Security Line
Resume:
Form
****A U.S. Individual Income Tax Return (**) 2017
Department of the Treasury—Internal Revenue Service OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space. Your first name and initial Last name
Your social security number
If a joint return, spouse’s first name and initial Last name Spouse’s social security number c Make sure the SSN(s) above
and on line 6c are correct.
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Foreign country name Foreign province/state/county Foreign postal code Presidential Election Campaign
Check here if you, or your spouse if
filing jointly, want $3 to go to this fund.
Checking a box below will not change your
tax or refund. You Spouse
Filing
status
Check only
one box.
1 Single
2 Married filing jointly (even if only one had income) 3 Married filing separately. Enter spouse’s SSN above and full name here. a
4 Head of household (with qualifying person). (See instructions.) If the qualifying person is a child but not your dependent, enter this child’s name here. a
5 Qualifying widow(er) (see instructions)
Exemptions 6a Yourself. If someone can claim you as a dependent, do not check box 6a.
b Spouse }
c
If more than six
dependents, see
instructions.
Dependents:
(1) First name Last name
(2) Dependent’s social
security number
(3) Dependent’s
relationship to you
(4) if child under
age 17 qualifying for
child tax credit (see
instructions)
d Total number of exemptions claimed.
Boxes
checked on
6a and 6b
No. of children
on 6c who:
• lived with
you
• did not live
with you due to
divorce or
separation (see
instructions)
Dependents
on 6c not
entered above
Add numbers
on lines
above a
Income
Attach
Form(s) W-2
here. Also
attach
Form(s)
1099-R if
tax was
withheld.
If you did not
get a W-2, see
instructions.
7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7 8a Taxable interest. Attach Schedule B if required. 8a b Tax-exempt interest. Do not include on line 8a. 8b 9a Ordinary dividends. Attach Schedule B if required. 9a b Qualified dividends (see instructions). 9b
10 Capital gain distributions (see instructions). 10 11 a IRA
distributions. 11a
11b Taxable amount
(see instructions). 11b
12 a Pensions and
annuities. 12a
12b Taxable amount
(see instructions). 12b
13 Unemployment compensation and Alaska Permanent Fund dividends. 13 14 a Social security
benefits. 14a
14b Taxable amount
(see instructions). 14b
15 Add lines 7 through 14b (far right column). This is your total income. a 15 Adjusted
gross
income
16 Educator expenses (see instructions). 16
17 IRA deduction (see instructions). 17
18 Student loan interest deduction (see instructions). 18 19 Tuition and fees. Attach Form 8917. 19
20 Add lines 16 through 19. These are your total adjustments. 20 21 Subtract line 20 from line 15. This is your adjusted gross income. a 21 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040A (2017) 1
2
Wagner
825 watt way j101
23,368.
23,368.
23,368.
1
Leo L Valencia ***-**-**** Grandchild
julianne L 544 88 7144
bend OR 97701
REV 02/22/18 Intuit.cg.cfp.sp
BAA
Form 1040A (2017) Page 2
Tax, credits,
and
payments
22 Enter the amount from line 21 (adjusted gross income). 22 23 a Check
if: { You were born before January 2, 1953, Blind
Spouse was born before January 2, 1953, Blind }Total boxes checked a 23a
b If you are married filing separately and your spouse itemizes Standard deductions, check here a 23b
Deduction
for—
• People who
check any
box on line
23a or 23b or
who can be
claimed as a
dependent,
see
instructions.
• All others:
Single or
Married filing
separately,
$6,350
Married filing
jointly or
Qualifying
widow(er),
$12,700
Head of
household,
$9,350
24 Enter your standard deduction.24
25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25 26 Exemptions. Multiply $4,050 by the number on line 6d. 26 27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is your taxable income. a 27
28 Tax, including any alternative minimum tax (see instructions). 28 29 Excess advance premium tax credit repayment. Attach Form 8962. 29
30 Add lines 28 and 29. 30
31 Credit for child and dependent care expenses. Attach Form 2441. 31
32 Credit for the elderly or the disabled. Attach
Schedule R. 32
33 Education credits from Form 8863, line 19. 33
34 Retirement savings contributions credit. Attach Form 8880. 34 35 Child tax credit. Attach Schedule 8812, if required. 35 36 Add lines 31 through 35. These are your total credits. 36 37 Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-. 37 38 Health care: individual responsibility (see instructions). Full-year coverage 38 39 Add line 37 and line 38. This is your total tax. 39 40 Federal income tax withheld from Forms W-2 and 1099. 40 41 2017 estimated tax payments and amount applied
from 2016 return. 41
If you have
a qualifying
child, attach
Schedule
EIC.
