IT-540-WEB Form – Fill Out and Use This PDF

6C dePendents – Enter dependent information below. If you have more than 6 dependents, attach a statement to your return with the

required information. Enter the total number from Federal Form 1040A, Line 6c, or Federal Form 1040, Line 6c.								6C
dependent First and Last name			social security number			Relationship to you	Birth date (mm/dd/yyyy)

6D totaL eXeMPtions – Total of 6A, 6B, and 6C

6d

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it-540-2d (Page 2 of 4)

Social Security Number

18 TOTAL INCOME TAX AND CONSUMER USE TAX - Add Lines 16 and 17.	18

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do not send CasH.

Status

Contribution and Donation

I declare that I have examined this return, and to the best of my knowledge, it is true and complete. Declaration of paid preparer is based on all available information. If I made a contribution to the START Savings Program, I consent that my Social Security Number may be given to the Louisiana Office of Student Financial Assistance to properly identify the START Savings Program account holder. If married filing jointly, both Social Security Numbers may be submitted. I understand that by submitting this form I authorize the disburse- ment of individual income tax refunds through the method as described on Line 35.

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Social Security Number

sCHeduLe d – 2013 DONATION SCHEDULE

Individuals who ile an individual income tax return and have overpaid their tax may choose to donate all or part of their overpayment shown on Line 31 of Form IT-540-2D to the organizations or funds listed below. Enter on Lines 2 through 25, the portion of the overpay- ment you wish to donate. The total on Line 26 cannot exceed the amount of your overpayment on Line 31 of Form IT-540-2D.

	26	TOTAL DONATIONS – Add Lines 2 through 25. This amount cannot be more than Line 1. Also, enter this
		amount on Form IT-540-2D, Line 32.	26

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eXeMPt inCoMe – Enter on Lines 4A through 4H the amount of exempted income included in Line 1 above. Enter description and associated code, along with the dollar amount.

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Social Security Number

sCHeduLe F – 2013 REFUNDABLE TAX CREDITS

1Credit for amounts paid by certain military servicemembers for obtaining Louisiana Hunting and Fishing Licenses.

Dependent name		Date of Birth (MM/DD/YYYY)
Dependent name		Date of Birth (MM/DD/YYYY)
Dependent name		Date of Birth (MM/DD/YYYY)
Dependent name		Date of Birth (MM/DD/YYYY)
1D Enter the total amount of fees paid for Louisiana hunting and ishing licenses purchased for the listed individuals.			1d

additional Refundable Credits

Enter description and associated code, along with the dollar amount.

Credit description

Code

amount of Credit Claimed

sCHeduLe H – 2013 MODIFIED FEDERAL INCOME TAX DEDUCTION

3 Add Line 1 and Line 2. Enter the result here and on Form IT-540-2D, Line 9.

3

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Social Security Number

sCHeduLe G – 2013 NONREFUNDABLE TAX CREDITS

3B Multiply Line 3A by 40 percent. Round to the nearest dollar.

3B

4CREDIT FOR CERTAIN FEDERAL TAX CREDITS

4A	Enter the amount of eligible federal credits.	4a
4B	Multiply Line 4A by 10 percent. Enter the result or $25, whichever is less. This credit is limited to $25.	4B

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2013 Louisiana school expense deduction Worksheet (For use with Form IT-540-2D)

i.This worksheet should be used to calculate the three School Expense Deductions listed below. Refer to Revenue Information Bulletin 12-008 and 09-019 on LDR’s website.

1.elementary and secondary school tuition – R.S. 47:297.10 provides a deduction for amounts paid during the tax year for tuition and fees required for your dependent child’s enrollment in a nonpublic elementary or secondary school that complies with the criteria set forth in Brumfield v. Dodd and Section 501(c)(3) of the Internal Revenue Code or to any public elementary or secondary laboratory school that is operated by a public college or university. The school can verify that it complies with the criteria. The deduction is equal to the actual amount of tuition and fees paid per dependent, limited to $5,000. The tuition and fees that can be deducted include amounts paid for tuition, fees, uniforms, textbooks and other supplies required by the school.

