Form IT-540 2011 Louisiana Resident Income Tax Return

Date of Birth (MM/DD/YYYY) Date of Birth (MM/DD/YYYY) Date of Birth (MM/DD/YYYY) Date of Birth (MM/DD/YYYY) Driver s License number State of issue Dependent name Driver s License number State of issue State of issue * If the qualifying person is not your dependent enter name here {Address} 1 2 3 1 OR Federal Form 1040A Line 21 OR Federal Form 1040 Line 37 Check box if amount is less than zero INTEREST AND DIVIDEND INCOME FROM OTHER STATES AND THEIR POLITICAL 12A 12B 12C 12B 2011 LOUISIANA NONREFUNDABLE CHILD CARE CREDIT Your Federal Adjusted Gross Income must be GREATER THAN $25 000 in order to claim a credit on this line See Nonrefundable Child Care Credit Worksheet 12C AMOUNT OF LOUISIANA NONREFUNDABLE CHILD CARE CREDIT CARRIED FORWARD FROM 2007 THROUGH 2010 See Nonrefundable Child Care Credit Worksheet 12D 2011 LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT Your Federal Adjusted Gross Income must be GREATER THAN $25 000 in order to claim a credit on this line See Nonrefundable School Readiness Credit Worksheet 5 4 3 2 12E 13 14 15 12E AMOUNT OF LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT CARRIED FORWARD FROM 2008 THROUGH 2010 See Nonrefundable School Readiness Credit Worksheet 13 EDUCATION CREDIT 14 OTHER NONREFUNDABLE TAX CREDITS From Schedule G Line 11 15 TOTAL NONREFUNDABLE TAX CREDITS Add Lines 12B through 14 19 19A 19B 19A Enter the qualified expense amount from the Refundable Child Care Credit Worksheet Line 3 19B Enter the amount from the Refundable Child Care Credit Worksheet Line 6 1A Yourself Off 1B Spouse Off 1C Dependents: List dependent names 1D Enter the total amount of fees paid for Louisiana hunting and fishing licenses purchased for the listed individuals 1D 2 2A 3 2 SUBDIVISIONS 20 2011 LOUISIANA REFUNDABLE SCHOOL READINESS CREDIT Your Federal Adjusted Gross Income must be EQUAL TO OR LESS THAN $25 000 to claim the credit on this line See Refundable School Readiness Credit Worksheet 5 4 3 2 2011 LOUISIANA RESIDENT 2011 Louisiana School Expense Deduction Worksheet 21 22 23 21 EARNED INCOME CREDIT See Louisiana Earned Income Credit (LA EIC) Worksheet Line 3 22 LOUISIANA CITIZENS INSURANCE CREDIT 23 OTHER REFUNDABLE TAX CREDITS From Schedule F Line 7 24 25 26 27 24 25 26 27 28 29 30 31 32 2A RECAPTURE OF START CONTRIBUTIONS 3 9 to indicate that your income tax deduction has been increased 3 TOTAL Add Lines 1 2 and 2A 33 34 35 36 37 36 37 38 39 40 41 42 43 44 45 39 40 41 42 43 44 45 46 47 48 SUBTOTAL Subtract Line 45 from Line 32 This amount of overpayment is available for credit or refund 47 48 49 50 51 52 53 54 55 56 57 58 4B 4C 4D 4E 4F 4G 4H 4I 4J 4K 5A 5B 5C 6 EXEMPTIONS: Enter a 1 in box if single 62497 66 12312011 65 or older 6B Spouse 6C DEPENDENTS Enter dependent information below If you have more than 6 dependents attach a statement to your return with the required information Enter the total number from Federal Form 1040A Line 6c or Federal Form 1040 Line 6c in the boxes here 6C 6D TOTAL EXEMPTIONS Total of 6A 6B and 6C 6D 8A 8B 8C 9 10 A B C D E F Accepted set by design1 Add Line 1 and Line 2 Also enter this amount on Form IT 540 Line 9 and mark the box on Line Additional Nonrefundable Credits Additional Refundable Credits ADJUSTED LOUISIANA INCOME TAX Subtract Line 15 from Line 11 If the result is less than zero or you are not required to file a federal return enter zero 0 Amended Return Off Amount from the Consumer Use You must mark one of these boxes AMOUNT OF CREDIT CARRIED FORWARD FROM 2010 AMOUNT OF ESTIMATED PAYMENTS MADE FOR 2011 AMOUNT PAID WITH EXTENSION REQUEST AMOUNT OF LINE 46 TO BE CREDITED TO 2012 INCOME TAX CREDIT AMOUNT OF LOUISIANA TAX WITHHELD FOR 2011 Attach Forms W 2 and 1099 AMOUNT PAID ON YOUR BEHALF BY A COMPOSITE PARTNERSHIP FILING Enter name of partnership AMOUNT TO BE REFUNDED Subtract Line 47 from Line 46 Use Address 2 on the next page If you file a paper return you will receive your refund on REFUND an Electronic Access Card (prepaid card) Annual Retirement Income Exemption for Taxpayers 65 or over Provide name of pension or annuity: Area code and daytime telephone number ATTACH TO RETURN IF COMPLETED attached Blind Capital Gain from Sale of Louisiana Business 20E Change COMPLETE AND SIGN RETURN ON NEXT PAGE CONSUMER USE TAX CONTINUE ON NEXT PAGE Credit Description Code Amount of Credit Claimed Credit Description Credit Code Amount of Credit Claimed Credit