42a Earned income credit (EIC). 42a
b Nontaxable combat pay election. 42b
43 Additional child tax credit. Attach Schedule 8812. 43 44 American opportunity credit from Form 8863, line 8. 44 45 Net premium tax credit. Attach Form 8962. 45
46 Add lines 40, 41, 42a, 43, 44, and 45. These are your total payments. a 46 Refund
Direct
deposit?
See
instructions
and fill in
48b, 48c,
and 48d or
Form 8888.
47 If line 46 is more than line 39, subtract line 39 from line 46. This is the amount you overpaid. 47
48a Amount of line 47 you want refunded to you. If Form 8888 is attached, check here a 48a a b Routing
number a c Type: Checking Savings
a d Account
number
49 Amount of line 47 you want applied to your
2018 estimated tax. 49
Amount
you owe
50 Amount you owe. Subtract line 46 from line 39. For details on how to pay, see instructions. a 50
51 Estimated tax penalty (see instructions). 51
Third party
designee
Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No Designee’s
name a
Phone
no. a
Personal identification
number (PIN) a
Sign
here
Joint return?
See instructions.
Keep a copy
for your records.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge. F
Your signature Date Your occupation Daytime phone number Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection PIN, enter it
here (see inst.)
Paid
preparer
use only
Print/Type preparer’s name Preparer’s signature Date Check a if self-employed
PTIN
Firm’s name a
Firm’s address a
Firm’s EIN a
Phone no.
Go to www.irs.gov/Form1040A for instructions and the latest information. Form 1040A (2017) 9,350.
14,018.
8,100.
5,918.
593.
593.
0.
1,043.
cook 541-***-****
Self-Prepared
1 3 3 1 6 8 6 7 0 1 1 0 7
23,368.
2,595.
5,142.
4,099.
4,099.
633.
593.
593.
914.
1,043.
0.
1,000.
3 2 5 0 7 0 7 6 0
REV 02/22/18 Intuit.cg.cfp.sp
SCHEDULE EIC
(Form 1040A or 1040)
Department of the Treasury
Internal Revenue Service (99)
Earned Income Credit
Qualifying Child Information
a Complete and attach to Form 1040A or 1040 only if you have a qualifying child. a Go to www.irs.gov/ScheduleEIC for the latest information. 1040A
. . . . . . . . . .
1040
EIC
`
OMB No. 1545-0074
2017
Attachment
Sequence No. 43
Name(s) shown on return Your social security number Before you begin: • See the instructions for Form 1040A, lines 42a and 42b, or Form 1040, lines 66a and 66b, to make sure that (a) you can take the EIC, and (b) you have a qualifying child.
• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child’s social security card is not correct, call the Social Security Administration at 1-800-***-****. F!
CAUTION
• You can't claim the EIC for a child who didn't live with you for more than half of the year.
• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.
• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child. Qualifying Child Information Child 1 Child 2 Child 3 1 Child’s name
If you have more than three qualifying
children, you have to list only three to get
the maximum credit.
First name Last name First name Last name First name Last name 2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040A, lines 42a
and 42b, or Form 1040, lines 66a and 66b,
unless the child was born and died in
2017. If your child was born and died in
2017 and did not have an SSN, enter
“Died” on this line and attach a copy of
the child’s birth certificate, death
certificate, or hospital medical records
showing a live birth.
3 Child’s year of birth
Year
If born after 1998 and the child is
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b;
go to line 5.
Year
If born after 1998 and the child is
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b;
go to line 5.
Year
If born after 1998 and the child is
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b;
go to line 5.
4 a Was the child under age 24 at the end of
2017, a student, and younger than you (or
your spouse, if filing jointly)?
Yes.
Go to
line 5.
No.
Go to line 4b.
Yes.
Go to
line 5.
No.
Go to line 4b.
Yes.
Go to
line 5.
No.
Go to line 4b.
b Was the child permanently and totally
disabled during any part of 2017? Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
5 Child’s relationship to you
(for example, son, daughter, grandchild,
niece, nephew, eligible foster child, etc.)
