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Deceased Deceased If you filed a return last year, and your Married fiing separately: Married filing jointly NOW GO TO THE BACK OF THE FORM ➛ 8 Federal adjusted gross income. Federal Form 1040, line 37; 1040A, line 21; 1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10. See instructions, page 13 ........................................................... • 8 9 Interest and dividends on state and local government bonds outside of Oregon ... • 9 10 • 10x • 10y $ Schedule included 10z • 10 ............................................................................................................. • 11 12 Income after additions. Add lines 8 and 11 ................................................................................................. • ..... • 13 1 ... • 14 15 Oregon income tax refund included in federal income ............................................ • 15 16 Interest from U.S. government, such as Series EE, HH, and I bonds ..................... • 16 % 17b % ... • 17 18 • 18x • 18y $ Schedule included 18z 18 19 Total subtractions. Add lines 13 through 18 ................................................................................................ • 19 20 Income after subtractions. Line 12 minus line 19 ........................................................................................ • 20 21 Itemized deductions from federal Schedule A, line 29 ............................................ • 21 22 Do not complete line 22 • 22 23 Total Oregon itemized deductions. Add lines 21 and 22 ......................................... • 23 24 State income tax claimed as an itemized deduction .......................................... • 24 • 25 OR 26 Standard deduction from page 19 ........................................................................... • 26 ......................................................................... • 27 28 ......................... • 28 29 Tax. See instructions, page 19. Enter tax here ........................................................ • 29 Check if tax is from: 29a Tax tables or charts or • 29b Form FIA-40 or • 29c Worksheet FCG 30 Interest on certain installment sales ......................................................................... • 30 31 Total tax before credits. Add lines 29 and 30 ................................... OREGON TAX BEFORE CREDITS • 31 ADDITIONS DEDUCTIONS TA X SUBTRACTIONS Inc lude proof of withholding (W-2s, 1099s), payment, and payment voucher Either line 25 or 26 7d • Someone else can claim you as a dependent 7c • Y ou have federal Form 8886 7b • Y ou filed an extension Fiscal year ending Spouse’ s/RDP’s first name and initial if joint return Date of birth (mm/dd/yyyy) Date of birth (mm/dd/yyyy) Last name Social Security No. (SSN) Spouse’ s/RDP’s last name if joint return Spouse’s/RDP’s SSN if joint return T elephone number City State ZIP code name or Country • 1 Single 2a 2b Registered domestic partners (RDP) filing jointly 3a Spouse’ s name Spouse’ s SSN 3b Registered domestic partner filing separately: Partner’ s name Partner’ s SSN 4 Head of household: Person who qualifes you 5 Qualifying widow(er) with dependent child Filing Status Check only one box Exemptions 6a Y ourself ........... Regular ...... Sever ely disabled .... 6a 6b Spouse/RDP ... Regular ...... Sever ely disabled ...... b 6c All dependents First names __________________________________ • c 6d Disabled First names __________________________________ • d childr en only (see instructions) T otal T otal 6e • • Check all that apply ➛ 7a • • Y ou were: 65 or older Blind Spouse/RDP was: 65 or older Blind .00 .00 .00 .00 • .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 Form 40 2013 OREGON 150-101-040 (Rev . 12-13) Amended Return K F P J 25 Net Oregon itemized deductions. Line 23 minus line 24......................................... 27 Total deductions. Line 25 or line 26, whichever is larger Oregon taxable income. Line 20 minus line 27. If line 27 is more than line 20, enter -0- 13 2013 federal tax liability ($0$6,250; see instructions for the correct amount) Other additions. Identify: INDIVIDUAL INCOME TAX RETURN Full-Year Residents Only Current mailing address (Not Supported) For office use only Round to the nearest dollar Other subtractions. Identify: 0 • If you are claiming itemized deductions, fill in lines 21 and 23–25. If you are claiming the standard deduction, fill in line 26 only. 12 Enter all dependents • address is different, check here 11 Total additions. Add lines 9 and 10 4 Social Security included on federal Form 1040, line 20b; or Form 1040A, line 14b 17 Federal pension income. See instructions, page 15. 17a First name Initial (Not Supported) (Not Supported) ----------------Page (0) Break---------------- C HARIT ABLE C HEC k OFF DONA TIONS, PAGE 26 I want to donate part of my tax refund to the following fund(s) 32 Total tax before credits from front of form, line 31 .......................................................................................... 