2.educational expenses for Home-schooled Children – R.S. 47:297.11 provides a deduction for educational expenses paid during the tax year for home-schooling your dependent child. In order to qualify for the deduction, you must be approved by the State Board of Elementary and Secondary Education (BESE) for home-schooling. The deduction is equal to 50 percent of the actual qualiied educational expenses paid for the home-schooling per dependent, limited to $5,000. Qualiied educational expenses include amounts paid for the purchase of textbooks and curricula necessary for home-schooling.

3.educational expenses for a Quality Public education – R.S. 47:297.12 provides a deduction for the fees or other amounts paid during the tax year for a quality education of a dependent child enrolled in a public elementary or secondary school, including Louisiana Department of Education approved charter schools. The deduction is equal to 50 percent of the amounts paid per dependent, limited to $5,000. The amounts that can be deducted include amounts paid for uniforms, textbooks and other supplies required by the school.

ii.On the chart below, list the name of each qualifying dependent and the name of the school the student attends. If the student is home-schooled, enter “home-schooled.” Enter an “X” in the box in column 1 if your dependent qualiies for the Elementary and Secondary School Tuition deduction, column 2 for Educational Expenses for Home-Schooled Children deduction, or column 3 for Quality Public Education deduction. If you have more than six qualifying dependents, attach a statement to your return with the required information.

			deduction as described
student	name of Qualifying dependent	name of school		in section i
			1		2		3
a
B
C
d
e
F

iii.Using the letters that correspond to each qualifying dependent listed in Section II, list the amount paid per student for each qualifying expense. For students attending a qualifying school, the expense must be for an item required by the school. Refer to the information in Section I to determine which expenses qualify for the deduction. Retain copies of cancelled checks, receipts and other documentation in order to support the amount of qualifying expenses. if you checked column 1 in section ii, skip the 50% calculation below; however, the deduction is still limited to $5,000.

	Qualifying expense		List the amount paid for each student as listed in Section II.
		A	B	C	D	E	F
	Tuition and Fees
	School Uniforms
	Textbooks, or Other Instructional Materials
	Supplies
	Total (add amounts in each column)
	If column 2 or 3 in Section II was checked,	50%	50%	50%	50%	50%	50%
	multiply by:
	deduction per student – Enter the result
	or $5,000 whichever is less.

iv.Total the Deduction per Student in Section III, based on the deduction for which the students qualiied as marked in boxes 1, 2, or 3 in Section II.

Enter the elementary and secondary school tuition deduction here and on IT-540-2D, Schedule E, code 17E.	$
Enter the educational expenses for Home-schooled Children deduction here and on IT-540-2D, Schedule E, code 18E.	$
Enter the educational expenses for a Quality Public education deduction here and on IT-540-2D, Schedule E, code 19E.	$

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2013 Louisiana Refundable Child Care Credit Worksheet (For use with Form IT-540-2D)

your Federal adjusted Gross income must be $25,000 or less in order to complete this form.

1.Care Provider information schedule – Complete columns A through D for each person or organization that provided care to your child. You may use Federal Form W-10, supplied by your provider, to obtain the information. If your care provider does not provide a Federal Form W-10, complete those parts of the Care Provider Information Schedule for which you have the information. You must follow the same rules of “Due Diligence” as the IRS requires if you do not have all of the care provider information. See IRS 2013 Publication 503 for information on “Due Diligence.” If additional lines are required for Lines 1 or 2, attach a schedule. Falsiication of any information provided on this form constitutes fraud and can result in criminal penalties.

Care Provider information schedule

	a	B	C	d
	Care provider’s name	Address (number, street, apartment	Identifying number	Amount paid
		number, city, state, and ZIP)	(SSN or EIN)	(See instructions.)

