Form Ia 1040 - Iowa Individual Income Tax Long Form - 2001
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1
2IA 1040
2001
Iowa Individual Income Tax Long Form
or fiscal year beginning __/__ 2001 and ending __/__ /__
STEP 1:
Fill in all spaces. You MUST fill in your Social Security Number.
•
Last name
Your first name/middle initial
Social Security Number
A .
•
Spouse’s last name
Spouse’s first name/middle initial
Social Security Number
•
Your Occupation
B .
Current mailing address (number and street, apartment, lot or suite number) or PO Box
Are your name,
•
your spouse’s
Spouse’s Occupation
name, if applic-
able, and your
City, State, ZIP
address the same
Residence on 12/31/01
•
•
as on last year’s
County No.
Sch.Dist.No.
return?
STEP 2 Filing Status: Mark one box only.
YES
NO
s
1
Single: Were you claimed as a dependent on another person’s Iowa return?
YES
NO
N
ONNO
School District Name
2
Married filing a joint return. (Two income families may benefit by using status 3 or 4)
3
Married filing separately on this combined return. Spouse use column B.
s
4
Married filing separate returns. Spouse’s name:
SSN:
Income: $
5
Head of household with qualifying person. If qualifying person is not claimed as a dependent on this return, enter the person’s name and Social Security Number below.
6
Qualifying widow(er) with dependent child. Name:
SSN:
s
STEP 3
40
a. Personal Credit: Enter 1 (Enter 2 if filing joint or head of household) .................... _______
X $ _________ = $ __________
YOU
s
Exemptions
20
b. Enter 1 for each spouse who is 65 or older and/or 1 for each spouse who is blind .... _______
X $ _________ = $ __________
(and spouse IF
s
filing jointly)
40
c. Dependents: Enter 1 for each dependent ..................................................................... _______
X $ _________ = $ __________
d. Enter first names of dependents here: _____________________________________
e. TOTAL $ ______________
s
40
a. Personal Credit: Enter 1 ................................................................................................. _______
X $ _________ = $ __________
SPOUSE
s
20
b. Enter 1 if 65 or older and/or 1 if blind ........................................................................... _______
X $ _________ = $ __________
(IF filing
s
40
status 3)
c. Dependents: Enter 1 for each dependent ..................................................................... _______
X $ _________ = $ __________
d. Enter first names of dependents here: ____________________________________
e. TOTAL $ ______________
B. Spouse/Status 3
A. You or Joint
B. Spouse/Status 3
A. You or Joint
1. Wages, salaries, tips, etc. ............................................................... 1. ______________ .00
______________ .00
STEP 4
2. Taxable interest income. If more than $400, complete Schedule B. 2. ______________ .00
______________ .00
Figure
3. Ordinary dividend income. If more than $400, complete Schedule B .. 3. ______________ .00
______________ .00
your
4. Alimony received .............................................................................. 4. ______________ .00
______________ .00
gross
5. Business income/(loss) from Federal Schedule C or C-EZ ............. 5. ______________ .00
______________ .00
income
6. Capital gain/(loss) from Federal Schedule D. See page 6 ............... 6. ______________ .00
______________ .00
7. Other gains/(losses) from Federal form 4797. See page 6 ............. 7. ______________ .00
______________ .00
8. Taxable IRA distributions ................................................................. 8. ______________ .00
______________ .00
9. Taxable pensions and annuities. See page 6 .................................. 9. ______________ .00
______________ .00
10. Rents, royalties, partnerships, estates, etc. See page 7 ................ 10. ______________ .00
______________ .00
11. Farm income/(loss) from Federal Schedule F ................................... 11. ______________ .00
______________ .00
12. Unemployment compensation ........................................................... 12. ______________ .00
______________ .00
13. Taxable Social Security benefits. See page 7 ................................. 13. ______________ .00
______________ .00
14. Other income. See page 8 ............................................................... 14. ______________ .00
______________ .00
s
15. GROSS INCOME. ADD lines 1-14 ............................................................................................................................. 15. _______________ .00
_______________ .00
16. Payments to an IRA, KEOGH or SEP .............................................. 16. ______________ .00
______________ .00
STEP 5
17. One-half of self-employment tax ...................................................... 17. ______________ .00
______________ .00
Figure
18. Health insurance deduction. See page 8 ......................................... 18. ______________ .00
______________ .00
your
19. Penalty on early withdrawal of savings ........................................... 19. ______________ .00
______________ .00
adjust-
20. Alimony paid ..................................................................................... 20. ______________ .00
______________ .00
ments
s
21. Pension/retirement income exclusion. See page 9 ......................... 21. ______________ .00
______________ .00
to
income
22. Moving expense deduction from Federal form 3903 ........................ 22. ______________ .00
______________ .00
s
23. Iowa capital gains deduction. See page 9 ....................................... 23. ______________ .00
______________ .00
24. Other adjustments. See page 10 ..................................................... 24. ______________ .00
______________ .00
s
25. Total adjustments. ADD lines 16-24 .......................................................................................................................... 25. _______________ .00
_______________ .00
s
26. NET INCOME. SUBTRACT line 25 from line 15. See page 11 for possible exemption from tax. ........................... 26. _______________ .00
_______________ .00
s
27. Federal income tax refund received in 2001 .................................... 27. ______________ .00
______________ .00
STEP 6
(Do NOT include special Federal Tax Rebate)
s
28. Self-employment/household employment taxes ............................... 28. ______________ .00
______________ .00
Figure
29. Addition for Federal taxes. ADD lines 27 and 28 ..................................................................................................... 29. _______________ .00
_______________ .00
your
30. Total. ADD lines 26 and 29. ...................................................................................................................................... 30. _______________ .00
_______________ .00
Federal
s
31. Federal tax withheld ......................................................................... 31. ______________ .00
______________ .00
tax
s
32. Federal estimated tax payments made in 2001 ............................... 32. ______________ .00
______________ .00
addition
s
33. Additional Federal tax paid in 2001 for 2000 and prior years .......... 33. ______________ .00
______________ .00
and
deduc-
34. Deduction for Federal taxes. ADD lines 31, 32, and 33 ........................................................................................... 34. _______________ .00
_______________ .00
tion
35. BALANCE. SUBTRACT line 34 from line 30. Enter here and on line 36, side 2 ....................................................... 35. _______________ .00
_______________ .00
L01
41-001a (9/6/01)
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