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Kentucky Individual Income Tax Return Form

The following Income Tax Return form has to be completed and submitted annually by all residents of the State of Kentucky.

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 A. 	Spouse’s Social Security Number 	B. Your Social Security Number	
 Name—Last, First, Middle Initial (Joint or combined return, give bot\
h names and initials.)
 Mailing Address (Number and Street including Apartment Number or P.O. B\
ox) 
 City, Town or Post Office 	State  ZIP Code	
Attach Form W-2(s), Other Supporting Statement(s) and Payment Here—\
Staple to Top Page Only
For calendar year or other taxable year beginning _________ , 2012, and \
ending ________ , 20____ .
74042A740Department of Revenue	
2012	
 FILING STATUS 	(see instructions)	
 1  Single
 2 	Married	, filing separately on this combined return. 	(If both had income.)	
 3 	Married	, filing joint return.	
 4 	Married	, filing separate returns. Enter spouse’s Social Security number ab\
ove	
  and full name here.	
POLITICAL PARTY FUND	
Designating $2 will not change your refund or tax due.
  A. Spouse B. Yourself
 Democratic	 	(1)  (4)	
 Republican 	(2)  (5)	
 No Designation 	(3)  (6)	
 A.  B.	
KENTUCKY	
INDIVIDUAL	 INCOME	 TAX	 RETURN	
Full-Year Residents Only	
*1200020001*	
  	 Spouse 	(Use if 	  	Yourself	   Filing Status 2 is checked.) 	 (or Joint)	
INCOME/TAX
  5  Enter amount from federal Form 1040, line 37; 1040A, line 21 or
  1040EZ, line 4.	 (If total of Columns A and B is $30,657 or less, you	
 may qualify for the Family Size Tax Credit. See instructions.)	   ....................	 • 5	 	•  5 	
 6  Additions from Schedule M, line 8	 ....................................................................	 •  6 	• 6 	
 7  Add lines 5 and 6	 ........................................................................\
........................	    7   7	
 8  Subtractions from Schedule M, line 20	 .............................................................	 •  8 	• 8 	
 9 	Subtract line 8 from line 7.  This is your 	Kentucky Adjusted Gross Income	 ...    9   9	
10 	Itemizers: 	Enter itemized deductions from Kentucky Schedule A.	
  Nonitemizers: 	Enter 	$2,290 	in Columns A and/or B	 ........................................	 •  10 	• 10	
11  Subtract line 10 from line 9.  This is your 	Taxable Income	  .............................	 •  11 	• 11	
12  Enter tax from Tax Table, Computation or Schedule J.
 Check if from Schedule J 	........................................................................\
...	   12   12	
13  Enter tax from Form 4972-K   ; Schedule RC-R  	 ....................................	 •  13 	• 13 	
14  Add lines 12 and 13 and enter total here 	 .........................................................	    14   14	
15  Enter amounts from page 3, Section A, lines 22A and 22B	 ............................	    15   15	
16  Subtract line 15 from line 14. If line 15 is larger than line 14, enter \
zero	 .......	    16   16	
17   	Enter personal tax credit amounts from page 3, Section B, lines 4A and 4\
B	   • 17 	• 17	
18  Subtract line 17 from line 16. If line 17 is larger than line 16, enter \
zero	 .......	    18   18	
19  Add tax amount(s) in Columns A and B, line 18 and enter here	 ........................................................................\
......	    19	
20  Check the box that represents your total family size (	see instructions	 before completing lines 20 and 21)	 ........	 •  20 	  1    2   3 4	
21 Multiply line 19 by 	Family Size Tax Credit 	decimal amount 	__ . __  __ 	(__ __ __%) 	and enter here	   ......................	 •  21 	
22  Subtract line 21 from line 19	 ........................................................................\
................................................................	    22	
23  Enter the 	Education Tuition Tax Credit 	from Form 8863-K	 ........................................................................\
...............	 •  23 	
24  Subtract line 23 from line 22	 ........................................................................\
................................................................	    24	
25  Enter 	Child and Dependent Care Credit	
 from federal Form 2441, line 9 	➤   x 20% 	(.20)	 .............................................	 •  25 	
26 	Income Tax Liability. 	Subtract line 25 from line 24. If line 25 is larger than line 24, enter \
zero	 ............................	    26	
27    	Enter KENTUCKY USE TAX due on Internet, mail order, or other out-of-stat\
e purchases (see instructions)	  • 27 	
28  Add lines 26 and 27.   Enter here and on page 2, line 29 	 ........................................................................\
...................	    28

