Fillable Form OR-24: 2021 Form OR-40 Oregon Individual Income (Oregon)

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Form OR-24: 2021 Form OR-40 Oregon Individual Income (Oregon)

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The Form OR-24: 2021 Form OR-40 Oregon Individual Income (Oregon) form is 8 pages long and contains:

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00462101010000
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2021 Form OR-40
Page 1 of 8
150-101-040
(Rev. 08-23-21, ver. 01)
• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples.
Oregon Department of Revenue
Amended return.
If amending for an NOL, tax
year the NOL was generated:
Fiscal year ending date
(MM/DD/YYYY)
Current address
Initial
Extension filed
Spouse’s date of birth (MM/DD/YYYY)
Date of birth (MM/DD/YYYY)
NOL tax year (YYYY)
Country
Spouse’s last name
Phone
ZIP codeState
Spouse’s Social Security number (SSN)
Spouse’s first name
Last name
Social Security number (SSN)
Federal Form 8886
Federal Form 8379
Initial
First name
Space for 2-D barcode—do not write in box below
Deceased
Short-year tax election
City
Deceased
Disaster relief
Calculated with “as if” federal return
Form OR-24
First time using this SSN (see instructions)
First time using this SSN (see instructions)
Applied for ITIN
Applied for ITIN
Married filing jointly
Qualifying widow(er) with dependent child
Married filing separately (enter spouse’s information above)
Single
Head of household (with qualifying dependent)
Filing Status (check only one box)
1. 2. 3.
4.
5.
Oregon Individual Income Tax Return for Full-year Residents
Clear form
00462101020000
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2021 Form OR-40
Page 2 of 8
150-101-040
(Rev. 08-23-21, ver. 01)
• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples.
Oregon Department of Revenue
6b. Credits for your spouse ..........................................................................................................................................................................6b.
Check boxes that apply:
6a. Credits for yourself .................................................................................................................................................................................. 6a.
Check boxes that apply:
Dependent 1: Social Security number (SSN)
Dependent 2: Social Security number (SSN)
Dependent 3: Social Security number (SSN)
Dependents.
List your dependents in order from youngest to oldest.
Dependent 1: Date of birth (MM/DD/YYYY)
Dependent 2: Date of birth (MM/DD/YYYY)
Dependent 3: Date of birth (MM/DD/YYYY)
Dependent 1: First name
Dependent 2: First name
Dependent 3: First name
Dependent 1: Last name
Dependent 2: Last name
Dependent 3: Last name
Social Security number (SSN)
Last name
6c. Total number of dependents .................................................................................................................................................................. 6c.
6d. Total number of dependent children with a qualifying disability (see instructions) ................................................................................6d.
6e. Total exemptions. Add 6a through 6d .......................................................................................................................................... Total 6e.
Regular
Regular
Severely disabled
Severely disabled
Someone else can claim you as a dependent.
Someone else can claim you as a dependent.
Exemptions
Note: Reprint page 1 if you make changes to this page.
Code *
Code *
Code *
If more than three, check this box
and include Schedule OR-ADD-DEP.
Dependent 1: Check if child
has a qualifying
disability
Dependent 2: Check if child
has a qualifying
disability
Dependent 3: Check if child
has a qualifying
disability
*Dependent relationship code (see instructions).
Initial
Initial
Initial
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2021 Form OR-40
Page 3 of 8
150-101-040
(Rev. 08-23-21, ver. 01)
• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples.
Oregon Department of Revenue
Social Security number (SSN)
Last name
Taxable income
7. Federal adjusted gross income from federal Form 1040, 1040-SR, and
1040-NR, line 11; or 1040-X, line 1C (see instructions) .............................................. 7.
8. Total additions from Schedule OR-ASC, Section A ................................................... 8.
9. Income after additions. Add lines 7 and 8 .................................................................. 9.
Subtractions
10. 2021 federal tax liability (see instructions) ............................................................. 10.
11. Social Security amount on federal Form 1040 or 1040-SR, line 6b ......................... 11.
12. Oregon income tax refund included in federal income ............................................. 12.
13. Total subtractions from Schedule OR-ASC, Section B ............................................ 13.
14. Total subtractions. Add lines 10 through 13 ............................................................. 14.
