Form 390 American Samoa PDF Details

Navigating the intricacies of tax obligations in American Samoa requires understanding the 390 American Samoa form, a cornerstone document for filing individual income taxes within this U.S. territory. This form, issued by the Department of Treasury—American Samoa Tax Division, demands a thorough scrutiny of one's income, deductions, and applicable credits for the tax year in question, specifically aligning with the U.S. Internal Revenue Code as of December 31, 2000, subject to amendments or variations dictated by American Samoa's laws. From declaring various forms of income such as wages, dividends, and business earnings to detailing deductions including student loan interest and medical savings account contributions, the form serves as a comprehensive tool for taxpayers. It also addresses specific adjustments like the American Samoa Minimum Tax and differentiates between standard and itemized deductions to accurately calculate the total tax liability or refund due. Essential for both local and foreign residents, this pivotal document outlines the eligibility for exemptions, credits, and the appropriate means to declare tax withheld from earnings, making it a critical step in fulfilling tax responsibilities in American Samoa.

QuestionAnswer
Form NameForm 390 American Samoa
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesamerican samoa taxes, american samoa tax office website, 2018 american samoa income tax forms 390, asgtaxform com

Form Preview Example

Form

Department of Treasury—American Samoa Tax Division

A.S. Individual Income Tax Return

The ASG has adopted legislation providing that the U.S. Internal Revenue Code in effect on December 31, 2000, shall be applicable in American Samoa

for all years thereafter, except as amended or incompatible with other American Samoa laws. Please use the 2000 tax table for computation of your tax

For the year Jan. 1–Dec. 31, 2010, or other tax year beginning

, 2010, ending

, 20

Please print or type

Filing Status

Check only one box.

Your first name and initial

Last name

Your social security number

 

 

 

 

 

 

 

 

 

 

If a joint return, spouse’s first name and initial

Last name

Spouse’s social security number

 

 

 

 

 

 

 

 

 

Home address (name of village). If you have a P.O. box

 

Home phone no

 

Business phone no.

 

 

 

 

 

 

 

 

City, town or post office, state, and ZIP code. If you have a foreign address

 

Do you live in a rental home

 

 

Yes

 

 

No

 

 

1Single

2Married filing joint return (even if only one had income)

3

Married filing separate return. Enter spouse’s social security no. above and full name here.

4Head of household (with qualifying person). (See page 19.) If the qualifying person is a child but not your dependent,

 

enter this child’s name here.

 

5

Qualifying widow(er) with dependent child (year spouse died

).

6a

Exemptions

b

Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax

No. of boxes checked

return, do not check box 6a

 

on 6 a and 6b

Spouse

 

 

c

Dependents:

 

(2) Date of

 

 

(4) Dependent’s

(5)

if qualifying

 

 

 

(3)

Dependent’s

relationship to

child for child tax

 

 

 

Birth

 

 

 

 

 

 

 

 

 

 

If more than six

(1) First name

Last name

 

 

social security number

you

credit (see page 20)

dependents,

 

 

 

 

 

 

 

1

 

1

 

 

 

 

 

 

 

 

 

1

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

1

 

 

 

 

 

 

 

 

 

1

 

1

 

 

 

 

 

 

 

 

 

1

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

1

 

d Total number of exemptions claimed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No. of your children on 6c who.

!lived with you

!did not live with

you due to divorce or seperated (see page 20)

Dependents on 6c not entered above

not entered above Add numbers entered on lines above !

 

7

Wages, salaries, tips, etc. Attach Form(s) W-2 7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

Income

7b

Tax-exempt income (as per ASCA PL 19-33)

 

 

 

 

Attach Worksheet

 

 

 

 

7c

 

8a

Taxable interest. Attach Schedule B if required 8a Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b

Tax-exempt interest. Do not include on line 8a

 

 

 

 

 

 

 

8b

 

 

 

 

 

 

Attach

9

Ordinary dividends. Attach Schedule B if required

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Forms W-2AS and

10

Taxable refunds, credits, or offsets of state and local income taxes

 

 

 

 

 

 

 

 

 

 

 

 

 

10

 

W-2G here.

11

Alimony received

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11

 

Also attach

12

Business income or (loss). Attach Schedule C or C-EZ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12

 

Form(s) 1099-R

13

Capital gain or (loss). Attach Schedule D if required. If not required, check here

 

 

 

 

 

 

 

 

 

 

13

 

if tax was

14

Other gains or (losses). Attach Form 4797

 

 

 

 

 

 

 

 

 

 

 

 

 

14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

withheld.

