$ 00 $ 00
and Renter Property Tax Credit
filing separately on same return Off
if: Filing an amended return See page 5
if: Filing for a deceased taxpayer See page 17
Square number
Subtractions from DC Income
Suffix number Lot number
#1 #2 #3
(month) to (month); number of months in DC
*120400110002*
*120400120002*
*129980110002*
00 43 $
1 Fill in only one:
10 Enter information from your real property tax bill or assessment If a section is blank on your property tax bill leave it blank here
10 Income reported and taxed this year on a DC franchise or fiduciary return 11 DC and federal government pension and annuity limited exclusion see page 20 Fill in
12 DC and federal government survivor benefits see page 20 13 Other subtractions from DC Schedule I Calculation B Line 16 14 Total subtractions from DC income Lines 7 13
13 Total payments made during 2012 $
15 DC adjusted gross income Line 6 minus Line 14 Fill in if loss
16 Deduction type Take the same type as you took on your federal return Fill in which type:
17 DC deduction amount Do not copy from federal return For amount to enter see page 21
17a RESERVED $
18 Number of exemptions If more than 1 (more than 2 if filing jointly) or if you or your 18
19 Exemption amount Multiply $1 675 by number on line 18 Part year DC residents see Calculation E page 19
2 Fill in if you are: Off
20 Add Lines 17 and 19
2012 D 40 Individual
2012 D 40 P1
2012 D 40 P2 Individual Income Tax Return page 2 File order 2
2012 SCHEDULE H Homeownerl
2012 SCHEDULE H P1 Revised 11/12 Homeowner and Renter Property Tax Credit File order 5
2012 SCHEDULE U
21 DC taxable income Subtract Line 20 from Line 15 Enter result
22 Tax If Line 21 is $100 000 or less use tax tables on pages 47 56 If more use Calculation I page 21
23 Credit for child and dependent care expenses
24 Non refundable credits from DC Schedule U Part 1a Line 6 Attach Schedule U
25 DC Low Income Credit See table on page 11 Take either this credit or Line 28 credit not both
25a Enter the number of exemptions claimed on your federal return 25a
26 Total non refundable credits Add Lines 23 24 and 25
27 Total tax Subtract Line 26 from Line 22 If Line 22 is less than Line 26 leave Line 27 blank
28 DC Earned Income Tax Credit Enter your federal EIC
28a Enter the number of qualified EITC children 28a
29 Property Tax Credit From your DC Schedule H; attach a copy
3 Federal adjusted gross income From adjusted gross income lines on Federal Forms 1040 1040A 1040EZ 1040NR or 1040NR EZ
30 Refundable credits from DC Schedule U Part 1b Line 4 Attach Schedule U
31 DC income tax withheld shown on Forms W 2 and 1099 Attach these forms
32 2012 estimated income tax payments
33 Tax paid with extension of time to file or with original return if this is an amended return
34 Total payments and refundable credits Add Lines 28 29 33
35 Amount you overpaid 35 $
36 Amount to be applied 36 $
37 Penalty See instructions 37 $
38 Refund Subtract sum of
39 Contribution amount
4 Franchise tax deducted on federal forms see instructions
40 Net refund 40 $
41 Tax due 41 $
42 Contribution amount 42 $
43a Penalty $
43b Interest $
5 Other additions from DC Schedule I Calculation A Line 8
6 Add Lines 3 4 and 5
7 Part year residents enter income received during period of nonresidence see pg 20 8
a b Wages salaries unemployment compensation and/or tips Business income or loss see instructions page 19 Fill in if loss see instructions page 19 ab Off
a Wages salaries tips bonuses commissions fees and a
account fill in oval and enter bank routing and account numbers See page 7 Routing Number Off
Account Number
Additional Miscellaneous Credits and Contributions
Additions to DC Income
Amount owed Complete if Line 34 is equal to or less than Line 27
and enter the name and phone number of that person See instructions page 8
any compensation for personal services
any data on this form other than your signature
any data on this form other than your signature
b Dividends and interest b
c Capital gain (or loss) Fill in if loss c Off
c Lottery winnings c
Can not exceed refund amt on Line 38 44 Total amount due 44 $
City State Zip Code +4
Computation of DC Gross and Adjusted Gross Income
D 40 PAGE 2
d Rental real estate royalties partnerships etc Fill in if loss d Off