15. Income after subtractions. Line 9 minus line 14 ....................................................... 15.
Deductions
16. Oregon itemized deductions. Enter your Oregon itemized deductions from
Schedule OR-A, line 23. If you are not itemizing your deductions, enter 0 .............. 16.
17. Standard deduction. Enter your standard deduction (see instructions) ................. 17.
You were: 17a. 65 or older 17b. Blind Your spouse was: 17c. 65 or older 17d. Blind
18. Enter the larger of line 16 or 17 ................................................................................. 18.
19. Oregon taxable income. Line 15 minus line 18. If line 18 is more than
line 15, enter 0 .......................................................................................................... 19.
Note: Reprint page 1 if you make changes to this page.
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2021 Form OR-40
Page 4 of 8
150-101-040
(Rev. 08-23-21, ver. 01)
• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples.
Oregon Department of Revenue
Social Security number (SSN)
Last name
Oregon tax
20. Tax (see instructions) ................................................................................................ 20.
Check the appropriate box if you’re using an alternative method to calculate your tax:
20a. Schedule OR-FIA-40 20b. Worksheet FCG 20c. Schedule OR-PTE-FY
21. Interest on certain installment sales ......................................................................... 21.
22. Total tax before credits. Add lines 20 and 21 ........................................................... 22.
Standard and carryforward credits
23. Exemption credit. If the amount on line 7 is $100,000 or less, multiply your total
exemptions on line 6e by $213. Otherwise, see instructions ................................... 23.
24. Political contribution credit. See limits in instructions ........................................... 24.
25. Total standard credits from Schedule OR-ASC, Section C ...................................... 25.
26. Total standard credits. Add lines 23 through 25 ....................................................... 26.
27. Tax minus standard credits. Line 22 minus line 26. If line 26 is more than
line 22, enter 0 .......................................................................................................... 27.
28. Total carryforward credits claimed this year from Schedule OR-ASC, Section D.
Line 28 can’t be more than line 27 (see Schedule OR-ASC instructions) ................ 28.
29. Tax after standard and carryforward credits. Line 27 minus line 28 ......................... 29.
30. Total credit recaptures claimed this year from Schedule OR-ASC, Section E .......... 30.
31. Tax after credit recaptures. Line 29 plus line 30 ...................................................... 31.
Note: Reprint page 1 if you make changes to this page.
00462101050000
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2021 Form OR-40
Page 5 of 8
150-101-040
(Rev. 08-23-21, ver. 01)
• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples.
Oregon Department of Revenue
Social Security number (SSN)
Last name
Payments and refundable credits
32. Oregon income tax withheld. Include a copy of your Forms W-2 and 1099 ........ 32.
33. Amount applied from your prior year’s tax refund .................................................... 33.
34. Estimated tax payments for 2021. Include all payments you made before
filing this return (see instructions). Do not include the amount on line 33 ................ 34.
35. Earned income credit (see instructions) .................................................................... 35.
36. Kicker (Oregon surplus credit). Enter your kicker credit amount
(see instructions). If you elect to donate your kicker to the
State School Fund, enter 0 and see line 53 .......................................................... 36.
37. Total refundable credits from Schedule OR-ASC, Section F ................................... 37.
38. Total payments and refundable credits. Add lines 32 through 37 ............................ 38.
Tax to pay or refund
39. Overpayment of tax. If line 31 is less than line 38, you overpaid.
Line 38 minus line 31 ................................................................................................ 39.
40. Net tax. If line 31 is more than line 38, you have tax to pay.
Line 31 minus line 38 ................................................................................................ 40.
41. Penalty and interest for filing or paying late (see instructions) ................................. 41.
42. Interest on underpayment of estimated tax. Include Form OR-10 ......................... 42.
Exception number from Form OR-10, line 1 42a. Check box if you annualized: 42b.
43. Total penalty and interest due. Add lines 41 and 42 ................................................ 43.
Note: Reprint page 1 if you make changes to this page.
Oregon Individual Income Tax Return for Full-year Residents
00462101060000
