 7) Indiana BC Test 2 Page 4 of 5 10/19/

5 Schedule IN-BAR State Form (R3 / 9-12) Schedule IN-BAR: Barcode Enclosure Sequence No. 20 Name(s) shown on Form IT-40, IT-40EZ, IT-40PNR or IT-40RNR Your Social Security Number OWE U MONEY & TUYOUNG TUDIE Designate the form with which Schedule IN-BAR is being fi led: 1. IT IT-40EZ 3. IT-40PNR 4. IT-40RNR B1 INDIANA Barcode Datasheet Enclose Schedule IN-BAR as the last schedule. Example. If fi ling an IT-40, Schedule 2, Schedule 3 and Schedule 7, place Schedule IN-BAR behind Schedule 7. Do NOT fi le this page alone. B2 B Indiana BC Test 2 Page 5 of 5 10/19/