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Government of the District of Columbia 20 13 D-40EZ Income Tax Return for Single and Joint Filers with No Dependents 2013 D-40EZ Revised 09/13 Income T ax Return STAPLE W-2s AND ANY OTHER WITHHOLDING STATEMENTS HERE 2 $ . 00 3 $ . 00 4 $ . 00 Signature Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on the information available to the preparer. Your signature Date Preparer’s signature Date Spouse’s/domestic partner’s signature if filing jointly Date Preparer’s Tax Identification Number (PTIN) PTIN telephone number STAPLE OTHER DOCUMENTS IN UPPER LEFT IN BACK 1 Total wages, salaries, tips, unemployment compensation, etc. 2 Taxable interest and ordinary dividends. (If more than $1500, file form D-40.) 3 DC adjusted gross income. Add Lines 1 and 2. 4 Standard deduction plus exemption. , 5 DC taxable income. Line 3 minus Line 4. If Line 4 is equal to or more than Line 3, make no entry. 6 Tax. Use the tax tables on pages 53-62 to find the tax on the Line 5 amount. 7 DC Low Income Credit. 7a Enter number of exemptions claimed on your federal return 7a 8 Net tax. Subtract Line 7 from Line 6. If Line 7 is equal to or more than Line 6, make no entry. 9a Contribution to Public Fund for Drug Prevention and Children at Risk. 9b Contribution to DC Statehood Delegation Fund. 9c Contribution to Anacostia River Cleanup and Protection Fund. 9d RESERVED 10 Tax and/or contribution(s). Add Lines 8, 9a, 9b, 9c and 9d. 11 Total DC income tax withheld, shown on Forms W-2 and 1099 – attach these forms. 12 Tax paid with extension of time to file or with original return if this is an amended return. 13 DC Earned Income Tax Credit. Enter your federal earned income credit 13a 14 Total tax payments and credits. Add lines 11–13. 15 Refund. If Line 14 is the larger, subtract Line 10 from Line 14. 16 Amount owed. If Line 10 is the larger, subtract Line 14 from Line 10. See payment options in instructions. 17 Penalty Interest See instructions. Enter results 18 TOTAL AMOUNT DUE. Add lines 16 and 17. 19 TOTAL REFUND. Subtract Line 17 (results) from Line 15 and enter here. Home address (number, street and apartment number if applicable) City State Zip Code Your first name M.I. Last name Spouse’s/registered domestic partner’s first name M.I. Last name Print in CAPITAL letters using black ink. Third party designee To authorize another person to discuss this return with the OTR, fll in here and enter the name and phone number of that person. See instructions. Designee’s name Phone number 1 $ . 00 If more than $100,000 file form D-40. 5 $ . 00 6 $ . 00 7 $ . 00 8 $ . 00 9a $ . 00 9b $ . 00 9c $ . 00 9d $ . 00 13 $ . 00 18 $ . 00 See instructions. 19 $ . 00 $ . 00 X .40 = 10 $ . 00 11 $ . 00 14 $ . 00 15 $ . 00 16 $ . 00 17 $ . 00 12 $ . 00 Your social security number (SSN) and and Personal information Your telephone number . Filing status: Single, Married filing jointly, Registered domestic partners filing jointly, Dependent claimed by someone else Fill in if Amended Return Date of Birth (MMDDYYYY) Spouse’s/registered domestic partner’s SSN Will the refund you requested go to an account outside the US? Yes No Routing Number Account Number $ .00 $ .00 Enter number of qualified EITC children 13a Date of Birth (MMDDYYYY) Use Calc. LIC/EITC to see if LIC or EITC is a greater benefit. See instructions. Use Calc. LIC/EITC to see if EITC is greater. Leave blank if you took Line 7 LIC credit. otr.dc.gov/refundprepaidcards. or if claimed as a dependent on another’s tax return, enter $4100 If single, enter $5775. If fling jointly, enter $7450 Refund Options: For information on the tax refund card and program limitations, visit our website Direct Deposit Account Type Checking OR Savings To deposit your refund, check the box and enter bank routing and account numbers. See instructions Mark one refund choice: Direct deposit Tax refund card Paper check ----------------Page (0) Break----------------