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

$1 50 to Democratic Party 00 75b Interest 00 ADD Enter total Early childhood development credit Spouse $1 50 to Republican Party tions Yourself $1 50 to Republican Party $1 50 to Campaign Fund $1 50 to Democratic 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) 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) 0 (text) 0 (text) 1 (text) 40 (text) 40 (text) PLEASE USE THE GREEN PRINT BUTTON TO PRINT THIS FORM THANK YOU / 2015 and ending / / 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 16 Payments to an IRA Keogh or SEP 16 18 Health insurance deduction 18 19 Penalty on early withdrawal of savings 19 20 Alimony paid 20 2015 IA 1040 IowFor fiscal year beginning 2015 IA 1040 page 5 IA 1040 page 2 21 Pension/retirement income exclusion 21 22 Moving expense deduction from federal form 3903 22 23 Iowa capital gain deduction; certain sales only Include IA 100 23 24 Other adjustments 24 25 Total adjustments Add lines 16 24 25 26 00 00 26 Net Income Subtract line 25 from line 15 27 Federal income tax refund/overpayment received in 2015 27 28 Self employment/household employment/other federal taxes 28 29 Addition for federal taxes Add lines 27 and 28 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 2015 32 33 Additional federal tax paid in 2015 for 2014 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 39 Tax from tables or alternate tax 39 4 Alimony received 4 40 Iowa lump sum tax 25% of federal tax from form 4972 40 41 001 (09/02/15) 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 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 5 IA 1040 IowFor fiscal year beginning 50 Out of state tax credit Include IA 130 51 BALANCE SUBTRACT line 50 from 49 If less than zero enter zero 51 52 Other nonrefundable Iowa credits Include IA 148 Tax Credits Schedule 53 BALANCE SUBTRACT line 52 from line 51 If less than zero enter zero 54 School district surtax or EMS surtax Take percentage from table; multiply by line 53 55 Total state and local tax ADD lines 53 and 54 56 TOTAL state and local tax before contributions Combine columns A and B on line 55 and enter here 56 58 TOTAL STATE AND LOCAL TAX AND CONTRIBUTIONS Add line 56 and line 57 and enter here 58 59 Iowa Fuel tax credit Include IA 4136 59 6 Capital gain/(loss) federal Sch D if required for federal purposes 6 60 Check One: Child and dependent care credit 61 Iowa earned income tax credit 15 0% ( 15) of federal credit 61 62 Other refundable credits Include IA 148 Tax Credits Schedule 62 63 Total refundable Iowa credits ADD lines 59 62 63 64 RESERVED FOR FUTURE USE 64 0 00 0 00 65 Taxpayers trust fund tax credit The credit for 2015 is $0 65 0 00 0 00 66 Iowa income tax withheld 66 67 Estimated and voucher payments made for tax year 2015 67 68 TOTAL ADD lines 63 65 66 and 67 68 69 TOTAL CREDITS ADD columns A and B on line 68 and enter here 69 7 Other gains/(losses) from federal form 4797 7 70 If line 69 is more than line 58 Subtract line 58 from line 69 This is the amount you overpaid 70 71 Amount of line 70 to be REFUNDED REFUND 72 Amount of line 70 to be applied to your 2016 estimated tax 72 73 If line 69 is less than line 58 Subtract line 69 from line 58 This is the AMOUNT OF TAX YOU OWE 74 Penalty for underpayment of estimated tax from IA 2210 IA 2210S or IA 2210F Check if annualized income method is used 75 Penalty and interest 75a Penalty 76 TOTAL AMOUNT DUE ADD lines 73 74 and 75 Enter here PAY THIS AMOUNT 8 Taxable IRA distributions 8 9 Taxable pensions and annuities 9 a Individual Income Tax Form 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 Adjust( 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 alternative minimum tax Include IA 6251 41 Child abuse Prevention 57d: City State ZIP Contribu 42 Total tax ADD lines 39 40 and 41 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 decrease your refund Deduction Dependent children for whom an exemption is claimed in Step 3 e Total $ e Total $ Email Address: Enter here 57 Firefighters/Veterans 57c: Fish/Wildlife 57a: For a faster refund file electronically Go to https://tax iowa gov for details 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 Make check payable to Treasurer State of Iowa Marked set by ERR) Married filing a joint return (Two income families may benefit by using status 3 or 4 ) Married filing separate returns Spouse's name: Married filing separately on this combined return Spouse use column B ments to 17 Deductible part of self employment tax 17 Name: Net Income: $ NOTE: Use only or red ink PO BOX 9187 Des Moines IA 50306 9187 Political Checkoff This checkoff does not Qualifying Widow(er) with dependent child Residence on 12/31/15: 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 Spouse's Signature Date Check if Deceased Date of Death Preparer's PTIN Firm's FEIN st fill in your Social Security Number (SSN) Standard State Fair 57b: Step 1: Fill in all spaces You muYour last name Step 10 Step 11Refund 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 12/31/15 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 7Federal Step 8 Step 9 Taxable text) This return is due May 2 2016 Please sign enclose W 2s and verify SSNs X $ 20 = $ X $ 40 = $ X $ 40 = $ You can pay online at https://tax iowa gov/ Your first name/middle initial Your Signature Your SSN