for amounts paid by certain military servicemembers for obtaining Louisiana Hunting and Fishing Licenses Decedent Deduction per Student Enter the result or $5 000 whichever is less Dependent name Description See instructions beginning on page 21 Code Educational Expenses for a Quality Public Education R S 47:297 12 provides a deduction for the fees or other amounts paid during the tax year for a quality education of a dependent child enrolled in a public elementary or secondary school including Louisiana Department of Education approved charter schools The deduction is equal to 50 percent of the amounts paid per dependent limited to $5 000 The amounts that can be deducted include amounts paid for uniforms textbooks and other supplies required by the school Educational Expenses for Home Schooled Children 18E Educational Expenses for Home Schooled Children R S 47:297 11 provides a deduction for educational expenses paid during the tax year for home schooling your dependent child In order to qualify for the deduction you must be approved by the State Board of Elementary and Secondary Education (BESE) for home schooling The deduction is equal to 50 percent of the actual qualified educational expenses paid for the home schooling per dependent limited to $5 000 Qualified educational expenses include amounts paid for the purchase of textbooks and curricula necessary for home schooling Educational Expenses for Quality Public Education 19E electronically! Elementary and Secondary School Tuition 17E Elementary and Secondary School Tuition R S 47:297 10 provides a deduction for amounts paid during the tax year for tuition and fees required for your dependent child s enrollment in a nonpublic elementary or secondary school that complies with the criteria set forth in Brumfield v Dodd and Section 501(c)(3) of the Internal Revenue Code or to any public elementary or secondary laboratory school that is operated by a public college or university The school can verify that it complies with the criteria The deduction is equal to the actual amount of tuition and fees paid per dependent limited to $5 000 The tuition and fees that can be deducted include amounts paid for tuition fees uniforms textbooks and other supplies required by the school Enter a 2 in box if married fi ling jointly 6A Enter a 5 in box if qualifying widow(er) Enter credit description and associated code along with the dollar amount of credit claimed See instructions beginning on page 26 Enter description and associated code along with the dollar amount See instructions beginning on page 23 Enter the amount of federal disaster credits allowed by IRS Enter the amount of your federal income tax liability found on Federal Form 1040 Line 55 Enter the Educational Expenses for a Quality Public Education Deduction here and on IT 540 Schedule E code 19E $ Enter the Educational Expenses for Home Schooled Children Deduction here and on IT 540 Schedule E code 18E $ Enter the Elementary and Secondary School Tuition Deduction here and on IT 540 Schedule E code 17E $ Enter the first 4 characters of your Enter the first 4 characters of your last name in these boxes Enter your Social Security Number Enter your Social Security Number Enter your Social Security Number EXCESS FEDERAL ITEMIZED DEDUCTIONS Subtract Line 8B from Line 8A Exempt Income Description Code Amount EXEMPT INCOME Enter on Lines 4A through 4H the amount of exempted income included in Line 1 above Enter description and associated code along with the dollar amount See instructions beginning on page 21 FEDERAL ADJUSTED GROSS INCOME Enter the amount from your Federal Form 1040EZ Line 4 FEDERAL ADJUSTED GROSS INCOME If your Federal Adjusted Gross FEDERAL INCOME TAX If your federal income tax has been decreased by a federal disaster credit allowed by IRS mark the box See instructions for Schedule H FEDERAL ITEMIZED DEDUCTIONS Federal Retirement Benefits Taxpayer date retired: Spouse date retired: FEDERAL STANDARD DEDUCTION File electronically! Filing filing status box It must agree with your federal return FILING STATUS: Enter the appropriate number in the First Name Last Name Social Security Number Relationship to you Birth Date (mm/dd/yyyy) From Louisiana I This worksheet should be used to calculate the three School Expense Deductions listed below Refer to Revenue Information Bulletin 09 019 on LDR s website If column 2 or 3 in Section II was checked multiply by: 50% 50% 50% 50% 50% 50% If