15a

Total IRA distributions

 

15a

 

 

 

 

 

b

Taxable amount

 

 

15

 

 

16a

Total pensions and annuities

 

16a

 

 

 

 

b

Taxable amount

 

 

16

 

 

17

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

17

 

If you did not

18

Farm income or (loss). Attach Schedule F

 

 

 

 

 

 

 

 

 

 

 

 

 

18

 

get a W-2,

19

Unemployment compensation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19

 

 

20a

Social security benefits

 

20a

 

 

 

b

Taxable amount

 

 

20

 

 

21

Other income. List type and amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21

 

 

22

Add the amounts in the far right column for lines 7 through 21. This is your total income

22

 

 

23

IRA deduction

 

 

 

 

 

 

 

 

 

 

 

 

23

 

 

 

 

 

 

 

 

 

 

24

Student loan interest deduction

 

 

 

 

 

 

 

 

 

 

 

24

 

 

 

 

 

 

 

 

 

Adjusted

25

Medical savings account deduction. Attach Form 8853

 

 

 

 

25

 

 

 

 

 

 

 

 

 

26

Moving expenses. Attach Form 3903

 

 

 

 

 

 

 

 

 

 

 

26

 

 

 

 

 

 

 

 

 

Gross

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27

One-half of self-employment tax. Attach Schedule SE

 

 

 

 

 

 

 

27

 

 

 

 

 

 

 

 

 

Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28

Self-employed health insurance deduction

 

 

 

 

 

 

 

28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29

Self-employed SEP, SIMPLE, and qualified plans

 

 

 

 

 

 

29

 

 

 

 

 

 

 

 

 

 

30

Penalty on early withdrawal of savings

 

 

 

 

 

 

 

 

 

30

 

 

 

 

 

 

 

 

 

 

31

Alimony paid b Recipient’s SSN

 

 

 

 

 

 

 

 

 

 

 

31a

 

 

 

 

 

 

 

32

Add lines 23 through 31a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32

 

 

33

Subtract line 32 from line 22. This is your adjusted gross income

 

 

 

 

 

 

 

 

 

 

 

 

 

33

 

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 390 (2011)

Form 390 (2011)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 2

 

34

Amount from line 33 (adjusted gross income)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34

 

 

 

 

 

 

Tax and

35a

Check if:

 

 

 

You were 65 or older,

 

 

 

 

 

 

 

Blind;

 

 

 

 

Spouse was 65 or older,

 

 

 

 

Blind.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Add the number of boxes checked above and enter the total here

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35a

 

 

 

 

 

 

 

 

 

 

 

Credits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b

If you are married filing separately and your spouse itemizes deductions, or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Standard

 

you were a dual-status alien, see page 31 and check here

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35b

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deduction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36

Enter your itemized deductions from Schedule A, line 28, or standard deduction shown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

for Most

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

people

 

on the left. But see page 31 to find your standard deduction if you checked any box on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Single:

 

line 35a or 35b or if someone can claim you as a dependent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36

 

 

 

 

 

 

$4,400.00

37

Subtract line 36 from line 34

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37

 

 

 

 

 

 

Head of

38

If line 34 is $96,700 or less, multiply $2,800 by the total number of exemptions claimed on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

household:

 

line 6d. If line 34 is over $96,700, see the worksheet on page 32 for the amount to enter

 

 

 

 

 

 

 

 

 

 

 

38

 

 

 

 

 

 

$6,450.00

39

Taxable income. Subtract line 38 from line 37. If line 38 is more than line 37, enter -0-

 

 

 

 

 

 

 

 

 

 

 

39

 

 

 

 

 

 

Married filing

40

Tax (see page 32). Check if any tax is from

 

 

 

 

 

 

 

a

 

 

Form(s) 8814

b

 

Form 4972

 

 

 

40

 

 

 

 

 

 

jointly or

41

Alternative minimum tax. Attach Form 6251

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

41

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Qualifying

42

Add lines 40 and 41

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

42

 

 

 

 

 

 

widow(er):

43

Foreign tax credit. Attach Form 1116 if required

 

 

 

 

 

 

 

 

 

 

 

 

 

43

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$7,350.00

44

Credit for child and dependent care expenses. Attach Form 2441

 

 

 

 

 

 

 

 

 

