egov.oregon.gov DOR PERTAX 101-044-05fill

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  • 1. Clear Form • Amended Return Form OREGON For office use only 40S 2005 Individual Income Tax Return A K F P FULL-YEAR RESIDENTS ONLY SHORT FORM Date of birth (mm/dd/yyyy) Last name First name and initial Social Security No. (SSN) – – Deceased Date of birth (mm/dd/yyyy) Spouse’s last name if joint return Spouse’s first name and initial if joint return Spouse’s SSN if joint return – – Deceased Current mailing address Telephone number ( ) City State Country ZIP code If you filed a return last year, and your name or address is different, check here • • • Filing Total Exemptions 1 Single Status 2 6a Yourself......Regular ......... 6a Married filing jointly ........ Severely disabled Check 3 6b Spouse ......Regular ........... b Married filing ........ Severely disabled Spouse’s name only separately one 6c All dependents First names ________________________________ • c Spouse’s SSN box 4 •d Head of household 6d Disabled Person who qualifies you First names ________________________________ children only • 6e 5 Qualifying widow(er) with dependent child Total • • 7c • 7d • 7b • 7a You Someone else You Check You were: 65 or older Blind can claim you as filed an all that filed federal apply ➛ Spouse was: a dependent extension 65 or older Blind Form 8886 8 Wages (enter in box 8a) + unemployment (enter in box 8b) + interest and dividends (enter in box 8c) Round to the nearest dollar TOTAL INCOME ➛ .00 + • 8b + • 8c = • • 8a .00 8 .00 .00 .00 2005 federal tax liability ($0–$4,500; see instructions for the correct amount) ........ • 9 9 .00 Standard deduction from the back of this form ........................................................... • 10 10 .00 Add lines 9 and 10........................................................................................................................................... • 11 11 .00 Oregon taxable income. Line 8 minus line 11. If line 11 is more than line 8, fill in -0- ..................................... • 12 12 .00 Tax. See pages 21 through 23 for tax tables or charts and enter tax here .................................................... • 13 13 .00 Exemption credit. Multiply your total exemptions on line 6e by $154 ....................... • 14 14 Staple .00 Earned income credit. See instructions, page 10........................................................ • 15 15 W-2s, .00 Child and dependent care credit. See instructions, page 10....................................... • payment, 16 16 and .00 • • 17b $ • 17d $ 17 Other credits. • 17a • 17c 17 payment .00 Total credits. Add lines 14 through 17 ............................................................................................................. • 18 18 voucher .00 Net income tax. Line 13 minus line 18. If line 18 is more than line 13, fill in -0- .............................................. • 19 19 here .00 Oregon income tax withheld. Attach your Form(s) W-2 and 1099 ........................... • 20 20 Attach Schedule .00 Working family child care credit from WFC, line 18.............CREDIT AMOUNT ➛ • 21 21 WFC if you claim Amount from WFC, line 16 • 21b $ Number from WFC, line 5 • 21a this credit Total payments. Add lines 20 and 21 .............................................................................................................. • 22 .00 22 Refund. If line 22 is more than line 19, you have a refund. Line 22 minus line 19 ................... REFUND ➛ • 23 .00 23 Tax to pay. If line 19 is more than line 22, you have tax to pay. Line 19 minus line 22 ...........TAX TO PAY ➛ • 24 .00 24 .00 Oregon Nongame Wildlife ............... $1 ...... $5..... $10 ..... Other $______ • 25 CHARITABLE 25 CHECKOFFS .00 Child Abuse Prevention................... $1 ...... $5..... $10 ..... Other $______ • 26 26 PAGE 12 These will I want to .00 Alzheimer’s Disease Research ....... $1 ...... $5..... $10 ..... Other $______ • 27 27 reduce donate part .00 Stop Domestic & Sexual Violence... $1 ...... $5..... $10 ..... Other $______ • 28 28 of my tax your refund refund to .00 AIDS/HIV Education and Services... $1 ...... $5..... $10 ..... Other $______ • 29 29 the following .00 ...... $1 ...... $5..... $10 ..... Other $______ • 30 Other charity. Code • 30a fund(s) 30 .00 Total. Add lines 25 through 30. Total can’t be more than your refund on line 23............................................. • 31 31 NET REFUND. Line 23 minus line 31. This is your net refund........................................... NET REFUND ➛• 32 .00 32 33 For direct deposit of your refund, see the instructions on page 34. DIRECT • Type of Account: Checking or Savings DEPOSIT • Routing No. • Account No. Under penalties for false swearing, I declare that I have examined this return, including accompanying schedules and I authorize the Department of statements. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person other than the Revenue to contact this preparer taxpayer, this declaration is based on all information of which the preparer has any knowledge. about the processing of this return. • License No. Your signature Date Signature of preparer other than taxpayer SIGN X X HERE Spouse’s signature (if filing jointly, BOTH must sign) Telephone No. Address Date X 150-101-044 (Rev. 12-05) Web
  • 2. Page 2 — 2005 Form 40S How to figure your standard deduction • Standard deduction. Unless you are claimed as • Standard deduction—Age 65 or older, or a dependent, or are age 65 or older, or blind, your blind. If you are age 65 or older, or blind, you are standard deduction is based on your filing status as entitled to a larger standard deduction based on your follows: filing status: 1. Are you:........................ 65 or older? Blind? Single............................................................$1,770 If claiming spouse’s exemption, Married filing jointly.................................... 3,545 is your spouse: ............ 65 or older? Blind? Married filing separately If spouse claims standard deduction .......1,770 2. If your And the Then your filing number of boxes standard If spouse claims itemized deductions ..........-0- status is... checked above is... deduction is... Head of household ....................................... 2,855 Single 1 $2,970 Qualifying widow(er)................................... 3,545 2 4,170 Married filing 1 4,545 2 5,545 jointly • Standard deduction—Dependents. If you can 3 6,545 be claimed as a dependent on another person’s 4 7,545 return, your standard deduction is limited to the Married filing 1 2,770 larger of: 2 3,770 separately 3 4,770 — Your earned income plus $250, up to the max- 4 5,770 imum allowed for your filing status, shown Head of 1 4,055 above, or 2 5,255 household Qualifying 1 4,545 — $800. 2 5,545 widow(er) This limit applies even if you can be, but are not, • Standard deduction—Nonresident aliens. claimed as a dependent on another person’s return. The standard deduction for nonresident aliens, as See the standard deduction worksheet for depen- defined by federal law, is -0-. dents on page 9. If you owe, make your check or money order payable to the Oregon Department of Revenue. Write your daytime telephone number and “2005 Form 40S” on your check or money order. Attach your payment, along with the payment voucher on page 11, to this return. Mail Mail REFUND returns Oregon Department of Revenue REFUND 4 4 TAX-TO-PAY and NO-TAX-DUE PO Box 14555 PO Box 14700 returns to returns to Salem OR 97309-0940 Salem OR 97309-0930 150-101-044 (Rev. 12-05) Web