Form IA 1040 Long Form return only 41-001 Fill-in and Calculating Version - for best results use Adobe PDF Reader Version 4.5 or higher. Use Adobe Reader Version 11 to save a copy of your completed return. Download the most recent Adobe PDF Reader for free.
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$1 50 to Campaign Fund $1 50 to Campaign Fund $1 50 to Democratic Party $1 50 to Democratic Party $1 50 to Republican Party s YOURSELF: $1 50 to Republican Party (: 1) Unchecked (: 1) Unchecked (: 2) Unchecked (: 2) Unchecked (: 3) Unchecked (: 3) Unchecked (: 4) Unchecked (: 5) Unchecked (: 6) Unchecked (: I) Unchecked (: N) Unchecked (: S) Unchecked (: Y) Unchecked (button) (checkbox) Unchecked (checkbox) Unchecked (Enter CITY) (Enter U S STATE with two characters (or enter country if address is foreign)) (Enter ZIP CODE) (other than taxpayer) is based on all information of which the preparer has any knowledge (Press to reset this form) CLEAR (PRINT) PRINT (Select County from list) SELECT COUNTY (Select School District from list) SELECT SCHOOL DISTRICT (Sticky Note comment ERR (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 0 (text) 1 (text) 40 (text) 40 (text) PLEASE USE THE GREEN PRINT BUTTON TO PRINT THIS FORM THANK YOU *1341001019999* *1341001029999* 1 Single: Were you claimed as a dependent on another person s Iowa return? YES NO 10 Rents royalties partnerships estates etc 10 00 00 10/8/2012 10:05:25 PM 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 17 Deductible part of self employment tax 17 00 00 18 Health insurance deduction 18 00 00 19 Penalty on early withdrawal of savings 19 00 00 2 Married filing a joint return (Two income families may benefit by using status 3 or 4 ) 20 Alimony paid 20 00 00 2013 IA 1040 Iowa Individual Income Tax Form 2013 IA 1040 page 2 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 28 Self employment/household employment taxes 28 00 s 00 29 Addition for federal taxes ADD lines 27 and 28 29 00 00 3 Married filing separately on this combined return Spouse use column B 3 Ordinary dividend income If more than $1 500 complete Sch B 3 00 00 30 Total ADD lines 26 and 29 30 00 00 32 Federal estimated tax payments made in 2013 32 00 s 00 33 Additional federal tax paid in 2013 for 2012 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 36 BALANCE From side 1 line 35 36 00 00 38 TAXABLE INCOME SUBTRACT line 37 from line 36 38 00 00 39 Tax from tables or alternate tax 39 00 s 00 4 Alimony received 4 00 00 4 Married filing separate returns Spouse s name: SSN: Net Income: $ 40 Iowa lump sum tax 25% of federal tax from form 4972 40 00 s 00 41 001a (09/03/13) 41 001b (09/03/13) 41 Iowa minimum tax Attach IA 6251 41 00 s 00 42 Total tax ADD lines 39 40 and 41 42 00 00 43 Total exemption credit amount(s) from Step 3 side 1 43 00 00 44 Tuition and textbook credit for dependents K 12 44 00 s 00 46 Total credits ADD lines 43 44 and 45 46 00 00 47 BALANCE SUBTRACT line 46 from line 42 If less than zero enter zero 47 00 s 00 49 BALANCE SUBTRACT line 48 from 47 If less than zero enter zero 49 00s 00 5 Business income/(loss) from federal Schedule C or C EZ 5 00 00 5 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 50 Other nonrefundable Iowa credits Include IA 148 Tax Credits Schedule 50 00 s 00 51 BALANCE SUBTRACT line 50 from line 49 If less than zero enter zero 51 00 s 00 52 School district surtax or EMS surtax Take percentage from table; multiply by line 51 52 00 s 00 53 Total tax ADD lines 51 and 52 53 00 s 00 54 TOTAL tax before contributions Combine columns A and B on line 53 and enter here 54 55 Contributions Contributions will reduce your refund or add to the amount you owe Amounts must be in whole dollars 56 TOTAL TAX AND CONTRIBUTIONS Add line 54 and line 55 and enter here 56 s 00 57 Out of state tax credit Include IA 130 57 00 s 00 58 Motor fuel tax credit Include IA 4136 58 00 s 00 59 Check One: 6 Capital gain/(loss) from federal Sch D if required for federal purposes 6 00 00 6 Qualifying widow(er) with dependent child Name: SSN: 60 Iowa earned income tax credit See Instructions 60 00 s 00 61 Other refundable credits