Form 41-144 - Telefile Worksheet - Iowa Department Of Revenue, 2001
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1IOWA
IOWA
department of Revenue and Finance
DEPARTMENT
OF
2001
TeleFile
Worksheet
and
9/26/01 41-144
Your Social Security Number
Confirmation #
Year of Birth
Spouse’s Social Security Number
4-digit PIN
Date Filed
RETAIN FOR YOUR RECORDS
Do Not Mail
yes
no
1
Enter your filing status number, Single = 1, Married filing joint = 2
If filing status “1”, were you claimed as a dependent on another person’s Iowa income tax return
2
Enter the total number of W-2 forms (5 or less)
Enter your W-2 information for 2001 in the appropriate boxes below
3
Wages
Federal
Iowa
Employer ID Number
(Including Tips)
Tax Withheld
Tax Withheld
$
$
$
1st W-2
NOTE:
,
,
,
$
Round all
$
$
2nd W-2
,
,
,
amounts
$
$
$
3rd W-2
to the
,
,
,
nearest dollar.
$
$
$
4th W-2
,
,
,
(ex: $57.50 = $58;
$
$
$
5th W-2
$57.49 = $57)
,
,
,
The Employer Identification Number is 9 digits and generally in Box b. Enter the total of wages and tips under the wages
column above. Wages are located in Box 16. Any tips not shown in Box 16 are in Box 8. Federal tax withheld is located in
Box 2. Iowa tax withheld is located in Box 17.
Income
Iowa Tax Withheld
Federal Tax Withheld
$
$
$
4
,
,
,
Unemployment compensation
$
5
Total taxable interest income from 1099’s
$
6
Total ordinary dividend income from 1099’s
Federal income tax refund received in 2001
$
7
,
8
Additional Federal tax paid in 2001 for 2000 and any prior years
$
,
9
2001 Federal earned income credit
$
,
To direct deposit your refund, the following information is needed:
10
Routing Transit Number (RTN) of your financial institution
Type of Account Depositing to: Checking
Savings
Depositor Account Number
$
,
11
Do you want to contribute to the Fish and Wildlife Fund, if yes, enter amount ..................
$
,
Do you want to contribute to the State Fairgrounds Renovation, if yes, enter amount .....
$
,
Do you want to contribute to the Keep Iowa Beautiful Fund, if yes, enter amount ............
$1.50 to Democratic Party
$1.50 to Democratic Party
Iowa Election
12
$1.50 to Republican Party
$1.50 to Republican Party
YOURSELF
SPOUSE
Campaign Fund
$1.50 to Green Party
$1.50 to Green Party
$1.50 to Campaign Fund
$1.50 to Campaign Fund
Before you call, please be sure you have completed this worksheet,
Joe Sample & Mary Sample
1234
1234 Old Oak Road
and made entries in the appropriate boxes.
Somewhere, USA 02020
20
PAY TO THE
ORDER OF:
DOLLARS
You are ready to TeleFile
Routing
number
Account
STOP
STOP
number
Dial 1-888-829-3742
FOR
:250250025:
:2502500286: 1234
TeleFile
will calculate your return using the standard deduction amount and tell you the following amounts.
Enter the amounts in the boxes provided below.
$
,
Amount you owe...................
$
,
Iowa net income ...........................................
Amount of refund after
$
,
contributions from line 11 ...
$
,
Amount of your refund .................................
Amount of tax you owe after
$
,
contributions from line 11 ...
Are you paying additional tax?
Mail your return and payment to Iowa Income Tax - Document Processing, PO Box 9187, Des Moines IA 50306-9187
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