Organ Donor
Program
Fund
X
4. Mark your filing status box below and enter the appropriate exemption amount on Line 4.
4 00
5.
Tax from federal return (Do not Enter this amount on Line 5 or $5,000, whichever is less.
enter federal income tax withheld.) If married filing combined, enter this amount on Line 5
or $10,000, whichever is less.
5 + 00
6. Missouri standard deduction or itemized deductions.
Single or Married Filing Separate— $6,300; Head of
Household — $9,250; Married Filing a Combined Return or Qualifying Widow(er) — $12,600
. If you are age 65 or
older, blind, or claimed as a dependent, see your federal return or page 7. If you are itemizing, see back of form. 6 + 00
7.
Number of dependents you claimed on your Federal Form 1040 OR 1040A, Line 6c.
Check box if claiming a stillborn child; see instructions on Page 7...........................................................
x $1,200 =
7 + 00
8. Long-term care insurance deduction ...................................................................................................................... 8 + 00
9. Total Deductions — Add Lines 4 through 8. ...........................................................................................................
9 = 00
12. Missouri tax withheld from your Forms W-2 and Forms 1099. Attach copies of Forms W-2 and Forms 1099. .... 12 00
13. Any Missouri estimated tax payments made for 2015 (include overpayment from 2014 applied to 2015) ............ 13 00
14. Total Payments — Add Lines 12 and 13. ...............................................................................................................
14 00
15. If Line 14 (Total Payments) is more than Line 11 (Total Tax), enter the difference (amount of overpayment)
here. (If Line 14 is less than Line 11, skip to Line 20.) ........................................................................................... 15 00
16. Amount from Line 15 that you want applied to your 2016 estimated tax ............................................................. 16 00
10. Missouri Taxable Income — Subtract Line 9 from Line 3. ...................................................................................... 10 00
11. Tax — Use the tax chart on the back of this form to figure the tax. .......................................................................
11 00
1. Federal adjusted gross income from your 2015 federal return. (See page 6 of the instructions.). ................................. 1 00
2. Any state income tax refund included in your 2015 federal adjusted gross income. ............................................ 2 – 00
3. Total Missouri adjusted gross income — Subtract Line 2 from Line 1. .................................................................
3 = 00
INCOMEDEDUCTIONS
TAX
REFUND
AMOUNT DUE
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.
YES NO
SIGNATURE
A. Single — $2,100 (See Box B before checking.)
B. Claimed as a dependent on another person’s federal
tax return — $0.00
C. Married filing joint federal & combined Missouri — $4,200
Check which spouse had income: Yourself Spouse
PREPARER’S PHONEE-MAIL ADDRESS
SIGNATURE DATE PREPARER’S SIGNATURE FEIN, SSN, OR PTIN
SPOUSE’S SIGNATURE (If filing combined, BOTH must sign) DAYTIME TELEPHONE PREPARER’S ADDRESS AND ZIP CODE DATE
For Privacy Notice, see instructions.
IN CARE OF NAME (ATTORNEY, EXECUTOR, PERSONAL REP., ETC.)
PRESENT ADDRESS (INCLUDE APARTMENT NO. OR RURAL ROUTE) COUNTY OF RESIDENCE
CITY, TOWN, OR POST OFFICE STATE ZIP CODE
AGE 65 OR OLDER BLIND 100% DISABLED NON-OBLIGATED SPOUSE
YOURSELF YOURSELF YOURSELF YOURSELF
SPOUSE SPOUSE SPOUSE SPOUSE
PLEASE CHECK THE APPROPRIATE BOXES THAT APPLY TO YOURSELF OR YOUR SPOUSE.
MISSOURI DEPARTMENT OF REVENUE 2015 FORM MO-1040A
INDIVIDUAL INCOME TAX RETURN
SINGLE/MARRIED
(
ONE INCOME
)
SOCIAL SECURITY NUMBER SPOUSE’S SOCIAL SECURITY NUMBER
NAME (LAST) (FIRST) M.I. JR, SR
SPOUSE’S (LAST) (FIRST) M.I. JR, SR
VENDOR CODE
006
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
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.