6 Number of months child lived
with you in the United States
during 2017
• If the child lived with you for more than
half of 2017 but less than 7 months,
enter “7.”
• If the child was born or died in 2017 and
your home was the child’s home for more
than half the time he or she was alive
during 2017, enter “12.”
months
Do not enter more than 12
months.
months
Do not enter more than 12
months.
months
Do not enter more than 12
months.
For Paperwork Reduction Act Notice, see your tax
return instructions.
Schedule EIC (Form 1040A or 1040) 2017
julianne L Wagner ***-**-****
Leo L Valencia
***-**-****
2 0 0 7
Grandchild
12
BAA REV 02/13/18 Intuit.cg.cfp.sp
SCHEDULE 8812
(Form 1040A or 1040)
Department of the Treasury
Internal Revenue Service (99)
Child Tax Credit
a Attach to Form 1040, Form 1040A, or Form 1040NR. a Go to www.irs.gov/Schedule8812 for instructions and the latest information.
OMB No. 1545-0074
2017
Attachment
Sequence No. 47
1040A
1040
8812
`
1040NR
Name(s) shown on return Your social security number Part I Filers Who Have Certain Child Dependent(s) with an Individual Taxpayer Identification Number (ITIN) F!
CAUTION
Complete this part only for each dependent who has an ITIN and for whom you are claiming the child tax credit. If your dependent is not a qualifying child for the credit, you cannot include that dependent in the calculation of this credit. Answer the following questions for each dependent listed on Form 1040, line 6c; Form 1040A, line 6c; or Form 1040NR, line 7c, who has an Individual Taxpayer Identification Number (ITIN) and that you indicated is a qualifying child for the child tax credit by checking column (4) for that dependent.
A For the first dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial presence test? See separate instructions.
Yes No
B For the second dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial presence test? See separate instructions.
Yes No
C For the third dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial presence test? See separate instructions.
Yes No
D For the fourth dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial presence test? See separate instructions.
Yes No
Note: If you have more than four dependents identified with an ITIN and listed as a qualifying child for the child tax credit, see separate instructions and check here a Part II Additional Child Tax Credit Filers
1 If you file Form 2555 or 2555-EZ, stop here; you cannot claim the additional child tax credit. If you are required to use the worksheet in Pub. 972, enter the amount from line 8 of the Child Tax Credit Worksheet in the publication. Otherwise:
1040 filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the instructions for Form 1040, line 52).
1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the instructions for Form 1040A, line 35).
1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the instructions for Form 1040NR, line 49). } 1
2 Enter the amount from Form 1040, line 52; Form 1040A, line 35; or Form 1040NR, line 49 2 3 Subtract line 2 from line 1. If zero, stop here; you cannot claim this credit 3 4a Earned income (see separate instructions) 4a b Nontaxable combat pay (see separate
instructions) 4b
5 Is the amount on line 4a more than $3,000?
No. Leave line 5 blank and enter -0- on line 6.
Yes. Subtract $3,000 from the amount on line 4a. Enter the result . . . 5 6 Multiply the amount on line 5 by 15% (0.15) and enter the result 6 Next. Do you have three or more qualifying children? No. If line 6 is zero, stop here; you cannot claim this credit. Otherwise, skip Part III and enter the smaller of line 3 or line 6 on line 13.
Yes. If line 6 is equal to or more than line 3, skip Part III and enter the amount from line 3 on line 13. Otherwise, go to line 7.
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 8812 (Form 1040A or 1040) 2017 julianne L Wagner ***-**-****
1,000.
0.
1,000.
23,368.
20,368.
3,055.
BAA REV 11/13/17 Intuit.cg.cfp.sp
Schedule 8812 (Form 1040A or 1040) 2017 Page 2
Part III Certain Filers Who Have Three or More Qualifying Children 7 Withheld social security, Medicare, and Additional Medicare taxes from Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse’s amounts with yours. If your employer withheld or you paid Additional Medicare Tax or tier 1 RRTA taxes, see separate instructions 7 8 1040 filers: Enter the total of the amounts from Form 1040, lines 27 and 58, plus any taxes that you identified using code
“UT” and entered on line 62.
1040A filers: Enter -0-.
1040NR filers: Enter the total of the amounts from Form 1040NR, lines 27 and 56, plus any taxes that you identified using code “UT” and entered on line 60.
} 8
9 Add lines 7 and 8 9
10 1040 filers: Enter the total of the amounts from Form 1040, lines 66a and 71.
