Fillable Printable Form 40N, Nonresident Individual Income Tax Return
Fillable Printable Form 40N, Nonresident Individual Income Tax Return
Form 40N, Nonresident Individual Income Tax Return
8 Wages, salaries, and other pay for work. Include all Forms W-2 ........................ 8F
•
8S
9 Taxable interest income from federal Form 1040, line 8a ...................................... 9F
•
9S
10 Dividend income from federal Form 1040, line 9a ................................................. 10F
•
10S
11 State and local income tax refunds from federal Form 1040, line 10 .................... 11F
•
11S
12 Alimony received from federal Form 1040, line 11 ................................................ 12F
•
12S
13 Business income or loss from federal Form 1040, line 12 ..................................... 13F
•
13S
14 Capital gain or loss from federal Form 1040, line 13 ............................................. 14F
•
14S
15 Other gains or losses from federal Form 1040, line 14 .......................................... 15F
•
15S
16 IRA distributions from federal Form 1040, line 15b ............................................... 16F
•
16S
17 Pensions and annuities from federal Form 1040, line 16b ..................................... 17F
•
17S
18 Rents, royalties, partnerships, etc., from federal Form 1040, line 17 .................... 18F
•
18S
19 Farm income or loss from federal Form 1040, line 18 ........................................... 19F
•
19S
20
Unemployment and other income from federal Form 1040, lines 19 through 21
... 20F
•
20S
21 Total income. Add lines 8 through 20 .................................................................
•
21F
•
21S
22 IRA or SEP and SIMPLE contributions, federal Form 1040, lines 28 and 32 ......... 22F
•
22S
23 Education deductions from federal Form 1040, lines 23, 33, and 34 .................... 23F
•
23S
24 Moving expenses from federal Form 1040, line 26 ................................................ 24F
•
24S
25 Deduction for self-employment tax from federal Form 1040, line 27 .................... 25F
•
25S
26 Self-employed health insurance deduction from federal Form 1040, line 29 ........ 26F
•
26S
27 Alimony paid from federal Form 1040, line 31a ..................................................... 27F
•
27S
28 Other adjustments to income. Identify:
•
28x
•
28y
$
Schedule
28z
•
28F
•
28S
29 Total adjustments to income. Add lines 22 through 28 ......................................
•
29F
•
29S
30 Income after adjustments. Line 21 minus line 29 ...............................................
•
30F
•
30S
31 Interest on state and local government bonds outside of Oregon .....................
•
31F
•
31S
32 Federal election on interest and dividends of a minor child ...............................
•
32F
•
32S
33
Other additions. Identify:
•
33x
•
33y
$
Schedule included 33z
......
•
33F
•
33S
34 Total additions. Add lines 31 through 33 ............................................................
•
34F
•
34S
35 Income after additions. Add lines 30 and 34 ......................................................
•
35F
•
35S
36
Social Security and tier 1 Railroad Retirement Board benefits included on line 20F
...
•
36F
37 Other subtractions. Identify:
•
37x
•
37y
$
Schedule included
37z
•
37F
•
37S
38 Income after subtractions. Line 35 minus lines 36 and 37 .................................
•
38F
•
38S
39
Oregon percentage. Line 38S ÷ line 38F (not more than 100.0%)
•
39
Federal column (F)
ADDITIONS
INCOME
Include proof
of withholding
(W-2s, 1099s),
payment,
and
payment
voucher
ADJUSTMENTS
TO INCOME
SUBTRACTIONS
__ __ __.__%
Oregon column (S)
➤
Carry this
➤
amount to line 40
NOW GO TO THE BACK OF THE FORM
➛
Fiscal year ending
Oregon resident:
From To
mm dd yyyy mm dd yyyy
Last name First name and initial
Social Security No. (SSN)
– –
– –
Telephone number
Current mailing address
City State ZIP code
If you filed a return last year, and your
name or address is different, check here
( )
Date of birth (mm/dd/yyyy)
For office use only
Country
Date of birth
(mm/dd/yyyy)
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K F P J
Deceased
Deceased
.00
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FOR NONRESIDENTS
OREGON
Individual Income Tax Return
Amended Return
150-101-048 (Rev. 12-13)
Spouse’s/RDP’s rst name and initial if joint returnSpouse’s/RDP’s last name if joint return Spouse’s/RDP’s SSN if joint return
•
1 Single
2a Married ling jointly
2b Registered domestic partners (RDP) ling jointly
3a Married ling separately:
Spouse’s name _____________________________ Spouse’s SSN ___________________
3b Registered domestic partner ling separately:
Partner’s name _____________________________ Partner’s SSN ___________________
4 Head of household: Person who qualies you ________________________________
5 Qualifying widow(er) with dependent child
Filing
Status
Check
only
one
box
Exemptions
6a
Yourself ...........Regular ......Severely disabled ....6a
6b Spouse/RDP ...Regular ...... Severely disabled ......b
6c All dependents First names __________________________________
•
c
6d
Disabled First names __________________________________
•
d
children only
(see instructions)
Total
Total
6e
•
••
7d You filed
Oregon
Form 24
7c
•
You have
federal
Form 8886
7b
•
You
filed an
extension
Check all that apply
➛
7a
• •
You were: 65 or older Blind
Spouse/RDP was: 65 or older Blind
2013
Form
40N
HW
Clear Form
DIRECT
DEPOSIT
Important: Include a copy of your federal Form 1040, 1040A, 1040EZ, or 1040NR.
