Indiana Full Year Resident Individual Income Tax Return Form
In the case of wanting to report the full year residential income in the State of Indiana to the IRS, the following form has to be completed and submitted.
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Indiana Full-Year Resident Individual Income Tax Return 2012 Form IT-40State Form 154 (R11 / 9-12) Due April 15, 2013 If fi ling for a fi scal year, enter the dates (see instructions) (MM/DD/YYYY): from to: Spouse’s Social Security Number Place “X” in box if you are married fi ling separately. Your Social Security Number Place “X” in box if applying for ITIN Place “X” in box if applying for ITIN School corporation number (see pages 59 and 60 ) Present address (number and street or rural route) Enter below the 2-digit county code numbers (found on the back of Schedule CT-40) for the county where you lived and worked on January 1, 2012. County where spouse livedCounty where spouse worked County where you livedCounty where you worked 1. Enter your federal adjusted gross income (AGI) from your federal tax return (from Form 1040, line 37; Form 1040A, line 21; or from Form 1040EZ, line 4) ___________________ Federal AGI 1 .00 2. Enter amount from Schedule 1, line 8, and enclose Schedule 1 ________ Indiana Add-Backs 2 .00 3. Add line 1 and line 2 ____________________________________________________________ 3 .00 4. Enter amount from Schedule 2, line 12, and enclose Schedule 2 _______ Indiana Deductions 4 .00 5. Subtract line 4 from line 3 __________________________________Indiana Adjusted Income 5 .00 6. You must complete Schedule 3. Enter amount from Schedule 3, line 5, and enclose Schedule 3 ______________________________________ Indiana Exemptions 6 .00 7. Subtract line 6 from line 5 _____________________________________State Taxable Income 7 .00 8. State adjusted gross income tax: multiply line 7 by 3.4% (.034) (if answer is less than zero, leave blank) ____________________ 8 .00 9. County tax. Enter county tax due from Schedule CT-40 (if answer is less than zero, leave blank) ____________________ 9 .00 10. Other taxes. Enter amount from Schedule 4, line 4 (enclose sch.) 10 .00 11. Add lines 8, 9 and 10. Enter total here and on line 16 on the back ___________Indiana Taxes 11 .00 Your fi rst name Initial Last name If fi ling a joint return, spouse’s fi rst name Initial Last name City State Zip/Postal code Foreign country 2-character code (see pg. 6 ) Round all entries Suffi x Suffi x 15112 111 6 9 4 12. Enter credits from Schedule 5, line 8 (enclose schedule) ____ 12 .00 13. Enter offset credits from Schedule 6, line 7 (enclose schedule) 13 .00 14. Automatic Taxpayer Refund credit. Leave blank if not eligible. See instructions on page 9. Enter $ 111 if you are eligible Enter $ 222 if joint fi ling and both are eligible Enter $ 111 if joint fi ling but only one is eligible ___________ 14 .00 15. Add lines 12, 13 and 14 ___________________________________________Indiana Credits 15 .00 16. Enter amount from line 11 ___________________________________________Indiana Taxes 16 .00 17. If line 15 is equal to or more than line 16, subtract line 16 from line 15 (if smaller, skip to line 24) 17 .00 18. Amount from line 17 to be donated to the Indiana Nongame Wildlife Fund ______________ 18 .00 19. Subtract line 18 from line 17 _________________________________________Overpayment 19 .00 20. Amount from line 19 to be applied to your 2013 estimated tax account (see instructions on page 11 ). Enter your county code county tax to be applied _ $ a .00 Spouse’s county code county tax to be applied _ $ b .00 Indiana adjusted gross income tax to be applied _________ $ c .00 Total to be applied to your estimated tax account (a + b + c; cannot be more than line 19) _____ 20d .00 21. Penalty for underpayment of estimated tax from Schedule IT-2210 or IT-2210A (enclose sch.) _ 21 .00 22. Refund: Line 19 minus lines 20d and 21. Note: If less than zero, see line 24 ___Your Refund 22 .00 23. Direct Deposit (see page 12 ) c. Type: Checking Savings Hoosier Works MC a. Routing Number b. Account Number d. Place an “X” in the box if refund will go to an account outside the United States 24. If line 16 is more than line 15, subtract line 15 from line 16. Add to this any amount on line 21 (see instructions on page 13 ) ____________________________________________________ 24 .00 25. Penalty if fi led after due date (see instructions) ______________________________________ 25 .00 26. Interest if fi led after due date (see instructions) ______________________________________ 26 .00 27. Amount Due: Add lines 24, 25 and 26 ______________________________Amount You Owe 27 .00 Do not send cash. Please make your check or money order payable to: Indiana Department of Revenue. Sign and date this return after reading the Authorization statement on Schedule 7. You must enclose Schedule 7. _____________________________________________________ _________________________________________________ Your Signature Date Spouse’s Signature Date • If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN 46207-7224. • Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040. 15112121694
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