1040A filers: Enter the total of the amount from Form 1040A, line 42a, plus any excess social security and tier 1 RRTA taxes withheld that you entered to the left of line 46
(see separate instructions).
1040NR filers: Enter the amount from Form 1040NR, line 67. } 10 11 Subtract line 10 from line 9. If zero or less, enter -0- 11 12 Enter the larger of line 6 or line 11 12 Next, enter the smaller of line 3 or line 12 on line 13. Part IV Additional Child Tax Credit
13 This is your additional child tax credit 13 1040A
1040
1040NR `
Enter this amount on
Form 1040, line 67,
Form 1040A, line 43, or
Form 1040NR, line 64.
Schedule 8812 (Form 1040A or 1040) 2017
1,000.
REV 11/13/17 Intuit.cg.cfp.sp
Form 8863
Department of the Treasury
Internal Revenue Service (99)
Education Credits
(American Opportunity and Lifetime Learning Credits) a Attach to Form 1040 or Form 1040A.
a Go to www.irs.gov/Form8863 for instructions and the latest information. OMB No. 1545-0074
2017
Attachment
Sequence No. 50
Name(s) shown on return Your social security number F!
CAUTION
Complete a separate Part III on page 2 for each student for whom you're claiming either credit before you complete Parts I and II.
Part I Refundable American Opportunity Credit
1 After completing Part III for each student, enter the total of all amounts from all Parts III, line 30 . 1 2 Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er) 2 3 Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you’re filing Form 2555, 2555-EZ, or 4563, or you’re excluding income from Puerto Rico, see Pub. 970 for the amount to enter 3 4 Subtract line 3 from line 2. If zero or less, stop; you can’t take any education credit 4
5 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) 5
6 If line 4 is:
• Equal to or more than line 5, enter 1.000 on line 6
• Less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to at least three places) } 6 7 Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet the conditions described in the instructions, you can’t take the refundable American opportunity credit; skip line 8, enter the amount from line 7 on line 9, and check this box a 7 8 Refundable American opportunity credit. Multiply line 7 by 40% (0.40). Enter the amount here and on Form 1040, line 68, or Form 1040A, line 44. Then go to line 9 below 8 Part II Nonrefundable Education Credits
9 Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions) 9 10 After completing Part III for each student, enter the total of all amounts from all Parts III, line 31. If zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19 10 11 Enter the smaller of line 10 or $10,000 11 12 Multiply line 11 by 20% (0.20) 12 13 Enter: $132,000 if married filing jointly; $66,000 if single, head of household, or qualifying widow(er) 13 14 Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you're filing Form 2555, 2555-EZ, or 4563, or you’re excluding income from Puerto Rico, see Pub. 970 for the amount to enter 14 15 Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0- on line 18, and go to line 19 15
16 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) 16
17 If line 15 is:
• Equal to or more than line 16, enter 1.000 on line 17 and go to line 18
• Less than line 16, divide line 15 by line 16. Enter the result as a decimal (rounded to at least three places) 17
18 Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) a 18 19 Nonrefundable education credits. Enter the amount from line 7 of the Credit Limit Worksheet (see instructions) here and on Form 1040, line 50, or Form 1040A, line 33 19 For Paperwork Reduction Act Notice, see your tax return instructions. Form 8863 (2017) julianne L Wagner ***-**-****
593.
2,284.
90,000.
1.000
23,368.
914.
10,000.
66,632.
2,284.
1,370.
BAA REV 02/13/18 Intuit.cg.cfp.sp
Form 8863 (2017) Page 2
Name(s) shown on return Your social security number F!
CAUTION
Complete Part III for each student for whom you’re claiming either the American opportunity credit or lifetime learning credit. Use additional copies of page 2 as needed for each student.
Part III Student and Educational Institution Information. See instructions. 20 Student name (as shown on page 1 of your tax return) 21 Student social security number (as shown on page 1 of your tax return)
22 Educational institution information (see instructions) a. Name of first educational institution
(1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions.
(2) Did the student receive Form 1098-T
from this institution for 2017?
Yes No
(3) Did the student receive Form 1098-T
from this institution for 2016 with box
2 filled in and box 7 checked?
Yes No
(4) Enter the institution’s employer identification number (EIN) if you’re claiming the American opportunity credit or if you checked “Yes” in (2) or (3). You can get the EIN from Form 1098-T or from the institution.
b. Name of second educational institution (if any)
(1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions.