Include IA 148 Tax Credits Schedule 61 00 s 00 62 Total refundable credits ADD lines 57 61 62 00 s 00 63 Tax after credits SUBTRACT line 62 from line 53 If less than 0 enter 0 63 00 s 00 64 Taxpayers trust fund tax credit See instructions 64 00 s 00 65 Iowa income tax withheld 65 00 s 00 66 Estimated and voucher payments made for tax year 2013 66 00 s 00 67 TOTAL ADD lines 62 64 65 and 66 67 00 s 00 68 TOTAL CREDITS ADD columns A and B on line 67 and enter here 68 69 If line 68 is more than line 56 SUBTRACT line 56 from line 68 This is the amount you overpaid 69 s 00 7 Other gains/(losses) from federal form 4797 7 00 00 72 If line 68 is less than line 56 SUBTRACT line 68 from line 56 This is the AMOUNT OF TAX YOU OWE 72 s 00 73 Penalty for underpayment of estimated tax from IA 2210 IA 2210S or IA 2210Fs 74 Penalty and interest 74a Penalty 00s 74b Interest 00s ADD Enter total 74 00 8 Taxable IRA distributions 8 00 00 9 Taxable pensions and annuities 9 00 00 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 = $ Addition Adjust Amount amount of tax you owe or decrease your refund and statements and to the best of my (our) knowledge and belief it is a true correct and complete return Declaration of preparer b Enter 1 for each taxpayer who is 65 or older and/or 1 for each taxpayer who is blind s X $ 20 = $ B Spouse/Status 3 A You or Joint B Spouse/Status 3 A You or Joint blue or black ink c Dependents: Enter 1 for each dependent s X $ 40 = $ Check if annualized income method is used 73 s 00 Check this box if you or your spouse were 65 or older as of 12/31/13 Checkoff Child Abuse Prevention 55d: s Child and dependent care credit OR City State ZIP Contribu 48 Credit for nonresident or part year resident Include IA 126 and federal return 48 00 s 00 Credits Current mailing address (number and street apartment lot or suite number) or PO Box d Enter first names of dependents here: Date Check if Deceased Date of Death Preparer s PTIN Firm s FEIN Date Check if Deceased Date of Death Preparer s Signature Date Daytime Telephone Number Deduc 31 Federal tax withheld 31 00 s 00 Dependent children for whom an exemption is claimed in Step 3 E Mail Address e TOTAL $ Early childhood development credit 59 00 s 00 Enter total 55 00 Federal Firefighters/Veterans 55c: s Fish/Wildlife 55a: Gross 2 Taxable interest income If more than $1 500 complete Sch B 2 00 00 How many do not have health care coverage? How many have health care coverage?(including Medicaid or hawk i) Income Income Itemized (include IA Schedule A) MAILING ADDRESS: See line 75 above Marked set by ERR) ments no pencils or red ink NOTE: Use only or 71 Amount of line 69 to be applied to your 2014 estimated tax 71 00 s 00 or fiscal year beginning / 2013 and ending / / PLEASE PO Box 9187 Des Moines IA 50306 9187 Make check payable to Treasurer State of Iowa Refund For a faster refund file electronically Go to www iowa gov/tax for details Residence on 12/31/13: County No School District No s SPOUSE: s X $ 20 = $ s X $ 40 = $ SIGN HERE Spouse s last name Spouse s first name/middle initial Spouse s Signature Spouse SSN Your SSN Standard 37 00 s 00 StateFair 55b: s STEP 1: Fill in all spaces You MUST fill in your Social Security Number (SSN) STEP 10 70 Amount of line 69 to be REFUNDED REFUND 70 s 00 STEP 11POLITICAL CHECKOFF This checkoff does not increase the STEP 12 I (We) the undersigned declare under penalty of perjury that I (we) have examined this return including all accompanying schedules STEP 2 Filing Status: Mark one box only STEP 3 Exemptions B Spouse (Filing Status 3 ONLY) A You or Joint STEP 4 1 Wages salaries tips etc 1 00 00 STEP 5 16 Payments to an IRA Keogh or SEP 16 00 00 STEP 6 27 Federal income tax refund / overpayment received in 2013 27 00 s 00 STEP 7 STEP 8 STEP 9 sX $ 40 = $ Tax 45 Volunteer Firefighter/EMS credit 45 00 s 00 Taxable 37 Deduction Check one box s This return is due April 30 2014 Please sign enclose W 2s and verify SSNs tions 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 Mailing address: Iowa Income Tax Document Processing You Owe Your last name Your first name/middle initial Your Signature