32 33 total exemptions on line 6e by $188. Otherwise, see instructions on page 20 ....... • 33 34 Retirement income credit. See instructions, page 20 .............................................. • 34 35 Child and dependent care credit. See instructions, page 21 ................................... • 35 36 Credit for the elderly or the disabled. See instructions, page 21 ............................. • 36 37 Political contribution credit. See limits, page 21 ...................................................... • 37 38 • 38y Schedule included 38z • 38 • 39x • 39y $ Schedule included 39z • 39 40 Total non-refundable credits. Add lines 33 through 39 ................................................................................ • 40 41 Net income tax. Line 32 minus line 40. If line 40 is more than line 32, enter -0- ......................................... • 41 .............................. • 42 43 ............. • 43 • 43a W olf depredation • 43b Claim of right 44 Earned income credit. See instructions, page 23 .................................................... • 44 45 W orking family child care credit fr om WFC, line 18 .............................................. • 45 46 Mobile home park closure credit. Include Schedule MPC ....................................... • 46 47 Total payments and refundable credits. Add lines 42 through 46 ................................................................ • 47 48 .... OVERP AYMENT ➛ • 48 49 T ax to pay. .... T AX TO PAY ➛ • 49 50 Penalty and interest for filing or paying late. See instructions, page 23 ..................... 50 • 51 Exception # from Form 10, line 1 • 51a Check box if you annualized • 51b 52 Total penalty and interest due. Add lines 50 and 51 ....................................................................................... 52 53 Line 49 plus line 52 ............................................................... AMOUNT YOU OWE ➛ • 53 54 Refund. .......................................... REFUND ➛ • 54 55 Estimated tax. ... • 55 American Diabetes Assoc. • 56 Or egon Coast Aquarium • 57 SMAR T • 58 SOL V • 59 The Natur e Conservancy • 60 St. Vincent DePaul Soc. of OR • 61 Or egon Humane Society • 62 The Salvation Army • 63 Doer nbecher Children’s Hosp. • 64 Or egon Veteran’s Home • 65 Charity code • 66a • 66b Charity code • 67a • 67b 68 • 68a You • 68b Spouse/RDP ........ • 68 69 .......... • 69 70 Total. Add lines 55 through 69. Total can’t be more than your refund on line 54 ......................................... • 70 71 NET REFUND. ..................................... NET REFUND ➛ • 71 72 For direct deposit of your refund, see instructions, page 27. • T ype of account: or Sa vings Will this refund go to an account outside the United States? • Ye s Page 2 — 2013 Form 40 NONREFUNDABLE CREDITS ADD TOGETHER Important: Include a copy of your federal Form 1040, 1040A, 1040EZ, 1040NR, or 1040NR-EZ. P AYMENTS AND REFUNDABLE CREDITS Inc lude Schedule WFC if you claim this credit ADD TOGETHER These will r educe your refund • Routing No. • Account No. DIRECT DEPOSIT Your signature Date Address Telephone no. X X Spouse’ s/RDP’s signature (if filing jointly, BOTH must sign) Date X • Pr eparer license no. Oregon Department of Revenue. Include your payment, along with the payment voucher on page 23, with this return. See instructions .00 .00 .00 .00 .00 .00 .00 PO Box 14555 Salem OR 97309-0940 Mail REFUND r eturns and NO - T AX - DUE r eturns to Mail T AX - TO - P AY r eturns to REFUND PO Box 14700 Salem OR 97309-0930 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 150-101-040 (Rev . 12-13) .00 42 Oregon income tax withheld.Include Form(s) W-2 and 1099 If line 41 is less than line 47, you overpaid. Line 47 minus line 41 If line 41 is more than line 47, you have tax to pay. Line 41 minus line 47 Fill in the part of line 54 you want applied to 2014 estimated tax W rite your daytime telephone number and 2013 Oregon Form 40 on your check or money order. 51 Interest on underpayment of estimated tax. Include Form 10 and check box 39 Other credits. Identify: Exemption credit. If the amount on line 8 is less than $100,000, multiply your Credit for income taxes paid to another state. State: Include proof Estimated tax payments for 2013 and payments made with your extension Overpayment. Amount you owe. Line 54 minus line 70. This is your net refund Under penalty for false swearing, I declare that the information in this return is true, correct, and complete. If you owe, make your check or money order payable to the Oregon Department of Revenue Is line 48 more than line 52? If so, line 48 minus line 52 Total Oregon 529 College Savings Plan deposits. See instructions, page 26 Political party $3 checkoff. Party code: Checking Signature of preparer other than taxpayer ----------------Page (1) Break----------------