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0 6 Missouri Department of Revenue 2017 Individual (Missouri)

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MO-1040A Page 1
Missouri Department of Revenue
2017 Individual Income Tax Return
Single/Married (One Income)
Form
MO-1040A
*17334010006*
17334010006
For Privacy Notice, see Instructions.
Age 65 or Older Blind 100% Disabled Non-Obligated Spouse
Yourself Spouse Yourself Spouse Yourself Spouse Yourself Spouse
Select the appropriate
Veterans
Trust Fund
Children’s
Trust Fund
Elderly Home
Delivered Meals
Trust Fund
Missouri
National Guard
Trust Fund
Workers
Workers’
Memorial
Fund
LEAD
Childhood
Lead Testing
Fund
Missouri Military
Family Relief
Fund
General
Revenue
General
Revenue
Fund
Organ Donor
Program Fund
You may contribute to any one or all of the trust funds on Line 18. See instructions for more trust fund information.
Print in BLACK ink only and DO NOT STAPLE.
NameAddress
Social Security Number Spouse’s Social Security Number
- -
M.I.
In Care Of Name (Attorney, Executor, Personal Representative, etc.) Attach form if applicable.
County of Residence
Present Address (Include Apartment Number or Rural Route)
City, Town, or Post Office
Last Name
in 2017
First Name Suffix
Spouse’s Last NameSpouse’s First Name
M.I.
Suffix
Deceased
Deceased
in 2017
Name
- -
Department Use Only
State ZIP Code
_
MO-1040A Page 1
boxes that apply.
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SELECT COUNTY
MO-1040A Page 2
Tax
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Refund
11. Missouri Taxable Income - Subtract Line 10 from Line 3................................
12. Tax - Use the tax chart on page 9 to figure the tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Missouri tax withheld from your Forms W-2 and Forms 1099.
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Include overpayment from 2016 applied to 2017......................................
15. Total Payments - Add Lines 13 and 14 .............................................
16. If Line 15 is more than Line 12, enter the difference. This is your overpayment.
If Line 15 is less than Line 12, skip to Line 21 ........................................
17. Amount from Line 16 that you want applied to your 2018 estimated tax ....................
*17334020006*
17334020006
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10
9. Long-term care insurance deduction ...............................................
10. Total Deductions - Add Lines 4 through 9 ...........................................
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7. Missouri standard deduction or itemized deductions.
If age 65 or older, blind, or claimed as a dependent, see federal return or page 6.
If you are itemizing, see page 14.................................................
Attach copies of Forms W-2 and Forms 1099.............................................
14. Any Missouri estimated tax payments made for 2017.
x $1,200 = 1040A, Line 6c. Do not include yourself or spouse..................
8. Number of dependents you claimed on your Federal Form 1040 or
Exemptions and Deductions
.
00
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. 4. Select your filing status box below. Enter the appropriate exemption amount on Line 4 ........
4
A. Single - $2,100 (see Box B before selecting.)
B. Claimed as a Dependent on Another Person’s
C. Married Filing Combined (joint federal) - $4,200
Select which spouse had income:
Yourself Spouse
D. Married Filing Separate - $2,100
E. Married Filing Separate (spouse NOT filing) - $4,200
F. Head of Household - $3,500
G. Qualifying Widow(er) with Dependent Child - $3,500
6. Tax from federal return.
income tax withheld. ...
Enter this amount on Line 6, not to
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6
Federal Tax Return - $0.00
Select box if claiming a stillborn child (see instructions on page 6).
Income
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1. Federal adjusted gross income from your 2017 federal return (see page 5 of the instructions) .........
1
2. Any state income tax refund included in your 2017 federal adjusted gross income. ...........
2
3. Total Missouri adjusted gross income - Subtract Line 2 from Line 1 .......................
3
• Single or Married Filing Separate - $6,350
• Head of Household - $9,350
• Married Filing Combined or Qualifying Widow(er) - $12,700
exceed $5,000 for an individual ler Do not enter federal
or $10,000 for combined lers
......
MO-1040A Page 2
5
5. Additional personal exemption (see instructions on page 6) .............................
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Line 1
Line 2
0
Line 4
Line 5
0
Line 6
Itemized Worksheet
0
Line 7
0
Line 8
Line 9
0
0
0
Line 12
Line 13
Line 14
0
0
Line 17
MO-1040A Page 3
If you would like your refund deposited directly to your checking or savings account, complete boxes a, b, and c below:
a. Routing
Number
b. Account
Number
c. SavingsChecking
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best
of my knowledge and belief it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of
which he or she has any knowledge. As provided in Chapter 143, RSMo, a penalty of up to $500 shall be imposed on any individual who
files a frivolous return. I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law
and that I am not eligible for any tax exemption, credit, or abatement if I employ such aliens.
*17334030006*
17334030006
Refund (continued)
18. Enter the amount of your donation in the trust fund boxes below (see instructions for trust fund codes.)
19
20
00
.
