Schedules 3 & 4 Form It-40 - Schedule 3: Exemptions - 2013
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1Schedules 3 & 4
Schedule 3: Exemptions
Enclosure
2013
Form IT-40,
State Form 53997
(Schedule 4 begins after line 5 below)
Sequence No. 03
(R4 / 9-13)
Name(s) shown on Form IT-40
Your Social Security Number
Round all entries
.00
1. Number of exemptions claimed on your federal return
x $1,000 ____________________
1
• If you did not claim an exemption on your federal return, enter “1” in the box above.
• See instructions on page 26 if you did not fi le a federal return.
2. Claim an additional exemption for each dependent child
• who is a son, stepson, daughter, stepdaughter and/or foster child,
• who was under the age of 19 by Dec. 31, 2013, or a full-time student
who was under the age of 24 by Dec. 31, 2013, and
• who you are eligible to claim as a dependent on your federal tax return.
.00
Enter number you are eligible to claim
x $1500: you MUST enclose Schedule IN-DEP __
2
3. Place “X” in box(es) below if, by December 31, 2013
You were age 65 or older
and/or blind
Spouse was 65 or older
and/or blind
.00
Total number of boxes with Xs
x $1000 _____________________________________
3
4. If age 65 or older, enter amount from Form IT-40, line 1 $
If this amount is less than $40,000, place “X” in box(es) below if:
You were age 65 or older
Spouse was 65 or older
.00
Total number of boxes with Xs
x $500 ______________________________________
4
.00
5. Add lines 1, 2, 3 and 4. Enter here and on Form IT-40, line 6.
Total Exemptions
5
Schedule 4: Other Taxes
Instructions begin on page 27
.00
1. Use tax on out-of-state purchases from line 4 of Sales/Use Tax Worksheet __________________
1
.00
2. Household employment taxes. Enclose Schedule IN-H __________________________________
2
.00
3. Recapture of Indiana’s CollegeChoice 529 credit. Enclose Schedule IN-529R ________________
3
.00
4. Add lines 1 through 3. Enter here and on Form IT-40, line 10.
Total Other Taxes
4
23013111694
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