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2012 IA 1040 Iowa Individual Income Tax Form

or fiscal year beginning __/__ 2012 and ending __/__ /__

STEP 1: Fill in all spaces. You MUST fill in your Social Security Number (SSN).

Your last name

Your first name/middle initial

Spouse’s last name

Spouse’s first name/middle initial

Current mailing address (number and street, apartment, lot, or suite number) or PO Box

City, State, ZIP

Spouse SSN •

Your SSN •

E-Mail Address

STEP 2 Filing Status: Mark one box only.

•

Check this box if you or your spouse were 65 or older as of 12/31/12.

Single: Were you claimed as a dependent on another person’s Iowa return?

YES

NOs

Residence on 12/31/12: County No. •

School District No. •

Married filing a joint return. (Two-income families may benefit by using status 3 or 4.)

Dependent children for whom an exemption is claimed in Step 3

How many have health care coverage?(including Medicaid or HAWK-I)

•

Married filing separately on this combined return. Spouse use column B.

How many do not have health care coverage?

•

Married filing separate returns. Spouse’s name:

SSN:

sNet Income: $

Head of household with qualifying person. If qualifying person is not claimed as a dependent on this return, enter the person’s name and SSN below.

Qualifying widow(er) with dependent child.

Name:

SSN:

STEP 3 Exemptions		B. Spouse (Filing Status 3 ONLY)
STEP 3 Exemptions
a. Personal Credit: Col. A: Enter 1 (enter 2 if filing status 2 or 5); Col. B: Enter 1 if filing status 3	s		X $ 40 = $
b. Enter 1 for each person who is 65 or older and/or 1 for each person who is blind	s		X $ 20 = $
c. Dependents: Enter 1 for each dependent	s		X $ 40 = $
d. Enter first names of dependents here: ____________________________________		e. TOTAL $

s s

A. You or Joint

X $ 40 = $

X $ 20 = $

X $ 40 = $

			B. Spouse/Status 3		A. You or Joint	B. Spouse/Status 3		A. You or Joint
STEP 4	1.	Wages, salaries, tips, etc	1.	______________ .00	______________ .00
Gross	2.	Taxable interest income. If more than $1,500, complete Sch. B	2.	______________ .00	______________ .00
Income	3.	Ordinary dividend income. If more than $1,500, complete Sch. B	3.	______________ .00	______________ .00
	4.	Alimony received	4.	______________ .00	______________ .00
	5.	..............Business income/(loss) from federal Schedule C or C-EZ	5.	______________ .00	______________ .00		NOTE: Use only
	6.	Capital gain/(loss) from federal Sch. D if required for federal purposes .	6.	______________ .00	______________ .00		NOTE: Use only
	6.		6.	______________ .00	______________ .00		blue or black ink,
	7.	Other gains/(losses) from federal form 4797	7.	______________ .00	______________ .00		blue or black ink,
	7.	Other gains/(losses) from federal form 4797	7.	______________ .00	______________ .00		no pencils or red ink.
	8.	Taxable IRA distributions	8.	______________ .00	______________ .00		no pencils or red ink.
	8.	Taxable IRA distributions	8.	______________ .00	______________ .00
	9.	Taxable pensions and annuities	9.	______________ .00	______________ .00
	9.	Taxable pensions and annuities	9.	______________ .00	______________ .00
	10.	Rents, royalties, partnerships, estates, etc	10.	______________ .00	______________ .00
	11.	Farm income/(loss) from federal Schedule F	11.	______________ .00	______________ .00
	12.	Unemployment compensation. See instructions	12.	______________ .00	______________ .00
	13.	Taxable Social Security benefits	13.	______________ .00 s ______________ .00
	14.	Other income, gambling income, bonus depreciation/section 179 adjustment ...	14.	______________ .00	______________ .00
	15.	GROSS INCOME. ADD lines 1-14				15. _______________ .00 s _______________ .00
STEP 5	16. Payments to an IRA, Keogh, or SEP		16.	______________ .00	______________ .00
Adjust-	17. Deductible part of self-employment tax		17.	______________ .00	______________ .00
ments	18.	Health insurance deduction	18.	______________ .00	______________ .00
to	18.	Health insurance deduction	18.	______________ .00	______________ .00
to	19.	Penalty on early withdrawal of savings	19.	______________ .00	______________ .00
Income	19.	Penalty on early withdrawal of savings	19.	______________ .00	______________ .00
Income
	20.	Alimony paid	20.	______________ .00	______________ .00
	21.	Pension/retirement income exclusion	21.	______________ .00 s ______________ .00
	22.	Moving expense deduction from federal form 3903	22.	______________ .00	______________ .00
	23.	Iowa capital gain deduction; certain sales ONLY (see instructions)	23.	______________ .00 s ______________ .00
	24.	Other adjustments	24.	______________ .00	______________ .00
	25.	Total adjustments. ADD lines 16-24				25. _______________ .00 s _______________ .00
	26.	NET INCOME. SUBTRACT line 25 from line 15				26. _______________ .00 s _______________ .00

