Form 40 - Oregon Individual Income Tax Return - 2001
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1
2Clear Form
Form
Oregon
2001
0
4
Individual
Income Tax
For office use only
Fiscal year ending
Date received
FULL-YEAR
Return
RESIDENTS ONLY
Last name
First name and initial
Social Security No. (SSN)
Birth year
For office
use only
1
Spouse’s last name if different and joint return
Spouse’s first name and initial if joint return
Spouse’s SSN, if joint return
Spouse’s
birth year
2
Current mailing address
Telephone number
(
)
3
City
State
ZIP code
If you filed a return in 2000, and this
address is different, check here
•
1
Single
•
Filing
Severely
Exemptions
Regular
Total
disabled
Status
2
Married filing jointly
6a Yourself
6a
3
Married filing separately
Check
(Spouse’s name)
6b Spouse
b
only one
box
•
c
6c All dependents
(Spouse’s Social Security number)
(First names)
•
d
6d Disabled
4
Head of household
children only
(Person who qualifies you)
(First names)
6e
Total
•
5
Qualifying widow(er) with dependent child
•
•
65 or older
Blind
7a
Check if: You were:
7b
Check if you filed an extension
65 or older
Blind
Spouse was:
Attach a Copy of Your Federal Form 1040, 1040A, or 1040EZ. Do Not Attach Federal Schedules.
8 Federal adjusted gross income. Federal Form 1040, line 33; 1040A, line 19;
or 1040EZ, line 4. See instructions
8
•
9 Interest on government bonds of other states
9
ADDITIONS
•
10 Other additions. Identify
10
11 Total additions. Add lines 9 and 10
11
12 Income after additions. Add lines 8 and 11
12
•
SUBTRACTIONS
13 2001 federal tax liability ($0 - $3,000, see instructions for the correct amount)
13
•
14 Social Security included on federal Form 1040, line 20b or Form 1040A, line14b
14
•
15 Oregon income tax refund included in federal income
15
Staple
•
16 Interest from U.S. government, such as Series EE and HH bonds
16
W-2
•
wage
17 Federal pension income (see instructions on page 26) _______%
17
slips
•
18 Other subtractions. Identify
18
here
19 Total subtractions. Add lines 13 through 18
19
20 Income after subtractions. Line 12 minus line 19
20
If you are claiming itemized deductions, fill in lines 21–25. If you are claiming the standard deduction, fill in line 26 only.
DEDUCTIONS
•
21 Itemized deductions from Schedule A, line 28
21
•
22 Special Oregon medical deduction (you or your spouse must be at least age 62)
22
23 Total Oregon itemized deductions. Add lines 21 and 22
23
•
24 State income tax claimed as an itemized deduction from Schedule A, line 5
24
25 Net Oregon itemized deductions. Line 23 minus line 24
25
(Either line 25 or 26)
OR
26 Standard deduction from page 28
26
27 Total deductions. Line 25 or line 26, whichever is larger
27
•
•
28 Oregon taxable income.
28
Line 20 minus line 27. If line 27 is more than line 20, fill in -0-
NOW GO TO THE BACK OF THE FORM
150-101-040 (Rev. 10-01) Web
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