Form 40 - Oregon Individual Income Tax Return - 2001 Page 2
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Form 40 2001
The Tax Rate Charts and Tables are on pages 21 through 23
Page 2 –
29 Oregon taxable income from front of form, line 28
29
30 Oregon tax from tables or tax rate charts, pages 21 through 23
OREGON TAX
•
30
31 Interest on certain installment sales
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31
32 Total tax. Add lines 30 and 31
32
33 Exemption credit. Multiply your total exemptions on line 6e by $142
33
CREDITS
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34 Earned income credit. See instructions, page 29
34
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35 Working family child care credit. See instructions, page 29
35
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36 Retirement income credit. See instructions, page 31
36
ADD TOGETHER
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37 Child and dependent care credit. See instructions, page 31
37
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38 Credit for the elderly or the disabled. See instructions, page 32
38
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39 Political contribution credit. See limits, page 32
39
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40 Credit for income taxes paid to another state.
40
Name of state
Attach proof
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41 Other credits. Identify
41
42 Total credits. Add lines 33 through 41
42
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43 Net income tax. Line 32 minus line 42. If line 42 is more than line 32 fill in -0-
43
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44 Oregon income tax withheld from income. Attach Form(s) W-2 and 1099
44
TAX
ADD TOGETHER
PAYMENTS,
45 Estimated tax payments for 2001.
•
45
Include payments made with your extension
PENALTY,
46 Total payments. Add lines 44 and 45
46
AND
INTEREST
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47 OVERPAYMENT.
OVERPAYMENT
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If line 43 is less than line 46, you overpaid. Line 46 minus line 43
47
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48 TAX-TO-PAY.
TAX-TO-PAY
48
If line 43 is more than line 46, you have tax-to-pay. Line 43 minus line 46
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49 Penalty and interest for filing or paying late. See instructions, page 33
49
50 Interest on estimated tax underpayment.
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50
If Form 10 is attached, check
51 Total penalty and interest due. Add lines 49 and 50
51
52 AMOUNT-YOU-OWE. Line 48 plus line 51
AMOUNT-YOU-OWE
52
STOP HERE!
REFUND
53 REFUND. Is line 47 more than line 51? If so, line 47 minus line 51
53
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54
ESTIMATED TAX.
54
Fill in the part of line 53 you want applied to 2002 estimated tax
•
55 Oregon Nongame Wildlife
$1,
$5,
$10,
Other $ _____
55
DONATIONS
These will
I wish to
•
56 Child Abuse Prevention
$1,
$5,
$10,
Other $ _____
56
donate
reduce
•
57 Alzheimer’s Disease Research
$1,
$5,
$10,
Other $ _____
57
part of my
your refund
tax refund
•
58 Stop Domestic & Sexual Violence
$1,
$5,
$10,
Other $ _____
58
to the
•
59 AIDS/HIV Education and Services
$1,
$5,
$10,
Other $ _____
59
following
•
fund(s)
•
60
60 Other charity. Enter code ______
$1,
$5,
$10,
Other $ _____
61
61 Total. Add lines 54 through 60. Total can’t be more than your refund on line 53
62
NET REFUND.
Line 53 minus line 61. This is your net refund
NET REFUND
62
63 For direct deposit of your refund, see the instructions on pages 4 and 35.
•
DIRECT
Type of account:
Checking or
Savings
DEPOSIT
•
•
Routing No.
Account No.
Important: Attach a Copy of Your Federal Form 1040, 1040A, or 1040EZ.
Under penalties for false swearing, I declare that I have examined this return, including accom-
I authorize the Department of Revenue to discuss
panying schedules and statements. To the best of my knowledge and belief it is true, correct,
this return with this preparer or any member of his
Yes
No
and complete. If prepared by a person other than the taxpayer, this declaration is based on all
or her firm.
information of which the preparer has any knowledge.
Your signature
Date
Signature of preparer other than taxpayer
License No.
SIGN
X
X
HERE
Spouse’s signature (If filing jointly, BOTH must sign)
Date
Address
Telephone No.
X
Mail tax-to-pay returns to:
Mail refund returns and no tax due returns to:
Make check or money order payable
to Oregon Department of Revenue.
Oregon Department of Revenue
REFUND
Write your Social Security number
PO Box 14555
PO Box 14700
and “2001 Form 40” on your payment.
Salem OR 97309-0940
Salem OR 97309-0930
150-101-040 (Rev. 10-01)
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