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2021 Form OR-40
Page 6 of 8
150-101-040
(Rev. 08-23-21, ver. 01)
• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples.
Oregon Department of Revenue
Account number
Checking or
Routing number
Social Security number (SSN)
Savings
Last name
Tax to pay or refund (continued)
44. Net tax including penalty and interest.
Line 40 plus line 43 .................................................. This is the amount you owe. 44.
45. Overpayment less penalty and interest.
Line 39 minus line 43 ...............................................................This is your refund. 45.
46. Estimated tax. Fill in the portion of line 45 you want applied to your open
estimated tax account .............................................................................................. 46.
47. Charitable checkoff donations from Schedule OR-DONATE, line 30 ....................... 47.
48. Political party $3 checkoff ........................................................................................ 48.
Party code: 48a. You 48b. Spouse
49. Oregon 529 college savings plan deposits from Schedule OR-529
(see instructions) ....................................................................................................... 49.
50. Total. Add lines 46 through 49. Line 50 can’t be more than your
refund on line 45 ....................................................................................................... 50.
51. Net refund. Line 45 minus line 50 .................................... This is your net refund. 51.
Direct deposit
52. For direct deposit of your refund, see instructions. Check the box if the final deposit destination is outside the United States:
Type of account:
Account information:
Kicker donation
53. If you elect to donate your kicker to the State School Fund, check this box. ......... 53a.
Complete the kicker worksheet, located in the instructions, and enter the
amount here. ........................................................... This election is irrevocable. 53b.
Note: Reprint page 1 if you make changes to this page.
00462101070000
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2021 Form OR-40
Page 7 of 8
150-101-040
(Rev. 08-23-21, ver. 01)
• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples.
Oregon Department of Revenue
Preparer first name
Preparer address
Social Security number (SSN)
Preparer license number
Date (MM/DD/YYYY)
Last name
Date (MM/DD/YYYY)
Initial Preparer last name
Phone
City State ZIP code
Date (MM/DD/YYYY)
Signature of preparer other than taxpayer
X
Spouse’s signature
X
Your signature
X
Signing this return does not grant your preparer the right to represent you or make decisions on your behalf. For more information, see the instructions for
the Tax Information Authorization and Power of Attorney for Representation form on our website.
Important: Include a copy of your federal Form 1040, 1040-SR, 1040-X, or 1040-NR. We may adjust your return without it.
Pay the amount due (shown on line 44)
• Online: www.oregon.gov/dor.
• By mail: Payable to the Oregon Department of Revenue. Write “2021 Oregon Form OR-40” and the last four digits of your SSN or ITIN on your
check or money order. Include your payment with this return. Don’t use Form OR-40-V payment voucher if you’re mailing payment with your return.
Mail your return
• Non-2-D barcode. If the large 2-D barcode box on the first page of this form is blank:
— Mail tax-due returns to: Oregon Department of Revenue, PO Box 14555, Salem OR 97309-0940.
— Mail refund and no-tax-due returns to: Oregon Department of Revenue, PO Box 14700, Salem OR 97309-0930.
• 2-D barcode. If the large 2-D barcode box on the first page of this form is filled in:
— Mail tax-due returns to: Oregon Department of Revenue, PO Box 14720, Salem OR 97309-0463.
— Mail refund and no-tax-due returns to: Oregon Department of Revenue, PO Box 14710, Salem OR 97309-0460.
Note: Reprint page 1 if you make changes to this page.
Sign here. Under penalty of false swearing, I declare that the information in this return is true, correct, and complete.
00462101080000
2021 Form OR-40
Page 8 of 8
150-101-040
(Rev. 08-23-21, ver. 01)
• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples.
Oregon Department of Revenue
Social Security number (SSN)
Last name
Amended statement. Complete this Section only if you’re amending your 2021 return or filing with a new SSN.
If filing an amended return, use this space to explain what you’re changing. Include the return line numbers and the reason for each change. If your
filing status has changed, explain why. Include all supporting forms and schedules when you file your amended return, even if you haven’t changed
anything on them.
If filing with a new SSN, enter your former identification number.
Note: Reprint page 1 if you make changes to this page.
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Form OR-24: 2021 Form OR-40 Oregon Individual Income (Oregon)

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Completed 22 March 2022

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