.00

.00

.00

.00

.00

2.For each child under age 13, enter their name in column E, their Social Security Number in column F, and the amount of Qualiied Expenses you incurred and paid in 2013 in column G.

			e			F				G
			Qualifying person’s name			Qualifying person’s				Qualiied expenses you
										incurred and paid in 2013 for
		First			Last	Social Security Number
										the person listed in column (E)
											.00
											.00
											.00
											.00
											.00
3	Add the amounts in column G, Line 2. Do not enter more than $3,000 for one qualifying person or							3
	$6,000 for two or more persons. Enter this amount here and on Form IT-540-2D, Line 19A.										.00
4	Enter your earned income.							4			.00
5	If married iling jointly, enter your spouse’s earned income (if your spouse was a student or was							5
	disabled, see IRS Publication 503). All other iling statuses, enter the amount from Line 4.										.00
6	Enter the smallest of Lines 3, 4, or 5. Enter this amount on Form IT-540-2D, Line 19B.							6			.00
7	Enter your Federal Adjusted Gross Income from Form IT-540-2D, Line 7, or Schedule E, Line 1 if iled.							7			.00
	Enter on Line 8 the decimal amount shown below that applies to the amount on Line 7.
		if Line 7 is:	over		but not over	decimal amount
			$0		$15,000	.35
8			$15,000		$17,000	.34		8		X . _______
			$17,000		$19,000	.33
			$19,000		$21,000	.32
			$21,000		$23,000	.31
			$23,000		$25,000	.30
9	Multiply Line 6 by the decimal amount on Line 8.							9			.00
10	Multiply Line 9 by 50 percent and enter this amount on Line 11.							10		X .50
11	Enter this amount on Form IT-540-2D, Line 19.							11			.00

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2013 Louisiana Refundable school Readiness Credit Worksheet (For use with Form IT-540-2D)

R.S. 47:6104 provides a School Readiness Credit in addition to the credit for child care expenses as provided under R.S. 47:297.4. To qualify for this credit, the taxpayer must have Federal Adjusted Gross Income of $25,000 or less and must have incurred child care expenses for a qualiied dependent under age six who attended a child care facility that is participating in the Quality Start Rating program administered by the Louisiana Department of Children and Family Services. The qualifying child care facility must have provided the taxpayer with Form R-10614 which veriies the facility’s name, the state license number, the LA Revenue Account number, the Star Rating, and the rating award date.

Complete this worksheet only if you claimed a Louisiana Refundable Child Care Credit on Form it 540-2d, Line 19.

1.Enter the amount of 2013 Louisiana Refundable Child Care Credit on

the Louisiana Refundable Child Care Credit Worksheet, Line 11

1

. 00

Using the Star Rating of the child care facility that your qualiied dependent attended during 2013, shown on Form R-10614, determine the applicable percentage for the School Readiness Credit from the chart shown below:

a Quality Rating	B Percentages for star Rating
Five Star	200% (2.0)
Four Star	150% (1.5)
Three Star	100% (1.0)
Two Star	50% (.50)
One Star	0% (.00)

2.Enter the number of your qualiied dependents under age six who attended a:

	Five Star Facility	________	and multiply the number by 2.0	(i) __________ . ______
	Four Star Facility	________	and multiply the number by 1.5	(ii) __________ . ______
	Three Star Facility	________	and multiply the number by 1.0	(iii) __________ . ______
	Two Star Facility	________	and multiply the number by .50	(iv) __________ . ______
3	Add lines (i) through (iv) and enter the result. Be sure to include the decimal			. . . . . . . . . . . 3 __________ . ______

4Multiply Line 1 by the total on Line 3. If the number results in a decimal, round to the nearest dollar

and enter the result here and on Form IT-540-2D, Line 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ______________ . 00

On Form IT-540-2D, Line 20, enter in the boxes designated for 5, 4, 3, or 2 the number of your qualiied dependents as shown on Line 2 above for the associated star rated facility.

2013 Louisiana earned income Credit Worksheet

R.S. 47:297.8 allows a refundable credit for resident individuals who claimed and received a Federal Earned Income Credit (EIC). The Federal EIC is available for certain individuals who work, have a valid Social Security Number, and have a qualifying child, or are between ages 25 and 64. These individuals cannot be a qualifying child or dependent of another person.

Complete only if you claimed a Federal earned income Credit (eiC)

1Federal Earned Income Credit – Enter the amount from Federal Form 1040EZ,

	Line 8a, OR Federal Form 1040A, Line 38a, OR Federal Form 1040, Line 64a	1		. 00
2	Multiply Line 1 above by 3.5 percent, round to the nearest dollar, and enter the result on Line 3	2	X .035
3	Enter this amount on Form IT-540-2D, Line 21	3		. 00

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