you are not required to fi le a federal If you did not itemize your deductions on your federal return leave Lines 8A 8B and 8C blank and go to Line 9 II On the chart below list the name of each qualifying dependent and the name of the school the student attends If the student is home schooled enter home schooled Enter an X in the box in column 1 if your dependent qualifies for the Elementary and Secondary School Tuition deduction column 2 for Educational Expenses for Home Schooled Children deduction or column 3 for Quality Public Education deduction If you have more than six qualifying dependents attach a statement to your return with the required information III Using the letters that correspond to each qualifying dependent listed in Section II list the amount paid per student for each qualifying expense For students attending a qualifying school the expense must be for an item required by the school Refer to the information in Section I to determine which expenses qualify for the deduction Retain copies of cancelled checks receipts and other documentation in order to support the amount of qualifying expenses If you checked column 1 in Section II skip the 50% calculation below; however the deduction is still limited to $5 000 IMPORTANT! Income is less than zero enter 0 Interest and Dividends on US Government Obligations 01E IT 540 WEB IV Total the Deduction per Student in Section III based on the deduction for which the students qualified as marked in boxes 1 2 or 3 in Section II last name in these boxes Louisiana Chapter of the National Multiple Sclerosis Society Fund Louisiana Food Bank Association Louisiana Bicentennial Commission and Battle of New Orleans Bicentennial Commission Make A Wish Foundation of the Texas Gulf Coast and Louisiana TOTAL DONATIONS Add Lines 33 through 44 Louisiana Prostate Cancer Trust Fund Louisiana Animal Welfare Commission Community Based Primary Health Care Fund National Lung Cancer Partnership Louisiana State Employees Retirement Benefits Taxpayer date retired: Spouse date retired Louisiana State Teachers Retirement Benefits Taxpayer date retired: Spouse date retired: Mark Box: Mark this box and enter zero 0 on Line 16 Military Pay Exclusion 10E Native American Income 08E No use tax due NONREFUNDABLE TAX CREDITS 12A FEDERAL CHILD CARE CREDIT Enter the amount from your Federal Form 1040A Line 29 or Federal Form 1040 Line 48 This amount will be used to compute your 2011 Louisiana Nonrefundable Child Care Credit or State Identification Other Retirement Benefits Provide name or statute: Taxpayer date retired: Spouse date retired: Other see instructions page 23 Identify: Qualifying Qualifying Expense List the amount paid for each student as listed in Section II Recreation Volunteer 13E REFUNDABLE TAX CREDITS 19 2011 LOUISIANA REFUNDABLE CHILD CARE Your Federal Adjusted Gross Income must be EQUAL TO OR LESS THAN $25 000 to claim the credit on this line See instructions page 28 and Refundable Child Care Credit Worksheet return indicate wages here Road Home 11E Schedule E SCHEDULE E 2011 ADJUSTMENTS TO INCOME SCHEDULE F 2011 REFUNDABLE TAX CREDITS SCHEDULE H 2011 MODIFIED FEDERAL INCOME TAX DEDUCTION School Uniforms Signature of paid preparer other than taxpayer Spouse Decedent Spouse s Spouse s Signature (If filing jointly both must sign ) START Savings Program Contribution 09E Student Name of Qualifying Dependent Name of School Deduction as described in Section I Supplies Total (add amounts in each column) Tax Worksheet Line 2 Taxable Amount of Social Security 07E Telephone number of paid preparer Textbooks or Other Instructional Materials The Military Family Assistance Fund Coastal Protection and Restoration Fund The START Program TOTAL INCOME TAX AND CONSUMER USE TAX Add Lines 16 and 17 Total of 6A & 6B Tuition and Fees Voluntary Retrofit Residential Structure 16E Volunteer Firefighter 14E WEB 6238 WEB 6251 WEB 6254 WEB 6255 WEB 6256 Widow(er) Wildlife Habitat and Natural Heritage Trust Fund You must enter your SSN below in the same order as shown on your federal return YOUR LOUISIANA INCOME TAX Enter the amount from the tax table that corresponds with your fi ling status YOUR LOUISIANA TAX TABLE INCOME Subtract Lines 8C and 9 from Line 7 If less than zero enter 0 Use this figure to find your tax in the tax tables Your Name Your Signature Your Social Security Number Yourself Enter a 3 in box if married fi ling separately Enter a 4 in box if head of household *