STEP 6 Federal Tax Addition and Deduc- tion

27.	Federal income tax refund / overpayment received in 2012	27.	______________ .00 s ______________ .00
28.	Self-employment/household employment taxes	28.	______________ .00 s ______________ .00
29.	Addition for federal taxes. ADD lines 27 and 28			29.	_______________ .00	_______________ .00
30.	Total. ADD lines 26 and 29			30.	_______________ .00	_______________ .00
31.	Federal tax withheld	31.	______________ .00 s ______________ .00
32.	Federal estimated tax payments made in 2012	32.	______________ .00 s ______________ .00
33.	Additional federal tax paid in 2012 for 2011 and prior years	33.	______________ .00 s ______________ .00
34.	Deduction for federal taxes. ADD lines 31, 32, and 33			34.	_______________ .00	_______________ .00
35.	BALANCE. SUBTRACT line 34 from line 30. Enter here and on line 36, side 2			35.	_______________ .00 s _______________ .00

*1241001019999*

41-001a (10/11/12)

2012 IA 1040, page 2

B. Spouse/Status 3

A. You or Joint

B. Spouse/Status 3

A. You or Joint

STEP 7

36.

BALANCE. From side 1, line 35

36.

_______________ .00

Taxable

37. Total itemized deductions from federal Schedule A

37.

______________ .00

}

Income

Taxpayers with bonus depreciation/section 179 must use Iowa Schedule A.

Complete lines 37-40

38. Iowa income tax if included in line 5 of federal Schedule A

38.

______________ .00

ONLY if you itemize.

39. BALANCE. Subtract line 38 from line 37 or enter the

39.

______________ .00

amount of itemized deductions from the Iowa Schedule A.

40. Other deductions

40.

______________ .00

41.

Deduction. Check one box. s Itemized. Add lines 39 and 40.

Standard

41.

_______________ .00 s _______________ .00

42.

TAXABLE INCOME. SUBTRACT line 41 from line 36

42.

_______________ .00

STEP 8

43.

Tax from tables or alternate tax

43.

______________ .00 s ______________ .00

Tax,

44.

Iowa lump-sum tax. 25% of federal tax from form 4972

44.

______________ .00 s ______________ .00

Credits

and

45.

Iowa minimum tax. Attach IA 6251

45.

______________ .00 s ______________ .00

Checkoff

46.

Total tax. ADD lines 43, 44, and 45

46.

_______________ .00

Contribu- 47.

Total exemption credit amount(s) from Step 3, side 1

47.

______________ .00

tions

48.

Tuition and textbook credit for dependents K-12

48.

______________ .00 s ______________ .00

.............................

49.

Total credits. ADD lines 47 and 48

49.

_______________ .00

50.

BALANCE. SUBTRACT line 49 from line 46. If less than zero, enter zero

50.

_______________ .00 s _______________ .00

51.

Credit for nonresident or part-year resident. Attach IA 126 and federal return

51.

_______________ .00 s _______________ .00

52.

BALANCE. SUBTRACT line 51 from 50. If less than or equal to zero, enter zero

52.

_______________ .00

53.

Other nonrefundable Iowa credits. Attach IA 148 Tax Credits Schedule

53.

_______________ .00 s _______________ .00

54.

BALANCE. SUBTRACT line 53 from line 52

54.

_______________ .00

55.

School district surtax/EMS surtax. Take percentage from table; multiply by line 54.

..............................................

55.

_______________ .00 s _______________ .00

56.

