Form IA-1040 Return - Fillable Version 41-001
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

$1 50 to Republican Party 00 74b Interest 00 ADD Enter total Early childhood development credit Spouse $1 50 to Democratic Party tions Yourself $1 50 to Democratic Party $1 50 to Campaign Fund $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) (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 (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) (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 1 Wages salaries tips etc 1 10 Rents royalties partnerships estates etc 10 10/8/2012 10:05:25 PM 11 Farm income/(loss) from federal Schedule F 11 12 Unemployment compensation See instructions 12 13 Gambling winnings 13 14 Other income bonus depreciation and section 179 adjustment 14 15 00 00 15 Gross Income Add lines 1 14 17 Deductible part of self employment tax 17 00 18 Health insurance deduction 18 00 19 Penalty on early withdrawal of savings 19 00 2 Married filing a joint return (Two income families may benefit by using status 3 or 4 ) 20 Alimony paid 20 00 2014 IA 1040 Iowa Individual Income Tax Form 2014 IA 1040 page page 2 21 Pension/retirement income exclusion 21 00 22 Moving expense deduction from federal form 3903 22 00 23 Iowa capital gain deduction; certain sales only See instructions 23 00 24 Other adjustments 24 00 25 Total adjustments Add lines 16 24 25 26 Net Income Subtract line 25 from line 15 26 27 Federal income tax refund / overpayment received in 2014 27 28 Self employment/household employment taxes 28 29 Addition for federal taxes Add lines 27 and 28 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 30 Total Add lines 26 and 29 31 Federal tax withheld 31 32 Federal estimated tax payments made in 2014 32 33 Additional federal tax paid in 2014 for 2013 and prior years 33 34 Deduction for federal taxes Add lines 31 32 and 33 35 Balance Subtract line 34 from line 30 Enter here and on line 36 page 2 36 BALANCE From side 1 line 35 36 38 00 00 38 TAXABLE INCOME SUBTRACT line 37 from line 36 4 Alimony received 4 40 Iowa lump sum tax 25% of federal tax from form 4972 40 41 001 (09/11/14) 43 Total exemption credit amount(s) from Step 3 side 1 43 44 Tuition and textbook credit for dependents K 12 44 45 Volunteer firefighter/EMS/reserve peace officer credit 45 46 Total credits ADD lines 43 44 and 45 46 47 BALANCE SUBTRACT line 46 from line 42 If less than zero enter zero 47 48 Credit for nonresident or part year resident Include IA 126 and federal return 48 49 BALANCE SUBTRACT line 48 from 47 If less than zero enter zero 49 5 Business income/(loss) from federal Schedule C or C EZ 5 50 Other nonrefundable Iowa credits Include IA 148 Tax Credits Schedule 50 51 BALANCE SUBTRACT line 50 from line 49 If less than zero enter zero 51 52 School district surtax or EMS surtax Take percentage from table; multiply by line 51 52 53 Total tax ADD lines 51 and 52 54 TOTAL tax before contributions Combine columns A and B on line 53 and enter here 54 56 TOTAL TAX AND CONTRIBUTIONS Add line 54 and line 55 and enter here 56 57 Out of state tax credit Include IA 130 57 58 Iowa Fuel tax credit Include IA 4136 58 59 Check One: Child and dependent care credit 6 Capital gain/(loss) federal Sch D if required for federal purposes 6 60 Iowa earned income tax credit 15 0% ( 15) of federal credit 60 61 Other refundable credits Include IA 148 Tax Credits Schedule 61 62 Total refundable credits ADD lines 57 61 62 63 Tax after credits Subtract line 62 from line 53 If less than 0 enter 0 63 64 Taxpayers trust fund tax credit See instructions 64 65 Iowa income tax withheld 65 66 Estimated and voucher payments made for tax year 2014 66 67 TOTAL ADD lines 62 64 65 and 66 67 68 00 68 TOTAL CREDITS ADD columns A and B on line 67 and enter here 69 If line 68 is more than line 56 Subtract line 56 from line 68 This is the amount you overpaid 7 Other gains/(losses) from federal form 4797 7 71 Amount of line 69 to be applied to your 2015 estimated tax 71 72 If line 68 is less than line 56 Subtract line 68 from line 56 This is the AMOUNT OF TAX YOU OWE 73 Penalty for underpayment of estimated tax from IA 2210 IA 2210S or IA 2210F Check if annualized income method is used 74 Penalty and interest 74A Penalty 75 TOTAL AMOUNT DUE ADD lines 72 73 and 74 and enter here PAY THIS AMOUNT 8 Taxable IRA distributions 8 9 Taxable pensions and annuities 9 a Personal Credit: Col A: Enter 1 (enter 2 if filing status 2 or 5); Col B: Enter 1 if filing status 3 A You or Joint Addition Adjust16 Amount b Enter 1 for each taxpayer who is 65 or older and/or 1 for each taxpayer who is blind B Spouse/Status 3 A You or Joint B Spouse/Status 3 A You or Joint blue or black c Dependents: Enter 1 for each dependent Check 41 Iowa minimum tax Attach IA 6251 41 Child abuse Prevention 55d: City State ZIP Contribu 42 Total tax ADD lines 39 40 and 41 Contributions Contributions will reduce your refund or add to the amount you owe Amounts must be in whole dollars 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 Signature Date Daytime Telephone Number Daytime Telephone Number decrease your refund Deduction Dependent children for whom an exemption is claimed in Step 3 Due For a faster refund file electronically Go to www iowa gov/tax for details e Total $ e Total $ Email Address: Enter here 55 Federal Firefighters/Veterans 55c: Fish/Wildlife 55a: For fiscal year beginning / 2014 and ending / / Gross 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 How many do not have health care coverage? How many have health care coverage?(including Medicaid or hawk i) 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 Income Income 2 Taxable interest income If more than $1 500 complete Sch B 2 Income 37 Deduction Check one box Itemized (Include IA Schedule A) increase the amount of tax you owe or ink no pencils knowledge Mailing address: Iowa Income Tax Document Processing PO Box 9187 Des Moines IA 50306 9187 Make check payable to Treasurer State of Iowa MAILING ADDRESS: See line 75 above Marked set by ERR) Married filing separate returns Spouse's name: ments to Name: Net Income: $ NOTE: Use only or 70 Amount of line 69 to be REFUNDED REFUND or red ink Payments to an IRA Keogh or SEP 16 00 Political Checkoff This checkoff does not Qualifying Widow(er) with dependent child Refund Residence on 12/31/14: County No School District No Single: Were you claimed as a dependent on another person s Iowa return? Yes Spouse s last name Spouse s first name/middle initial Spouse SSN Your SSN Spouse's Signature Date Check if Deceased Date of Death Preparer's PTIN Firm's FEIN Standard State Fair 55b: Step 1: Fill in all spaces You must fill in your Social Security Number (SSN) Step 10 Step 11 Step 12 Step 13 Step 2 Filing Status: Mark one box only Check this box if you or your spouse were 65 or older as of 12/31/14 Step 3 Exemptions B Spouse (Filing Status 3 ONLY) A You or Joint Step 4 Reportable Social Security Benefits as calculated on line 11 of Iowa social security worksheet B Spouse/Status 3 Step 5 Step 6 Step 7 Step 8 Step 9 Tax 39 Tax from tables or alternate tax 39 Taxable This return is due April 30 2015 Please sign enclose W 2s and verify SSNs X $ 20 = $ X $ 40 = $ X $ 40 = $ You can pay online at www iowa gov/tax Your last name Your first name/middle initial Your Signature