•
Preparer license no.
Under penalty for false swearing, I declare that the information in this return is true, correct, and complete.
Signature of preparer other than taxpayerYour signature Date
Address Telephone no.
X
X
Spouse’s/RDP’s signature (if filing jointly, BOTH must sign) Date
X
These will
reduce
your refund
EITHER,
NOT BOTH
ADD TOGETHER
ADD TOGETHER
PAYMENTS AND
REFUNDABLE
CREDITS
ADD TOGETHER
DEDUCTIONS
AND
MODIFICATIONS
OREGON
TAX
NONREFUNDABLE
CREDITS
Include Schedule
WFC-N/P if you
claim this credit
40 Amount from front of form, line 38S (Oregon amount) ...................................................................................... 40
41 Itemized deductions from federal Schedule A, line 29 .........................................
•
41
42 State income tax claimed as itemized deduction .................................................
•
42
43 Net Oregon itemized deductions. Line 41 minus line 42 ......................................
•
43
44 Standard deduction from page 26 ........................................................................
•
44
45
2013 federal tax liability ($0–$6,250; see instructions for the correct amount)
....
•
45
46 Other deductions and modifications. Identify:
•
46x
•
46y
$
Schedule
46z
•
46
47 Deductions and modifications X Oregon percentage. See page 26 .....................
•
47
4 8 Deductions and modifications not multiplied by the Oregon percentage. See page 29
•
48
49 Total deductions and other modifications. Add lines 47 and 48 ....................................................................
•
49
50 Oregon taxable income. Line 40 minus line 49 ...............................................................................................
•
50
51 Tax. See page 29 for instructions. Enter tax here ................................................
•
51
Check if tax is from: 51a
Tax charts or
•
51b Form FIA-40N or
•
51c
Worksheet FCG
52 Interest on certain installment sales ......................................................................
•
52
53 Total tax before credits. Add lines 51 and 52 ................................................................... OREGON TAX
➛
•
53
54 Exemption credit. See instructions, page 30 ......................................................
•
54
55 Credit for income taxes paid to another state. State:
•
55y
Schedule 55z
•
55
56 Other credits. Identify:
•
56x
•
56y
$
Schedule included
56z
•
56
57 Total non-refundable credits. Add lines 54 through 56 ..................................................................................
•
57
58 Net income tax. Line 53 minus line 57. If line 57 is more than line 53, enter -0-
............................................
•
58
59 Oregon income tax withheld from income. Include Forms W-2 and 1099 .........
•
59
60 Estimated tax payments for 2013 and payments made with your extension .......
•
60
•
60a Wolf depredation
•
60b Claim of right
61 Tax payments from pass-through entity and real estate transactions ..................
•
61
62 Earned income credit. See instructions, page 32 .................................................
•
62
63 Working family child care credit from WFC-N/P, line 21 ..................................
•
63
64 Mobile home park closure credit. Include Schedule MPC ....................................
•
64
65 Total payments and refundable credits. Add lines 59 through 64 ..................................................................
•
65
66 Overpayment. Is line 58 less than line 65? If so, line 65 minus line 58
...................
OVERPAYMENT
➛
•
66
67 Tax to pay. Is line 58 more than line 65? If so, line 58 minus line 65
...............................
TAX TO PAY
➛
•
67
68 Penalty and interest for filing or paying late. See instructions, page 33 .................. 68
69
Interest on underpayment of estimated tax. Include Form 10 and check box
...
•
69
Exception # from Form 10, line 1
•
69a Check box if you annualized
•
69b
70 Total penalty and interest due. Add lines 68 and 69 ......................................................................................... 70
71 Amount you owe. Line 67 plus line 70 .................................................................AMOUNT YOU OWE
➛
•
71
72 Refund. Is line 66 more than line 70? If so, line 66 minus line 70
............................................
REFUND
➛
•
72
73 Estimated tax. Fill in the part of line 72 you want applied to 2014 estimated tax
•
73
American Diabetes Assoc.
•
74 Oregon Coast Aquarium
•
75
SMART
•
76 SOLV
•
77
The Nature Conservancy
•
78 St. Vincent DePaul Soc. of OR
•
79
Oregon Humane Society
•
80 The Salvation Army
•
81
Doernbecher Children’s Hosp.
•
82 Oregon Veteran’s Home
•
83
Charity code
•
84a
•
84b
Charity code
•
85a
•
85b
86 Total Oregon 529 College Savings Plan deposits. See instructions, page 34 ......
•
86
87 Total. Add lines 73 through 86. Total can’t be more than your refund on line 72 ..........................................
•
87
88 NET REFUND. Line 72 minus line 87. This is your net refund .........................................NET REFUND
➛
•
88
89 For direct deposit of your refund, see instructions, page 34.
•
Type of account: Checking or Savings
Will this refund go to an account outside the United States? • Yes
•
Routing No.
•
Account No.
CHARITABLE
CHECKOFF
DONATIONS,
PAGE 34
I want to donate
part of my tax
refund to the
following fund(s)
Page 2 — 2013 Form 40N
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150-101-048 (Rev. 12-13)