(2) Did the student receive Form 1098-T
from this institution for 2017?
Yes No
(3) Did the student receive Form 1098-T
from this institution for 2016 with box
2 filled in and box 7 checked?
Yes No
(4) Enter the institution’s employer identification number
(EIN) if you’re claiming the American opportunity credit or if you checked “Yes” in (2) or (3). You can get the EIN from Form 1098-T or from the institution.
23 Has the Hope Scholarship Credit or American opportunity credit been claimed for this student for any 4 tax years before 2017?
Yes — Stop!
Go to line 31 for this student. No — Go to line 24. 24 Was the student enrolled at least half-time for at least one academic period that began or is treated as having begun in 2017 at an eligible educational institution in a program leading towards a postsecondary degree, certificate, or other recognized postsecondary educational credential? See instructions.
Yes — Go to line 25. No — Stop! Go to line 31
for this student.
25 Did the student complete the first 4 years of postsecondary education before 2017? See instructions.
Yes — Stop!
Go to line 31 for this
student.
No — Go to line 26.
26 Was the student convicted, before the end of 2017, of a felony for possession or distribution of a controlled substance?
Yes — Stop!
Go to line 31 for this
student.
No — Complete lines 27
through 30 for this student.
F!
CAUTION
You can't take the American opportunity credit and the lifetime learning credit for the same student in the same year. If you complete lines 27 through 30 for this student, don't complete line 31. American Opportunity Credit
27 Adjusted qualified education expenses (see instructions). Don’t enter more than $4,000 27 28 Subtract $2,000 from line 27. If zero or less, enter -0- 28 29 Multiply line 28 by 25% (0.25) 29 30 If line 28 is zero, enter the amount from line 27. Otherwise, add $2,000 to the amount on line 29 and enter the result. Skip line 31. Include the total of all amounts from all Parts III, line 30, on Part I, line 1 . 30 Lifetime Learning Credit
31 Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts III, line 31, on Part II, line 10 31 Form 8863 (2017)
julianne L Wagner ***-**-****
julianne L
Wagner ***-**-****
Laurus College LLC
421 East Betteravia #100
Santa Maria CA 93454
30-0353535
3,134.
1,134.
284.
2,284.
Office use only
Filing status (check only one box)
1. Single.
2. Married filing jointly.
3. Married filing separately (enter spouse’s information above). 4. Head of household (with qualifying dependent).
5. Qualifying widow(er) with dependent child.
2017 Form OR-40
Page 1 of 4, 150-101-040 (Rev. 12-17) Oregon Department of Revenue Oregon Individual Income Tax Return for Full-year Residents Last name
Spouse’s last name
Date of birth (mm/dd/yyyy) Spouse’s date of birth
First name and initial
Spouse’s first name and initial
Social Security no. (SSN)
Spouse’s SSN
Deceased
Deceased
Applied
for ITIN
Applied
for ITIN
Phone
Current mailing address
City State ZIP code Country
Exemptions Total
6a. Credits for yourself: Regular Severely disabled 6a. Check box if someone else can claim you as a dependent. 6b. Credits for spouse: Regular Severely disabled 6b. Check box if someone else can claim your spouse as a dependent. Check if child with
qualifying disability
Dependent’s date
First name Last name Code* Dependent’s SSN of birth (mm/dd/yyyy) Dependents. List your dependents in order from youngest to oldest. If more than four, check this box and include Schedule OR-ADD-DEP with your return.
6c. Total number of dependents 6c. 6d. Total number of dependent children with a qualifying disability (see instructions) 6d. 6e. Total exemptions. Add 6a through 6d Total 6e. Amended return. If amending for an NOL,
tax year the NOL was generated:
Calculated using “as if” federal return.
Short year tax election.
Extension filed.
Form OR-24.