00
.
19. Amount from Line 16 to be deposited into a Missouri 529 College Savings Plan (MOST) account.
Enter amount from Line E of Form 5632 ............................................
20. REFUND - Subtract Lines 17, 18, and 19 from Line 16 and enter here.....................
21
Amount
Due
21. AMOUNT DUE - If Line 15 is less than Line 12, enter the difference here ................
00
.
If you pay by check, you authorize the Department to process the check electronically. Any returned check may be presented again electronically.
Signature
Yes No
I authorize the Director of Revenue or delegate to discuss my return and attachments with the preparer
or any member of the preparer’s firm
........................................................
Preparer’s Telephone
Signature
Preparer’s Signature
Spouse’s Signature (If filing combined, BOTH must sign)
Daytime Telephone
Date (MM/DD/YY)
Preparer’s Address ZIP CodeState
E-mail Address
Preparer’s FEIN, SSN, or PTIN
Date (MM/DD/YY)
Date (MM/DD/YY)
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18
00
.
Total Donation - Add amounts from Boxes 18a through 18k and enter here.................
18a. 18b. 18c.
18d. 18e. 18f.
18g. 18h. 18i.
18j.
Additional
Fund
Code
Additional
Fund
Amount
00
.
18k.
Additional
Fund
Code
Additional
Fund
Amount
Department Use Only
FA E10A DE F
00
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00
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00
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Veterans
Trust Fund
Elderly Home
Delivered Meals
Trust Fund
00
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00
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00
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Workers’
Memorial Fund
Childhood
Lead
Testing Fund
00
.
00
.
00
.
General
Revenue Fund
Organ Donor
Program Fund
Children’s
Trust Fund
Missouri
National Guard
Trust Fund
Missouri
Military Family
Relief Fund
.
MO-1040A Page 3
0
Line 18
MOST
0
0
Line 20
0
Click here to finish
M1
MO-1040A Page 4
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• Complete this section only if you itemized deductions on your federal return (see the information on page 6 and 8).
• Attach a copy of your Federal Form 1040 (pages 1 and 2) and Federal Schedule A.
• If you are subject to “additional Medicare tax”, attach a copy of Federal Form 8959.
1. Total federal itemized deductions (from Federal Form 1040, Line 40) .....................
2. 2017 Social security tax .........................................................
3. 2017 Railroad retirement tax - (Tier I and Tier II)......................................
4. 2017 Medicare tax (
see instructions on page 8) ........................................
5. 2017 Self-employment tax (see instructions on page 8) ................................
6. Total - Add Lines 1 through 5.....................................................
7. State and local income taxes (from Federal Schedule A,
Line 5 or see the worksheet below) .........................
8. Earnings taxes included in Line 7 (see instructions on page 8)....
9. Net state income taxes - Subtract Line 8 from Line 7 or enter Line 8 from worksheet below ....
Form MO-1040A...................................................................
Note: If Line 10 is less than your federal standard deduction, see information on page 6.
Complete this worksheet only if your federal adjusted gross income from Federal Form 1040, Line 37 is more than $313,800
if married ling combined or qualifying widow(er), $287,650 if head of household, $261,500 if single or claimed as a dependent,
or $156,900 if married ling separate. If your federal adjusted gross income is less than or equal to these amounts, do not complete
this worksheet. Attach a copy of your Federal Itemized Deduction Worksheet (page A-12 of Federal Schedule A instructions).
1. Enter amount from Federal Itemized Deduction Worksheet, Line 3 (see page A-12 of Federal
Schedule A instructions). If $0 or less, enter “0” .....................................
2. Enter amount from Federal Itemized Deduction Worksheet, Line 9 (see Federal Schedule A
instructions)..................................................................
3. State and local income taxes from Federal Form 1040, Schedule A, Line 5 ................
4. Earnings taxes included on Federal Form 1040, Schedule A, Line 5 .....................
5. Subtract Line 4 from Line 3 .....................................................
6. Divide Line 5 by Line 1.........................................................
7. Multiply Line 2 by Line 6........................................................
8. Subtract Line 7 from Line 5. Enter here and on Missouri Itemized Deductions, Line 9, above ..
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*17334040006*
17334040006
Mail To: Balance Due: Refund or No Amount Due: Phone (Balance Due): (573) 751-7200
Missouri Department of Revenue Missouri Department of Revenue Phone (Refund or No Amount Due): (573) 751-3505
P.O. Box 3370 P.O. Box 3222 Fax: (573) 526-1881
Jefferson City, MO 65105-3370 Jefferson City, MO 65105-3222 E-mail: income@dor.mo.gov
Visit http://dor.mo.gov/personal/individual/ for additional information.