 

 

 

44

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Married

45

Credit for the elderly or the disabled. Attach Schedule R

 

 

 

 

 

 

 

 

 

 

 

 

45

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

filing

46

Education credits. Attach Form 8863

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

46

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

separately:

47

Child tax credit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

47

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$3,675.00

48

Adoption credit. Attach Form 8839

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

48

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

49

Other. Check if from

a

 

 

Form 3800

b

 

 

Form 8396

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c

 

 

Form 8801

d

 

 

Form (specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

49

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50

Add lines 43 through 49. These are your total credits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50

 

 

 

 

 

 

 

51

Subtract line 50 from line 42. If line 50 is more than line 42, enter -0-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

51

 

 

 

 

 

 

 

52

Self-employment tax. Attach Schedule SE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

52

 

 

 

 

 

 

Other

53

Tax on IRAs, other retirement plans, and MSAs. Attach Form 5329 if required

 

 

 

 

 

 

 

 

 

 

 

53

 

 

 

 

 

 

54

Household employment taxes. Attach Schedule H

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

54

 

 

 

 

 

 

Taxes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55

Add lines 51 through 54.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

56

American Samoa Minimum Tax (4% of the AGI, line 34 or attach worksheet if PL 19-33 applies)

 

 

 

 

 

 

 

 

 

 

 

56

 

 

 

 

 

 

 

57a

This is your total income tax: line 55 or 56 whichever is larger

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

57a

 

 

 

 

 

 

 

57b

Wage Tax (2% of line 7)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

57b

 

 

 

 

 

 

 

57c Total tax (add line 57a and line 57b)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

57c

 

 

 

 

 

 

 

58

Samoa income and wage tax withheld from Forms W-2AS and 1099

 

 

 

 

 

 

 

 

58

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payments

59

2011 estimated tax payments and amount applied from 2010 return

 

 

 

 

 

 

 

 

59

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60

Earned income credit (EIC). (Not applicable in American Samoa)

 

 

 

 

 

 

 

 

 

 

 

 

60

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

61

Excess social security and RRTA tax withheld (Not Applicable)

 

 

 

 

 

 

 

 

 

 

61

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

62

Additional child tax credit. Attach Form 8812

 

 

 

 

 

 

 

 

 

 

 

 

 

62

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

63

Amount paid with request for extension to file.

 

 

 

 

 

 

 

 

 

 

 

 

63

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other payments. Check if from a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

64

 

 

 

Form 2439

 

 

 

b

 

 

 

Form 4136

 

 

64

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

65

Add lines 58, 59, 60a, and 61 through 64. These are your total payments

 

 

 

 

 

 

 

 

 

 

 

65

 

 

 

 

 

 

 

66

If line 65 is more than line 57, subtract line 57 from line 65. This is the amount you overpaid

 

 

 

 

 

 

 

 

 

66

 

 

 

 

 

 

Refund

67

Amount of line 66 you want refunded to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

67

 

 

 

 

 

 

 

68

Amount of line 66 you want applied to your 2011 estimated tax

 

 

 

 

 

 

 

 

 

 

68

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount

69

If line 57c is more than line 65, subtract line 65 from line 57c. This is the amount you owe.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

you

 

For details on how to pay, (Call the ASG Tax Office, refer to the Collection Section)

 

 

 

 

 

 

 

 

 

 

 

69

 

 

 

 

 

 

owe

70

Estimated tax penalty. Also include on line 69

 

 

 

 

 

 

 

 

 

 

 

 

70

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Third Party

71

Do you want to allow another person to discuss this return with the ASG?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

Complete the following

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Designee's

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Personal Identification

 

 

 

 

 

Designee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number (PIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sign Here

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and

belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Joint return?

Your signature

Date

Your occupation

 

Day time phone number

Both spouses

 

 

 

 

 

 

 

 

must sign.

 

 

 

 

 

 

 

 

Spouse’s signature. If a joint return, both must sign.

Date

Spouse’s occupation

 

 

Keep a copy

 

 

for records

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preparer’s

Date

Check if

 

Preparer’s SSN or PTIN

Paid

signature

 

self-employed

 

 

 

 

prepared

Firm’s name (or

 

 

 

 

 

 

Use Only

yours if self-employed),

 

 

 

 

EIN

 

 

 

 

 

 

 

 

address, and ZIP code

 

 

 

Phone no.

 

 

Form 390 (2011)

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