*Dependent relationship code—Please see instructions to determine the appropriate code. Submit original form—do not submit photocopy
Fiscal year ending: Space for 2-D barcode—do not write in box below First time using
this SSN (see
instructions)
First time using
this SSN (see
instructions)
X
JULIANNE L WAGNER ***-**-****
BEND OR 97701 USA 541-***-****
10/30/1961
X 1
2
***-**-****
1
LEO VALENCIA GC ***-**-**** 02/13/2007
825 WATT WAY APT J101
1555 REV 11/13/17 INTUIT.CG.CFP.SP
Oregon Department of Revenue
2017 Form OR-40
Page 2 of 4, 150-101-040 (Rev. 12-17)
Taxable income
7. Federal adjusted gross income. Federal Form 1040, line 37; 1040A, line 21; 1040EZ, line 4; 1040NR, line 36; 1040NR-EZ, line 10; or 1040X, line 1C. See instructions 7. 8. Total additions from Schedule OR-ASC, section 1 8. 9. Income after additions. Add lines 7 and 8 9. Subtractions
10. 2017 federal tax liability. See instructions for the correct amount: $0-$6,550 10. 11. Social Security included on federal Form 1040, line 20b; or Form 1040A, line 14b 11. 12. Oregon income tax refund included in federal income 12. 13. Total subtractions from Schedule OR-ASC, section 2 13. 14. Total subtractions. Add lines 10 through 13 14. 15. Income after subtractions. Line 9 minus line 14 15. Deductions
16. Itemized deductions from federal Schedule A, line 29. If you are not itemizing your deductions, skip lines 16 through 18 ... 16. 17. State income tax claimed as an itemized deduction 17. 18. Net Oregon itemized deductions. Line 16 minus line 17 18. 19. Standard deduction. See instructions 19. You were: 19a. 65 or older 19b. Blind Your spouse was: 19c. 65 or older 19d. Blind 20. Enter the larger of line 18 or line 19. If you skipped line 18, enter the amount from line 19 20. 21. Oregon taxable income. Line 15 minus line 20. If line 20 is more than line 15, enter -0- 21. Oregon tax
22. Tax. See instructions. Enter tax on line 22. Check box if tax is calculated using an alternative method 22. 22a. Form OR-FIA-40 22b. Worksheet OR-FCG 22c. Schedule OR-PTE-FY 23. Interest on certain installment sales 23. 24. Total tax before credits. Add lines 22 and 23 24. Standard and carryforward credits
25. Exemption credit. If the amount on line 7 is less than $100,000, multiply your total exemptions on line 6e by $197. Otherwise, see instructions 25. 26. Political contribution credit. See limits 26. 27. Total standard credits from Schedule OR-ASC, section 3 27. 28. Total standard credits. Add lines 25 through 27 28. 29. Tax minus standard credits. Line 24 minus line 28. If line 28 is more than line 24, enter -0- 29. 30. Total carryforward credits claimed this year from Schedule OR-ASC, section 4. Line 30 can’t be more than line 29 (see Schedule OR-ASC instructions) 30. 31. Tax after standard and carryforward credits. Line 29 minus line 30 31. Name SSN
***-**-****
0.00
394.00
JULIANNE L WAGNER ***-**-****
3,500.00
3,134.00
20,234.00
3,500.00
16,734.00
1,037.00
1,037.00
394.00
643.00
643.00
23,368.00
23,368.00
3,134.00
1555 REV 11/13/17 INTUIT.CG.CFP.SP
Oregon Department of Revenue
2017 Form OR-40
Page 3 of 4, 150-101-040 (Rev. 12-17)
Payments and refundable credits
32. Oregon income tax withheld. Include a copy of Form(s) W-2 and 1099 32. 33. Amount applied from your prior year’s tax refund 33. 34. Estimated tax payments for 2017. Include all payments made prior to the filing date of this return. Do not include the amount already reported on line 33 34. 35. Earned income credit. See instructions 35. 36. Oregon surplus credit (kicker). Enter your kicker amount. See instructions. If you elect to donate your kicker to the State School Fund, enter -0- and see line 53 36. 37. Total refundable credits from Schedule OR-ASC, section 5 37. 38. Total payments and refundable credits. Add lines 32 through 37 38. Tax to pay or refund
39. Overpayment of tax. If line 31 is less than line 38, you overpaid. Line 38 minus line 31 39. 40. Net tax. If line 31 is more than line 38, you have tax to pay. Line 31 minus line 38 40. 41. Penalty and interest for filing or paying late. See instructions 41. 42. Interest on underpayment of estimated tax. Include Form OR-10 42. Exception number from Form OR-10, line 1: 42a. Check box if you annualized: 42b. 43. Total penalty and interest due. Add lines 41 and 42 43. 44. Net tax including penalty and interest. Line 40 plus line 43 This is the amount you owe 44. 45. Overpayment less penalty and interest. Line 39 minus line 43 This is your refund 45. 46.
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