Total Tax. ADD lines 54 and 55

56.

_______________ .00 s _______________ .00

57.

Total tax before contributions. ADD columns A & B on line 56 and enter here

57.

_______________ .00

58.

Contributions. Contributions will reduce your refund or add to the amount you owe. Amounts must be in whole dollars.

Fish/Wildlife 58a: s

StateFair 58b: s

Firefighters/Veterans 58c: s

Child Abuse Prevention 58d: s

Enter total. .

58.

_______________ .00

59.

TOTAL TAX AND CONTRIBUTIONS. ADD lines 57 and 58

59.

_______________ .00

STEP 9 Credits

60.	Iowa income tax withheld		60.	______________ .00 s ______________ .00
61.	Estimated and voucher payments made for tax year 2012		61.	______________ .00 s ______________ .00
62.	Out-of-state tax credit. Attach IA 130		62.	______________ .00 s ______________ .00
63.	Motor fuel tax credit. Attach IA 4136		63.	______________ .00 s ______________ .00
64.	Check One:	Child and dependent care credit OR
	s	Early childhood development credit	64.	______________ .00 s ______________ .00
65.	Iowa earned income tax credit. See Instructions		65.	______________ .00 s ______________ .00
66.	Other refundable credits. Attach IA 148 Tax Credits Schedule		66.	______________ .00 s ______________ .00
67.	TOTAL. ADD lines 60 - 66		67.	______________ .00	______________ .00
68.	TOTAL CREDITS. ADD columns A and B on line 67 and enter here				68. _______________ .00

STEP 10 Refund or Amount You Owe


69.	If line 68 is more than line 59, SUBTRACT line 59 from line 68. This is the amount you overpaid					69. s _______________ .00
70.	Amount of line 69 to be REFUNDED	...........................................................................................................................................			REFUND	70. s _______________ .00
	For a faster refund file electronically. Go to www.iowa.gov/tax for details or mail return to
	Iowa Income Tax - Refund Processing, Hoover State Office Bldg, Des Moines IA 50319-0120
71.	Amount of line 69 to be applied to your 2013 estimated tax		71. ______________ .00 s ______________ .00
72.	If line 68 is less than line 59, SUBTRACT line 68 from line 59. This is the AMOUNT OF TAX YOU OWE					72. s _______________ .00
73.	Penalty for underpayment of estimated tax from IA 2210 or IA 2210F s			Check if annualized income method is used		73. s _______________ .00
74.	Penalty and interest	74a. Penalty ______________ .00 s 74b. Interest _______________			.00 s ADD Enter total 74. _______________ .00
75.	TOTAL AMOUNT DUE. ADD lines 72, 73, and 74, and enter here.		........................................................................		PAY THIS AMOUNT	75. s _______________ .00
	You can pay online at www.iowa.gov/tax or pay by mail to Iowa Income Tax - Document Processing,
	PO Box 9187, Des Moines IA 50306-9187. Make check payable to Treasurer, State of Iowa.

STEP 11 POLITICAL CHECKOFF. This checkoff does not increase the

amount of tax you owe or decrease your refund.

s SPOUSE:

$1.50 to Republican Party	$1.50 to Republican Party
$1.50 to Democratic Party sYOURSELF:	$1.50 to Democratic Party
$1.50 to Campaign Fund	$1.50 to Campaign Fund

STEP 12

PLEASE

I (We), the undersigned, declare under penalty of perjury that I (we) have examined this return, including all accompanying schedules and statements, and, to the best of my (our) knowledge and belief, it is a true, correct, and complete return. Declaration of preparer (other than taxpayer) is based on all information of which the preparer has any knowledge.

SIGN HERE

Your Signature

Date

Check if Deceased

Date of

Death

Preparer’s Signature

Date

SIGN HERE

Spouse’s Signature

Date

Check if Deceased

Date of

Death

Preparer’s PTIN

Firm’s FEIN

*1241001029999*

Daytime Telephone Number

This return is due April 30, 2013. Please sign, enclose W-2s, and verify SSNs.

MAILING ADDRESSES: See lines 70 and 75 above.	41-001b (09/24/12)

Question	Answer
Form Name	Iowa Form Ia 1040
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	1241001 1040 long form iowa 2012

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