Professional Documents
Culture Documents
40301
TC-40
incometax.utah.gov
9998
2013
543889756
GREGORY
256438819
Last name
LULU
CLIFDEN
B.
Telephone number
801-555-1234
State
DRAPER
CLIFDEN
R.
IMPORTANT!
Last name
CODE
UT
84070
3. Election campaign fund - enter code (see instr.)
1 - Single
2 - Married filing jointly
3 - Married filing separately
4 - Head of household
5 - Qualifying widow(er)
1
3
0
5
ZIP + 4
CODE
b - Spouse
From federal return
c - Dependents
d - Dependents with a disability (see instr.)
e - Total exemptions (add a through d)
C - Constitution
D - Democratic
L - Libertarian
R - Republican
Yourself
Spouse
N - No contribution
Does not increase your tax or
reduce your refund.
82644 .00
5. Additions to income from TC-40A, Part 1 (attach TC-40A, page 1) (see instructions)
2490 .00
85134 .00
7. State tax refund included on federal form 1040, line 10, if any (see instructions)
0 .00
8. Subtractions from income from TC-40A, Part 2 (attach TC-40A, page 1) (see instructions)
0 .00
9. Utah taxable income (loss) - subtract sum of lines 7 and 8 from line 6
85134 .00
10. Utah tax - multiply line 9 by 5% (.05) (not less than zero)
10
11
14625 .00
12
20965 .00
13
35590 .00
14. State income tax deducted on federal Schedule A, line 5, if any (see instr.)
14
7120 .00
15
28470 .00
16
1708 .00
17
26726 .00
18
58408 .00
19
759 .00
20. Taxpayer tax credit - subtract line 19 from line 16 (not less than zero)
21. If you are a qualified exempt taxpayer, enter X
(complete worksheet, see instr.)
4257 .00
Filing
electronically
is quick, easy
and free, and
will speed up
your refund
To learn more
go to
taxexpress.
utah.gov
20
949 .00
22
3308 .00
21
22. Utah income tax - subtract line 20 from line 10 (not less than zero) (see instructions)
40302
SSN: 543889756
23
3308 .00
24. Apportionable nonrefundable credits from TC-40A, Part 3 (attach TC-40A, page 1) (see instructions)
24
0 .00
25. Full-year resident, subtract line 24 from line 23 (not less than zero) (see instructions)
Non or part-year resident, enter tax from TC-40B, line 37 (see instructions)
25
3308 .00
26. Nonapportionable nonrefundable credits from TC-40A, Part 4 (attach TC-40A, page 1) (see instructions)
26
0 .00
27
3308 .00
28. Voluntary contributions from TC-40, page 3, Part 4 (attach TC-40, page 3)
28
0 .00
29
30
31
0 .00
32. Total tax, use tax and additions to tax - add lines 27 through 31
32
3308 .00
33. Utah income tax withheld shown on TC-40W, Part 1 (attach TC-40W, page 1) (see instructions)
33
670 .00
34. Credit for Utah income taxes prepaid from TC-546 and 2012 refund applied to 2013 (see instructions)
34
6000 .00
35. Pass-through entity withholding tax shown on TC-40W, Part 3 (attach TC-40W, page 2) (see instructions)
35
0 .00
36. Mineral production withholding tax shown on TC-40W, Part 2 (attach TC-40W, page 2) (see instructions)
36
0 .00
37
38. Refundable credits from TC-40A, Part 5 (attach TC-40A, page 2) (see instructions)
38
0 .00
39
6670 .00
40. Tax due - subtract line 39 from line 32 (not less than zero) (see instructions)
41. Penalty and interest (see instructions)
TAX DUE
41
44. Amount of refund from line 43 you want applied to your 2014 taxes (see instr.)
.00
.00
40
.00
.00
42. TOTAL DUE - PAY THIS AMOUNT - add line 40 and line 41 (see instructions)
43. REFUND - subtract line 32 from line 39 (not less than zero) (see instructions)
.00
REFUND
44
42
0 .00
43
3362 .00
0 .00
Amount to be
applied to 2014
45. DIRECT DEPOSIT YOUR REFUND - provide account information (see instructions for foreign accounts)
Bank routing number
Checking
Savings
Under penalties of perjury, I declare to the best of my knowledge and belief, this return and accompanying schedules reflect my true tax status.
Your signature
Spouse's signature (if filing jointly, both must sign even if only one had income) Date
Date
SIGN
HERE
Third Party Name of designee (if any) you authorize to discuss this return (see instructions) Designee telephone number
Designee
Preparer signature (see instructions)
Paid
Preparer
Section Firm name and address
Date
Attach TC-40 page 3 if you are filing for a deceased taxpayer, filing a fiscal year return, filed IRS form 8886, are making voluntary contributions, requesting
a direct deposit to be sent to your Utah Educational Savings Plan, requesting a direct deposit to be sent to a foreign account, or are no longer entitled to
a homeowners exemption.
40309
TC-40W
Rev. 12/13
Your social security number
543889756
CLIFDEN
Line explanations:
1 Employer/payer ID number (from W-2 box b or 1099)
2 Utah withholding ID number (from W-2 box 15 or 1099)
(14 characters, ending in WTH, no hyphens)
3 Employer/payer name and address (from W-2 box c or 1099)
4 Enter X if reporting Utah withholding from form 1099
5 Employees SSN (from W-2 box a or 1099)
6 Utah wages/income (from W-2 box 16 or 1099)
7 Utah withholding tax (from W-2 box 17 or 1099)
IMPORTANT
1
14 characters, no hyphens
2
3
Do not send your W-2s and 1099s with your return. Instead,
enter W-2 and 1099 information below, but only if there is Utah
withholding on the form.
Use additional TC-40W forms if you have more than four W-2s
and/or 1099s with Utah withholding tax.
Enter mineral production withholding from TC-675R in Part 2 of
TC-40; enter pass-through entity withholding in Part 3 of TC-40W.
2
3
US NAVY
43267
256438819
543889756
10200 .00
9400 .00
280 .00
290 .00
14 characters, no hyphens
14 characters, no hyphens
.00
.00
.00
.00
670 .00
40304
TC-40A
Rev. 12/13
CLIFDEN
543889756
Part 1 - Additions to Income (write the code and amount of each addition to income, see insructions)
Code
Code
54 Utah Educational Savings Plan (UESP) addback * 60 Untaxed income of a resident trust
55 Reimbursed adoption expenses *
Code
Amount
56
1000 .00
57
1490 .00
.00
.00
.00
Total additions to income (add all additions to income and enter total here and on TC-40, line 5)
2490 .00
Part 2 - Subtractions from Income (write the code and amount of each subtraction from income, see instructions)
Code
Code
Code
78
79
82
85
88
Code
Amount
.00
.00
.00
.00
.00
Total subtractions from income (add all subtractions and enter total here and on TC-40, line 8)
0 .00
Part 3 - Apportionable Nonrefundable Credits (write the code and amount of each nonrefundable credit, see instructions)
Code
Code
Code
Amount
.00
.00
.00
.00
.00
0 .00
Total apportionable nonrefundable credits (add all credits and enter total here and on TC-40, line 24)
Part 4 - Nonapportionable Nonrefundable Credits (write the code and amount of each nonrefundable credit, see instructions)
Code
Code
Code
Amount
.00
.00
.00
.00
.00
0 .00