d Trade or business income (or loss) d
DC tax credits and payments
Dependent claimed by someone else Off
Designee s name
Direct Deposit To have your refund deposited to your checking
District of Columbia
District of Columbia l
e Taxable and nontaxable pensions and annuities e
enter here and on Section A Line 1 or Section B Line 7
Enter total P & I
Enter your last name
Enter your SSN
f Capital gain (or loss) f
File order 6
File order 7
Filing status
Fill in
Fill in if loss
Fill in if loss
From federal Form 2441; If part year DC resident from Line 5 DC Form D 2441
From Federal Forms 1040 or 1040A
from Sched U Part II Line 6
from Sched U Part II Line 7
g Alimony received g
Government of the
Government of the District of Columbia
h Net rental and royalty income h
Head of household Enter qualifying dependent and/or non dependent information on Schedule S
Home address (number street and apartment number if applicable)
i Social security and/or railroad retirement i
if filing separately on same return Complete Calculation J on Schedule S
if you are 62 or older Off
If you are blind or disabled you must have this certificate completed to claim the Property Tax Credit File it with your Schedule H
if your spouse/domestic partner is 62 or older
Income Information Round cents to nearest dollar If zero leave the line blank
Income Tax Return
Individual Income Tax Return page 1 File order 1
Itemized See page 20 for amount to enter on Line 17
j Unemployment insurance and workers compensation j
k Support money and public assistance grants k
l Complete your federal return first Enter your dependents information on DC Schedule S l
l Interest on U S obligations l
Lines 36 and 37 from Line 35
List names and social security numbers of other household members If more than four list on a separate sheet of paper and attach with this form
m Disability income exclusion (from DC Form D 2440 Line 10) m
Married filing jointly Off
Married filing separately
Married filing separately on same return Enter combined amounts for Lines 4 42 See instructions page 6 Off
n Nontaxable portion of military compensation n
o Fellowship and scholarship awards and grants o
OFFICIAL USE ONLY
OffOff
OffOff
or savings
p Life insurance proceeds p
Paid preparer s PTIN Paid preparer s phone number
Part year resident in DC from
Personal information Fill in
Phone number
Put additional amt on Line 42 Add Lines 41 43
q Veteran s pension and disability payments q
r GI Bill benefits r
Refund Complete if Line 34 is more than Line 27
Registered domestic partners filing jointly or
Revised 11/12
s Income subject to unincorporated business franchise tax s
SCHEDULE U Additional Miscellaneous Credits and Contributions *120400170002*
See page 18
See page 8
Signature Under penalties of law I declare that I have examined this return and to the best of my knowledge it is correct Declaration of paid preparer is based on information available to the preparer
Single Off
Spouse s/domestic partner s signature if filing jointly or separately on same return Date
Spouse s/registered domestic partner s first name M I Last name
spouse/domestic partner are over 65 or blind attach a completed Calculation G Schedule S
Standard or
STAPLE OTHER DOCUMENTS IN UPPER LEFT IN BACK
STAPLE W 2s AND ANY OTHER WITHHOLDING STATEMENTS HERE
Subtract Line 34 from Line 27 Subtract Line 27 from Line 34
Subtract Line 39 from Line 38
t Cash distributions from a business or investment t
Taxable amount of social security and tier 1 railroad retirement
Taxable refunds credits or offsets of state and local income tax 9
Third party designee To authorize another person to discuss this return with OTR fill in here Off
This is a FILL IN format Please do not handwrite
This is a FILL IN format Please do not handwrite
to your 2013 estimated tax
u Other u
v Total gross income Add Lines a u for each column v
Vendor ID#0002
w Total household gross income Add amounts entered on Line v w $
Will the refund you requested go to an account outside the U S ? Yes
Your first name M I Last name
Your signature Date Paid preparer s signature Date
Your social security number (SSN) Spouse s/registered domestic partner s SSN Your daytime telephone number