FORM 740 (2012)	  	Page 2 of 3	
*1200020002*	
REFUND	
OWE	
SECTION A—BUSINESS INCENTIVE AND OTHER TAX CREDITS
 1  Enter nonrefundable limited liability entity credit (KRS 141.0401(2))\
 	 .................	  1 	00	  1 	00	
 2  Enter Kentucky small business investment credit	 .................................................	  2 	00	  2 	00	
 3  Enter skills training investment credit (attach copy(ies) of certifi\
cation)	 .............	  3 	00	  3 	00	
 4  Enter nonrefundable certified rehabilitation credit (KRS 171.397(1)\
(a))	 ..............	  4 	00	  4 	00	
 5  Enter credit for tax paid to another state	 (attach copy of other state’s return(s))	   5 	00	  5 	00	
 6  Enter unemployment credit (attach Schedule UTC)	 ..............................................	  6 	00	  6 	00	
 7  Enter recycling and/or composting equipment credit (attach Schedule RC)\
	 .......	  7 	00	  7 	00	
 8  Enter Kentucky investment fund credit (attach copy(ies) of certific\
ation)	 ...........	  8 	00	  8 	00	
 9  Enter coal incentive credit	 ........................................................................\
................	  9 	00	  9 	00	
10 Enter qualified research facility credit (attach Schedule QR)	 ................................	  10 	00	  10 	00	
11  Enter GED incentive credit (attach Form DAEL-31)	 ................................................	  11 	00	  11 	00	
12  Enter voluntary environmental remediation credit (attach Schedule VERB)\
	 .......	  12 	00	  12 	00	
13  Enter biodiesel and renewable diesel credit	 ...........................................................	  13 	00	  13 	00	
14  Enter environmental stewardship credit	 .................................................................	  14 	00	  14 	00	
15  Enter clean coal incentive credit	 ........................................................................\
......	  15 	00	  15 	00	
16  Enter ethanol credit (attach Schedule ETH)	 ............................................................	  16 	00	  16 	00	
17  Enter cellulosic ethanol credit (attach Schedule CELL)	 .........................................	  17 	00	  17 	00	
18  Enter energy efficiency products credit (attach Form 5695-K)	 ..............................	  18 	00	  18 	00	
Continue to page 3 to complete Section A	
 A. 	Spouse	 	B. 	Yourself	
PWR	
OFFICIAL USE ONLY	l  	Make check payable to 	Kentucky State Treasurer	 or visit 	www.revenue.ky.gov	 for more options.	
l 	Write your Social Security number and “KY Income Tax—2012” on t\
he check.	
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REFUND/TAX PAYMENT SUMMARY
29 Enter amount from page 1, line 28. This is your 	Total Tax Liability	  .......................................................................	 •  29	
30  (a) Enter 	Kentucky income tax withheld 	as shown on 	attached	
  	2012 Form W-2(s) and other supporting statements	 .......................................	 •  30(a)	
  (b) Enter 2012 Kentucky estimated tax payments	 ..................................................	 •  30(b)	
  (c) Enter 2012 refundable certified rehabilitation credit  (KRS 141.382(\
1)(b))	 .....	 •  30(c)	
  (d) Enter 2012 film industry tax credit  (KRS 141.383)	 ...........................................	 •  30(d)	
31  Add lines 30(a) through 30(d)	 ........................................................................\
..............................................................	 •    31	
32  If line 31 is larger than line 29, enter 	AMOUNT OVERPAID 	(see instructions)	 ........................................................	    32	
Fund Contributions; See instructions.	  ➤ 	(Enter amount(s) checked)	
33 	Nature and Wildlife Fund	 ............................................	   $10    $25   $50   Other 	• 33	
34 	Child Victims’ Trust Fund	 ...........................................	   $10    $25   $50   Other 	• 34 	
35 	Veterans’ Program Trust Fund	 ...................................	 	 $10    $25   $50   Other 	•  35	
36 	Breast Cancer Research/Education Trust Fund	  .......	 	 $10    $25   $50   Other 	• 36	
37  Add lines 33 through 36	 ........................................................................\
.......................................................................	    37	
38  Amount of line 32 to be 	CREDITED TO YOUR 2013 ESTIMATED TAX	  ....................................................................	 •  38	
39  Subtract lines 37 and 38 from line 32. Amount to be 	REFUNDED TO YOU	  .................................	 	•  39	
40  If line 29 is larger than line 31, enter 	ADDITIONAL TAX DUE	  ........................................................................\
..........	  •  40 	
41  (a) Estimated tax penalty and/or interest.   	Check if Form 2210-K attached	 ... 	41(a)	
  (b) Interest	 ........................................................................\
.........................................	 	41(b)	
  (c) Late payment penalty	 ........................................................................\
.................	 	41(c)	
 	(d)  Late filing penalty	 ........................................................................\
........................	  41(d)	
42  Add lines 41(a) through 41(d). Enter here	 ........................................................................\
...........................................	 • 42 	
43  Add lines 40 and 42 and enter here. This is the 	AMOUNT YOU OWE	  ................................................	   43