19. REFUND -
Subtract Lines 16, 17, and 18 from Line 15 and enter here. This is your refund.
Sign below and mail to
:
Department of Revenue, P.O. Box 3222, Jefferson City, MO 65105-3222. ...................................................... 19 00
20. AMOUNT DUE - If Line 14 is less than Line 11, enter the difference here. You have an amount due. Sign below and
mail to: Department of Revenue, P.O. Box 3370, Jefferson City, MO 65105-3370. See instructions for Line 20. ...... 20 00
If you pay by check, you authorize the Department of Revenue to process the check electronically. Any check returned unpaid may be presented again electronically.
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.
Checking Savings
DECEASED
IN 2015
17.
Enter the amount of your
donation in the trust fund
boxes to the right. See
instructions for fund codes...17.
00 00 00 00 00 00 00 00 00 00 00
Workers
Additional
Fund Code
(See Instr.)
______|______
Children’s
Trust
Fund
Veterans
Trust
Fund
Missouri
National Guard
Trust Fund
Workers’
Memorial
Fund
Elderly Home
Delivered Meals
Trust Fund
Childhood Lead
Testing
Fund
General
Revenue
LEAD
Missouri Military
Family Relief
Fund
General
Revenue
Fund
Additional
Fund Code
(See Instr.)
______|______
(__ __ __) __ __ __ - __ __ __ __
(__ __ __) __ __ __ - __ __ __ __
__ __/__ __/__ __ __ __
__ __/__ __/__ __ __ __
MO-1040A 2-D (Revised 12-2015)
18.
Amount from Line 15 to be deposited into a Missouri 529 College Savings Plan (MOST) account. Enter amount from Line E of Form 5632.
18 00
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INSTRUCTIONS:
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the field you want.
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006
SELECT COUNTY
Line 2
0
0
Itemized Worksheet
0
Line 6
0
0
0
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0
Line 16
Line 17
MOST
0
Line 18
0
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M1
Click here to finish
FORM MO-1040A
MO-1040A 2-D (Revised 12-2015)
Complete this worksheet only if your federal adjusted gross income from federal Form 1040, Line 37 is more than $309,900 if married filing combined or qualifying widow(er),
$284,050 if head of household, $258,250 if single or claimed as a dependent, or $154,950 if married filing 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-9 of Federal Schedule A instructions).
1. Enter amount from Federal Itemized Deduction Worksheet, Line 3
(See page A-9 of Federal Schedule A instructions.) If $0 or less, enter “0”. .................................... 1 00
2. Enter amount from Federal Itemized Deduction Worksheet, Line 9 (See Federal Schedule A instructions.) ........... 2 00
3. State and local income taxes from Federal Form 1040, Schedule A, Line 5 .................................... 3 00
4. Earnings taxes included on Federal Form 1040, Schedule A, Line 5 .......................................... 4 00
5. Subtract Line 4 from Line 3. .........................................................................
5 00
6. Divide Line 5 by Line 1. ............................................................................ 6 %
7. Multiply Line 2 by Line 6. ...........................................................................
7 00
8. Subtract Line 7 from Line 5. Enter here and on Missouri Itemized Deductions, Line 9, above. ......................
8 00
Missouri Itemized Deductions
Complete this section only if you itemized deductions on your federal return. (See the information on page 7.)
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 ......................................... 1 00
2. 2015 Social security tax ............................................................................ 2 00
3. 2015 Railroad retirement tax — (Tier I and Tier II) ....................................................... 3 00
4. 2015 Medicare tax.
See instructions on page 9.
......................................................... 4 00
5. 2015 Self-employment tax. See instructions on Page 9. .................................................. 5 00
6. Total - Add Lines 1 through 5 ....................................................................... 6 00
7. State and local income taxes. From Federal Schedule A, Line 5 or see the worksheet below. 7 00
8. Earnings taxes included in Line 7. See instructions on Page 9. ........................ 8 00
9. Net state income taxes. Subtract Line 8 from Line 7 or enter Line 8 from worksheet below. ....................... 9 00
10. MISSOURI ITEMIZED DEDUCTIONS - Subtract Line 9 from Line 6. Enter here and on front of form, Line 6 ......... 10 00
Note: If Line 10 is less than your federal standard deduction, see information on pages 6 & 7.
