IT-40EZ Form Fillable 2013 IT-40EZ Income Tax Form
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Check if applying for ITIN Daytime telephone number Hoosier Works MC 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 Keep a copy for your records (Account Numbe) (Address Where Rented) (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (City) (Landlord Name and Address) (Number of months rented) (R12 / 9 13) Indiana Resident Filers With No Dependents (Routing Number) (see page 7) (State) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (Total Rent) (Zip Code) 1 Enter your federal adjusted gross income from federal Form 1040EZ line 4 1 Renter s deduction 10 From W 2s: all Indiana state tax withheld 11 From W 2s: all Indiana county tax withheld 12 Add lines 10 and 11 Total Credits 13 If line 12 is more than line 9 subtract line 9 from line 12 This is an 15 Subtract line 14 from line 13 This is your refund Your Refund 15413111694 15413121694 16 a Routing Number 17 If line 9 is more than line 12 subtract line 12 from line 9 18 Penalty if filed after due date (see instructions on page 7) 19 Interest if filed after due date (see instructions on page 7) 2 character code 2 Enter the amount from line 3 of the Indiana Deduction Worksheet on the back of this form 2 Enter the amount from line 7 of the unemployment compensation worksheet found on page 8 2 00 20 Add lines 17 18 and 19 This is the amount you owe See page 7 for details on how to 2013 Spouse s date of death 3 Subtract line 2 from line 1 and enter total 3 Total deductions: Add lines 1 and 2 Carry this total to page 1 line 2 00 4 Enter $1 000 if filing a single return OR $2 000 if filing a joint return 5 Subtract line 4 from line 3 (if less than zero leave blank) State Taxable Income 6 State adjusted gross income tax: multiply line 5 by 3 4% ( 034) 7 County income tax (see instructions on page 8) 8 Use tax due on out of state purchases (see instructions on page 6) 9 Add lines 6 7 and 8 Total Tax Address Address where rented if different from the one on the front page (enter below) Amount from line 13 to be donated to the Indiana Nongame Wildlife Fund 14 Authorization b Account Number c Type Checking Savings contact the Social Security Administration in order to confirm the Social Security number(s) used on this return are correct County where spouse lived County where spouse workedCounty where you lived County where you worked d Place an X in the box if refund will go to an account outside the United States Date of Death Deposit Direct Due April 15 2014 Email address where we can reach you Enter the 2 digit county code numbers (found on the back of Schedule CT 40EZ) for the county where you lived and worked on January 1 2013 Enter the lesser of $3 000 OR total amount of rent paid Extension of time to file Foreign country I authorize the Department to discuss my return with my personal Paid Preparer: Firm s Name (or yours if self employed) If any individual listed at the top of the IT 40EZ died during 2013 enter date of death below (MMDD) If filing a joint return spouse s first name Indiana Deduction Worksheet Indiana Income Tax Return for Full Year Initial IT 40EZ Landlord s name and address (enter below) Last name make your payment including credit card options Amount You Owe Number (see pg 12 13) number account number account type and Social Security number to ensure my refund is properly deposited I give permission to the Department to number Address Number of months rented overpayment (If line 9 is more than line 12 skip to line 17 ) Overpayment Personal Representative s Name (please print) IN OPT on file with paid preparer if not fi ling electronically Place X in box if you have filed a federal extension of time to file Form 4868 Place X in box if you have filed an Indiana extension of time to file Form IT 9 or online via e Pay Preparer's Present address (number and street or rural route) representative (see page 10 ) request for direct deposit of my refund includes my authorization to the Indiana Department of Revenue to furnish my financial institution with my routing Round all entries School Corporation Security Number signature Spouse s Signature Date Spouse s Social State State Form 48438 State Zip Code Suffix Taxpayer's date of death Telephone Total amount of rent paid Under penalty of perjury I have examined this return and all attachments and to the best of my knowledge and belief it is true complete and correct I understand that if this is a joint return any refund will be made payable to us jointly and each of us is liable for all taxes due under this return Also my Yes No If yes complete the information below Your first name Your Signature Date Your Social Zip/Postal code