Form IT-540 2012 Louisiana Resident Income Tax Return

(mmddyyyy) 1 FEDERAL ADJUSTED GROSS INCOME Enter the amount from your Federal Form 1040EZ Line 4 OR Federal Form 1040A Line 21 OR Federal Form 1040 Line 37 Check box if amount is less than zero 10 Louisiana Food Bank Association 10 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 11 Louisiana Bicentennial Commission and Battle of New Orleans Bicentennial Commission 11 YOUR LOUISIANA INCOME TAX Enter the amount from the tax table that corresponds with your filing status 12 13 14 12 Make A Wish Foundation of the Texas Gulf Coast and Louisiana 12B 12C 12B 2012 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 2008 ThROUGh 2011 See Nonrefundable Child Care Credit Worksheet 12D 2012 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 12E AMOUNT OF LOUISIANA NONREFUNDABLE SChOOL READINESS CREDIT CARRIED FORWARD FROM 2008 ThROUGh 2011 See Nonrefundable School Readiness Credit Worksheet 13 EDUCATION CREDIT 13 Louisiana Association of United Ways/LA 2 1 1 14 Center of Excellence for Autism Spectrum Disorder 14 OThER NONREFUNDABLE TAX CREDITS From Schedule G Line 11 15 16 15 Alliance for the Advancement of End of Life Care 15 TOTAL NONREFUNDABLE TAX CREDITS Add Lines 12B through 14 16 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 16 American Red Cross 17 18 19 17 CONSUMER USE TAX You must mark one of these boxes No use tax due Amount from the Consumer Use Tax Worksheet Line 2 OffOff 17 New Opportunities Waiver Fund 18 Friends of Palmetto Island State Park 18 TOTAL INCOME TAX AND CONSUMER USE TAX Add Lines 16 and 17 19 Dreams Come True Inc 2 INTEREST AND DIVIDEND INCOME FROM OThER STATES AND ThEIR POLITICAL SUBDIVISIONS 20 TOTAL DONATIONS Add Lines 2 through 19 This amount cannot be more than Line 1 Also enter this amount on Form IT 540 Line 33 2012 LOuIsIANA ResIdeNT 2A RECAPTURE OF START CONTRIBUTIONS 3 4 5 6 7 3 Coastal Protection and Restoration Fund 3 TOTAL Add Lines 1 2 and 2A 4 The START Program 4B 4C 4d 4e 4F 4G 4h 4I 4J 4k 5A 5B 5C 4I eXeMPT INCOMe BeFORe APPLICABLe FedeRAL TAX Add Lines 4A through 4h 4J FEDERAL TAX APPLICABLE TO EXEMPT INCOME Use Option 1 or Option 2 see instructions 4K EXEMPT INCOME Subtract Line 4J from Line 4I 5 Wildlife habitat and Natural heritage Trust Fund 5A LOUISIANA ADJUSTED GROSS INCOME BEFORE IRC 280C EXPENSE ADJUSTMENT Subtract Line 4K from Line 3 5B IRC 280C EXPENSE ADJUSTMENT 5C LOUISIANA ADJUSTED GROSS INCOME Subtract Line 5B from Line 5A Also enter this amount on Form IT 540 Line 7 Mark the box on Form IT 540 Line 7 indicating that Schedule E was used 6 eXeMPTIONs: 6 Louisiana Prostate Cancer Trust Fund 63503 66 12312012 65 or 6A & 6B 6A X Yourself 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 6D TOTAL eXeMPTIONs Total of 6A 6B and 6C 6d 7 FEDERAL ADJUSTED GROSS INCOME If your Federal Adjusted Gross Income is less than zero enter 0 From Louisiana Schedule E attached Off 7 Louisiana Animal Welfare Commission 8 9 10 11 8 National Lung Cancer Partnership 8A 8B 8C 9 10 8A FEDERAL ITEMIZED DEDUCTIONS 8B FEDERAL STANDARD DEDUCTION 8C EXCESS FEDERAL ITEMIZED DEDUCTIONS Subtract Line 8B from Line 8A 9 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 Off 9 Louisiana Chapter of the National Multiple Sclerosis Society Fund Accepted set by design1 Amended Return Annual Retirement Income Exemption for Taxpayers 65 or over Provide name of pension or annuity: Area code and daytime telephone number Blind Capital Gain from Sale of Louisiana Business 20E Carryback Your Date of Birth CONTINue ON NeXT PAGe 6351 Decedent Filing description See instructions beginning on page 24 Code dONATIONs OF LINe 1 2 The Military Family Assistance Fund Educational Expenses for home Schooled Children 18E Educational Expenses for Quality Public Education 19E Elementary and Secondary School Tuition 17E Enter a 1 in box if single Enter a 2 in box if married filing jointly Enter a 3 in box if married filing separately Enter a 4 in box if head of household Enter a 5 in box if qualifying widow(er) Enter the first 4 characters of your Enter your Social Security Number Enter your Social Security Number 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 23 Federal Retirement Benefits Taxpayer date retired: Spouse date retired: File electronically! 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) If the qualifying person is not your dependent enter name here If you are not required to file 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 Individuals who file an individual income tax return and have overpaid their tax may choose to donate all or part of their overpayment shown on Line 32 of Form IT 540 to the organizations or funds listed below Enter on Lines 2 through 19 the portion of the overpayment Interest and Dividends on US Government Obligations 01E IT 540 WeB last name in these boxes 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 Name Change Native American Income 08E NOL Off 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 2012 Louisiana Nonrefundable Child Care Credit older Other Retirement Benefits Provide name or statute: Taxpayer date retired: Spouse date retired: Other see instructions page 25 Identify: Qualifying Recreation Volunteer 13E return indicate wages here Road home 11E sCheduLe d 2012 DONATION SChEDULE sCheduLe e 2012 ADJUSTMENTS TO INCOME Spouse Spouse Decedent Spouse s Date of Birth (mmddyyyy) START Savings Program Contribution 09E Taxable Amount of Social Security 07E Total of Voluntary Retrofit Residential Structure 16E Volunteer Firefighter 14E WeB 6355 WeB 6356 Widow(er) www revenue louisiana gov/fileonline You must enter your SSN below in the same order as shown on your federal return you wish to donate The total on Line 20 cannot exceed the amount of your overpayment on Line 32 of Form IT 540