(Revised 12-2017)
Worksheet for Net State Income Taxes,
Line 9 of Missouri Itemized Deductions
Missouri Itemized Deductions
%
MO-1040A Page 4
10. Missouri Itemized Deductions - Subtract Line 9 from Line 6. Enter here and on Line 7 of
Line 1
Line 2
Line 3
Line 4
Line 5
0
Line 7
Line 8
0
0
Line 10
Carry amount to 1040A Line 7
0
0
0
Reset Worksheet
Use data from worksheet
Back to MO-1040A, page 2
9
2017 Tax Chart
To identify your tax, use your Missouri taxable income from Form MO-1040A, Line 11 and the tax chart in Section A
below.
Calculate your Missouri tax using the online tax calculator at http://dor.mo.gov/personal/individual or by using the
worksheet in Section B below. Round to the nearest whole dollar and enter on Form MO-1040A, Line 12.
*17000000001*
17000000001
Section B
If the Missouri taxable income is: The tax is:
$0 to $100
................................................ $0
At least $101 but not over $1,008.............................. 1½% of the Missouri taxable income
Over $1,008 but not over $2,016 .............................. $15 plus 2% of excess over $1,008
Over $2,016 but not over $3,024 .............................. $35 plus 2½% of excess over $2,016
Over $3,024 but not over $4,032 .............................. $60 plus 3% of excess over $3,024
Over $4,032 but not over $5,040 .............................. $90 plus 3½% of excess over $4,032
Over $5,040 but not over $6,048 .............................. $125 plus 4% of excess over $5,040
Over $6,048 but not over $7,056 .............................. $165 plus 4½% of excess over $6,048
Over $7,056 but not over $8,064 .............................. $210 plus 5% of excess over $7,056
Over $8,064 but not over $9,072 .............................. $260 plus 5½% of excess over $8,064
Over $9,072 .............................................. $315 plus 6% of excess over $9,072
Section A
Tax Rate Chart
Tax Calculation Worksheet
($61.98
rounded to the
nearest dollar)
($490.68
rounded to the
nearest dollar)
2017
Missouri Taxes Withheld
Earnings Tax
Diagram 1: Form W-2
Yourself Example A Example B
1. Missouri taxable income (Form MO-1040A,
Line 11) ..................................
$
_____________
$ 3,090 $ 12,000
2. Enter the minimum taxable income for your tax
bracket (see Section A above) ................
- $
_____________
- $ 3,024 $ 9,072
3. Difference - Subtract Line 2 from Line 1 . . . . . . . . .
= $
_____________
= $ 66 $ 2,928
4. Enter the percent for your tax bracket (see
Section A above)...........................
X
_____________
%
X 3% 6%
5. Multiply Line 3 by the percent on Line 4 .........
= $
_____________
= $ 1.98 $ 175.68
6. Enter the tax from your tax bracket - before
applying the percent (see Section A above) . . . . . .
+ $
_____________
+ $ 60 $ 315
7. Total Missouri Tax - Add Line 5 and 6. Enter here
and on Form MO-1040A, Line 12 ..............
= $
_____________
= $ 62 $ 491
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Missouri Department of Revenue
2017 MOST - Missouri’s 529 College Savings Plan
Direct Deposit Form - Individual Income Tax
Form
5632
Taxpayer
*17348010001*
17348010001
MOST-Missouri’s 529 College Savings Plan
Form 5632 (Revised 12-2017)
If you wish to deposit all or a portion of your refund into a Missouri MOST 529 College Savings Plan, you must include this form with your
Taxation Division
Add the amounts from Line A through Line D and enter the total deposit amount here
Requirements
If you want to deposit your refund as a contribution to one or more Missouri MOST 529 College Savings Plan accounts:
• You must have an open Missouri MOST 529 College Savings Plan account that is administered by the Missouri Higher
Education Savings Program. See the contact information below.
• Your total deposit must be at least $25.
• If your overpayment is adjusted and the amount you requested to deposit exceeds your available refund, the Department will
• If your refund is offset to pay another debt, the Department will cancel your deposit.
cancel your deposit and issue a refund to you.
Enter the 11-digit MOST 529 account number and the amount you want contributed to each account. (You may contribute to a
maximum of four accounts.)
529 Account
A) Account Number
B) Account Number
C) Account Number
D) Account Number
Total Deposit
and on Form MO-1040, Line 49; Form MO-1040A, Line 19; or Form MO-1040P, Line 25.
Contact Information
-
A) Amount
B) Amount
C) Amount
D) Amount
Missouri Individual Income Tax Return.
E-mail: most529@missourimost.org
Telephone: (888) 414-6678
https://www.missourimost.org
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M.I.
Last Name
First Name Suffix
Spouse’s Last NameSpouse’s First Name
M.I.
Suffix
00
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00
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00
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00
.
Social Security Number Spouse’s Social Security Number
- - - -
Department Use Only
(MM/DD/YY)
$0
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0 6 Missouri Department of Revenue 2017 Individual (Missouri)

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