Form Indiana Full-Year Resident Due April 15, 2010

IT-40
State Form 154
2009 Individual Income Tax Return
(R8 / 9-09) If you are not filing for the calendar year January 1 through December 31, 2009, enter period from:

/ /2009 to: / /2009

Your Social Spouse’s Social

Security Number Security Number

Place “X” in box if applying for ITIN Place “X” in box if applying for ITIN

Your first name Initial Last name

If filing a joint return, spouse’s first name Initial Last name

Present address (number and street or rural route)

Place “X” in box if you are
married filing separately.
City State Zip code + 4

Foreign Country (if applicable) School Corporation Number (see pages 43 and 44)

Enter below the 2-digit county code numbers (found on the back of Schedule CT-40) for the county where you lived and
worked on January 1, 2009.
County where County where County where County where
you lived you worked spouse lived spouse worked

Round all entries

1. Enter your federal adjusted gross income (AGI) from your federal tax return (from Form 1040,
line 37; Form 1040A, line 21; or from Form 1040EZ, line 4). ....................................... Federal AGI 1 ● 00

2. Enter amount from Schedule 1, line 15, and attach Schedule 1 ....................... Indiana Add-Backs 2 ● 00

3. Add line 1 and line 2 ............................................................................................................................. 3 ● 00

4. Enter amount from Schedule 2, line 12, and attach Schedule 2 ..................... Indiana Deductions 4 ● 00

5. Subtract line 4 from line 3..................................................................................................................... 5 ● 00

6. You must complete Schedule 3. Enter amount from Schedule 3, line 5,

and attach Schedule 3 .................................................................................... Indiana Exemptions 6 ● 00

7. Subtract line 6 from line 5 (if answer is less than zero, leave blank)............. State Taxable Income 7 ● 00

8. State adjusted gross income tax: multiply line 7 by 3.4% (.034) ......... 8 ● 00

9. County tax. Enter county tax due from Schedule CT-40 ..................... 9 ● 00

10. Other taxes. Enter amount from Schedule 4, line 5 (attach schedule) 10 ● 00

11. Add lines 8, 9 and 10. Enter total here and on line 15 on the back ............................Indiana Taxes 11 ● 00

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12. Enter credits from Schedule 5, line 9 (attach schedule) ...................... 12 ● 00

13. Enter offset credits from Schedule 6, line 7 (attach schedule) ............ 13 ● 00

14. Add lines 12 and 13 ................................................................................................ Indiana Credits 14 ● 00

15. Enter amount from line 11 ....................................................................................... Indiana Taxes 15 ● 00

16. If line 14 is equal to or more than line 15, subtract line 15 from line 14 (if smaller, skip to line 23) ..... 16 ● 00

17. Amount from line 16 to be donated to the Indiana Nongame Wildlife Fund ................................ 17 ● 00

18. Subtract line 17 from line 16........................................................................................Overpayment 18 ● 00

19. Amount from line 18 to be applied to your 2010 estimated tax account (see instructions on page 9).

Enter your county code county tax to be applied ....... $ a ● 00

Spouse’s county code county tax to be applied ....... $ b ● 00

Indiana adjusted gross income tax to be applied ....................... $ c ● 00

Total to be applied to your estimated tax account (a + b + c; cannot be more than line 18) ................ 19d ● 00

20. Penalty for underpayment of estimated tax from Schedule IT-2210 or IT-2210A................................. 20 ● 00

21. Refund: Line 18 minus lines 19d and 20. Note: If less than zero, see line 23 instructions Your Refund 21 ● 00

22. a. Routing Number

Direct Deposit
b. Account Number (see page 11)

c. Type: Checking Savings Hoosier Works MC

23. If line 15 is more than line 14, subtract line 14 from line 15. Add to this any amount on line 20
(see instructions on page 11) ............................................................................................................... 23 ● 00

24. Penalty if filed after due date (see instructions) ................................................................................... 24 ● 00

25. Interest if filed after due date (see instructions) ................................................................................... 25 ● 00

26. Amount Due: Add lines 23, 24 and 25 ................................................................Amount You Owe 26 ● 00
► No payment is due if you owe less than $1. Do not send cash. Please make your check or money
order payable to: Indiana Department of Revenue. Credit card payers must see instructions.

Sign and date this return after reading the Filing Authorization statement on Schedule 7. Attach Schedule 7.

_____________________________________________________ _________________________________________________
Your Signature Date Spouse’s Signature Date

• If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN 46207-7224.
• Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.

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