Worksheet For Net State Income Taxes, Line 9 of Missouri Itemized Deductions
2015 TAX CHART
If Missouri taxable income from Form MO-1040A, Line 10, is less than $9,000, use the chart to figure tax;
if more than $9,000, use worksheet below or use the online tax calculator at http://dor.mo.gov/personal/individual/.
Missouri taxable income (Line 10) ..............................
Subtract $9,000 .....................................................
Difference ..............................................................
Multiply by 6%........................................................
Tax on income over $9,000
Add $315 (tax on first $9,000) ...............................
TOTAL MISSOURI TAX ........................................
FIGURING TAX
OVER $9,000
$ _______________
$ 9,000
= $ _______________
x 6%
= $ _______________
+ $ 315
= $ _______________
Example
$ 12,000
$ 9,000
= $ 3,000
x 6%
= $ 180
+ $ 315
= $ 495
If the Missouri taxable income is: The tax is:
$0 to $99 .............................$0
At least $100 but not over $1,000 ..........1½% of the Missouri taxable income
Over $1,000 but not over $2,000 ...........$15 plus 2% of excess over $1,000
Over $2,000 but not over $3,000 ...........$35 plus 2½% of excess over $2,000
Over $3,000 but not over $4,000 ...........$60 plus 3% of excess over $3,000
Over $4,000 but not over $5,000 ...........$90 plus 3½% of excess over $4,000
Over $5,000 but not over $6,000 ...........$125 plus 4% of excess over $5,000
Over $6,000 but not over $7,000 ...........$165 plus 4½% of excess over $6,000
Over $7,000 but not over $8,000 ...........$210 plus 5% of excess over $7,000
Over $8,000 but not over $9,000 ...........$260 plus 5½% of excess over $8,000
Over $9,000 ...........................$315 plus 6% of excess over $9,000
Example: If Line 10 is $3,090, the tax
would be computed as follows: $60 +
$2.70 (3% of $90) = $62.70. The whole
dollar amount to enter on Line 11 would
be $63.
FIGURING TAX
ON $9,000 OR LESS
If more than $9,000,
tax is $315 PLUS 6% of
excess over $9,000.
Round to nearest whole
dollar and enter on
Form MO-1040A, Line 11.
Line 1
Line 2
Line 3
Line 4
Line 5
0
Line 7
Line 8
0
0
Line 10
Carry amount to 1040A Line 6
Reset Worksheet
Use data from worksheet
0
0
0
Form
5632
Missouri Department of Revenue
2015 MOST - Missouri’s 529 College Savings Plan
Direct Deposit Form - Individual Income Tax
Requirements
• Provideyournameandsocialsecuritynumber.Ifyouaremarriedandlingacombinedreturn,also
provide your spouse’s name and social security number.
Enter below 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.)
Add the amounts from Lines A through D and enter the “Total Deposit” below and on your Missouri
Individual Income Tax Return.
Instructions
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 cancel your deposit and issue a refund to you.
• If your refund is offset to pay another debt, the Department will cancel your deposit.
Last Name First Name Social Security Number
Spouse’s Last Name Spouse’s First Name Spouse’s Social Security Number
Taxpayer
A) Account Number A) Amount
B) Account Number B) Amount
C) Account Number C) Amount
D) Account Number D) Amount
E) Total Deposit
529 Account
MOST-Missouri’s 529 College Savings Plan MOST 529 Advisor Plan
https://www.missourimost.org https://www.most529advisor.com/
Telephone: (888) 414-6678 Telephone: (800) 617-5097
E-mail: most529@missourimost.org
Contact Information
Form 5632 (Revised 12-2015)
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 Missouri Individual Income Tax Return.
Taxation Division
___ ___ ___ - ___ ___ - ___ ___ ___ ___
___ ___ ___ - ___ ___ - ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ - ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ - ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ - ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ - ___ ___
Enter the Total Deposit amount on Form MO-1040, Line 46;
Form MO-1040A, Line 18; or Form MO-1040P, Line 25.
.00
.00
.00
.00
.00
$0
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