FORM 740 (2012)	  	Page 3 of 3	
*1200020040*	
 REFUNDS	 	Kentucky Department of Revenue, Frankfort, KY 40618-0006.	
 PAYMENTS	 	Kentucky Department of Revenue, Frankfort, KY 40619-0008.	
Mail to:
	
SECTION B—PERSONAL TAX CREDITS 	Check Regular Check both if 65 or over  Check both if blind	
 1  (a)  Credits for yourself:
 (b) Credits for spouse:
 2 	Dependents:	
  	   Dependent’s Check if qualifying	      Dependent’s relationship child for family First name  Last name  Social Security number to you size tax credit
 3 Add total number of credits claimed on lines 1 and 2. 
 	If married filing separately on a combined return (Filing Status 2),\
 each taxpayer must claim his or her	
   own credits from line 1, divide the credits on line 2, and enter the tot\
als in Boxes 3A and 3B.  All other
 filers enter the amount from line 3 in Box 3B 	 ........................................................................\
................................	➤ 	• 3A	 	• 3B	
 4  Multiply credits on line 3A by $20 and enter on line 4A. Multiply credit\
s on line 3B by $20 and 	 	x $20  x	 $20	
 enter on line 4B. 	Enter here and on page 1, line 17, Columns A and B	  ..................................................................	 	 4A   4B
1 Enter number of boxes checked on line 1	 ........................	
2  Enter number of dependents who:
	 •	 lived	with	you	 ............	
	 •	 did	not	live	with	you    (see instructions)	 .......	
	 •	 other	dependents	  ......	
3  Enter total credits	 .........	 
Yourself	Spouse	
SECTION C—FAMILY SIZE TAX CREDIT 	(List the name and Social Security number of qualifying children that a\
re not claimed as dependents in	Section B.)
First name  Last name  Social Security number First name Last name  Social Security number
Attach a complete copy of federal Form 1040 if you received farm, busine\
ss, or rental income or loss. If not required, check here.
I, the undersigned, declare under penalties of perjury that I have examined this return, including all accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. I also understand and agree that our election to file a combined return under the provisions of Regulation 103 KAR 17:020 will result in refunds being made payable to us jointly and in each of us being jointly and severally liable for all taxes accruing under this return.
Your Signature (If joint or combined return, both must sign.)  Spouse’s Signature Date Signed
Typed or Printed Name of Preparer Other than Taxpayer  I.D. Number of Preparer Date
Firm Name  EIN Date	
Telephone Number (daytime)	
(      )	
SECTION A—BUSINESS INCENTIVE AND OTHER TAX CREDITS (continued)
19 Enter railroad maintenance and improvement credit (attach Schedule RR-I\
)	 .....	  19 	00	  19 	00	
20  Enter Endow Kentucky credit (attach Schedule ENDOW)	 .....................................	  20 	00	  20 	00	 	
21  Enter New Markets Development Program credit	 .................................................	  21 	00	  21 	00	 	
22  Add lines 1 through 21, Columns A and B. 	Enter here and on page 1, line 15	   . 22 	00	  22 	00	
 A. 	Spouse	 	B. 	Yourself
Next: Kentucky Fiduciary Income Tax Return Form Previous: Kansas Estate Tax Return Form
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