Form Schedule A-B-DC Fillable Itemized Deductions, Interest and Dividend Income and Donation Checkoffs (Form 40) (blank)
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(FORM 40) (Form 40) 2013 (Schedules B and DC (You MUSTattach Federal Form 2106 if required See instructions ) *130003401283* *130004401283* 000000000000000000000000000000000000000000000000000000000013567810a10b11121315161719a19b20212223Medical andDental Expenses(See page 18) 10aHome mortgage interest and points reported to you on Federal Form 1098 11Qualified mortgage insurance premiums 12Points not reported to you on Form 1098 13Investment interest (Attach Form 4952A ) 14Add the amounts on lines 10a through 13 Enter the total here 16Other than cash or check (You MUSTattach Federal Form 8283 if over $500 ) 17Carryover from prior year 18Add the amounts on lines 15 through 17 Enter the total here 19aEnter the amount from Federal Form 4684 line 16 (See page 19) 1Medical and dental expenses 20Unreimbursed employee expenses job travel union dues job education etc 21Other expenses (investment tax preparation safe deposit box etc ) List typeand amount 22Add the amounts on lines 20 and 21 Enter the total 23Multiply the amount on Form 40 line 10 by 2% ( 02) Enter the result here 24Subtract line 23 from line 22 Enter the result If zero or less enter 0 25Other (from list on page 20 of instructions) List type and amount 26Enter amount here 27Add the amounts on lines 4 9 14 18 19c 24 25 and 26 Enter the total here Thenenter on Form 40 page 1 line 11 2Enter amount from Form 40 line 10 3Multiply the amount on line 2 by 4% ( 04) Enter the result 49141819c242526272Schedule A (Form 40) 201300 4Subtract line 3 from line 1 Enter the result If zero or less enter 0 5Real estate taxes 6FICA Tax (Social Security and Medicare) and Federal Self Employment Tax 7Railroad Retirement (Tier 1 only) 8Other taxes (List include personal property taxes ) 9Add the amounts on lines 5 through 8 Enter the total here Alabama Arts Development Fund Alabama Association of Rescue Squads Alabama Breast & Cervical Cancer Program Alabama Department of Revenue Alabama Firefighters Annuity and Benefit Fund Alabama Military Support Foundation Alabama Nongame Wildlife Fund Alabama State Historic Preservation Fund Alabama Veterans Program Alabama Veterinary Medical Foundation and Dividends and Most OtherMiscellaneousDeductions(See page 20) Archives Services Fund are on back page) ATTACH TO FORM 40 SEE INSTRUCTIONS FOR SCHEDULE A bEnter 10% of your Adjusted Gross Income (Form 40 line 10) bHome mortgage interest not reported to you on Federal Form 1098 (If paid toan individual show that person s name and address ) Cancer Research Institute Casualty and CAUTION: Do not include expenses reimbursed or paid by others CAUTION: Do not include medical premiums CAUTION: If you made a charitable contribution and received a benefit in return Check Offs Child Abuse Trust Fund cSubtract line 19b from line 19a If zero or less enter 0 differ Please see instructions before completing this schedule PART YEAR RESIDENTS: A resident of Alabama for only a part of the year should list below Dividend Donation Enter here and on Form 40 page 1 line 6 Exempt Interest Foster Care Trust Fund Gifts to Charity(See page 18) If you received more than $1500 of interest and dividend income you must complete Schedule B See instructions on page 21 Income Interest Interest You Paid(See page 19) Job Expenses List Payers and Amounts Mental Health Name(s) as shown on Form 40 Name(s) as shown on Form 40 (Do not enter name and social security number if shown on other side) NOTE: Personalinterest is notdeductible only those deductions actually paid while a resident of Alabama OtherMiscellaneousDeductionsQualified Long Page 2 PremiumsTotal ItemizedDeductionsTaxes You Paid(See page 18) Sch A B & DC SCHEDULE Schedule A Itemized Deductions SCHEDULES Schedules B & DC (Form 40) 2013 see page 18 15Contributions by cash or check Senior Services Trust Fund Spay Neuter Program Taxable Interest Term Care Ins The itemized deductions you may claim for the year 2013 are similar to the itemized deductions claimed on your Federal return however the amounts may Theft Loss(Attach Form 4684) Total Donations Add lines 1a b c d e f g h i j k l m n o and p Enter here and on Form 40 page 1 line 33 TOTAL TAXABLE INTEREST AND DIVIDENDS Victims of Violence Assistance You may donate all or part of your overpayment (Enter the amount in the appropriate boxes ) Your social security number