Iowa Tax Return Form 2010

2010 IA 1040 Iowa Individual Income Tax Long Form

or fiscal year beginning and ending

Your Social Security Number:    Spouse Social Security Number:

Check this box if you or your spouse were 65 or older as of 12/31/10.

Residence on 12/31/10 — County No.:    School District No.:

STEP 1: Fill in all spaces. You MUST fill in your Social Security Number.

Your last name    Your first name/middle initial

Spouse’s last name    Spouse’s first name/middle initial

Current mailing address (number and street, apartment, lot, or suite number) or PO Box

City, State, ZIP

Dependent children for whom an exemption is claimed in Step 3

How many have health care coverage?    How many do not have health care coverage?

STEP 2 Filing Status: Mark one box only.

1 Single: Were you claimed as a dependent on another person’s Iowa return? YES NO

2 Married filing a joint return.

3 Married filing separately on this combined return. Spouse use column B.

4 Married filing separate returns. Spouse’s name: SSN: Income: $

5 Head of household with qualifying person. If qualifying person is not claimed as a dependent on this return, enter the person’s name and Social Security Number below.

6 Qualifying widow(er) with dependent child. Name: SSN:

STEP 3 Exemptions

YOU (and spouse if filing jointly)

a. Personal Credit: Enter 1. X $40 =

b. Enter 1 if 65 or older and/or 1 if blind. X $40 =

c. Dependents: Enter 1 for each dependent. X $40 =

d. Enter first names of dependents here: e. TOTAL $

SPOUSE (if filing status 3)

a. Personal Credit: Enter 1. X $40 =

b. Enter 1 if 65 or older and/or 1 if blind. X $40 =

c. Dependents: Enter 1 for each dependent. X $40 =

d. Enter first names of dependents here: e. TOTAL $

STEP 4 Gross Income

1. Wages, salaries, tips, etc.    2. Taxable interest income

3. Ordinary dividend income    4. Alimony received

5. Business income/(loss)    6. Capital gain/(loss)

7. Other gains/(losses)    8. Taxable IRA distributions

9. Taxable pensions and annuities    10. Rents, royalties, partnerships, estates, etc.

11. Farm income/(loss)    12. Unemployment compensation

13. Taxable Social Security benefits    14. Other income

15. GROSS INCOME. ADD lines 1-14.

STEP 5 Adjustments to Income

16. Payments to an IRA, Keogh, or SEP    17. One-half of self-employment tax

18. Health insurance deduction    19. Penalty on early withdrawal of savings

20. Alimony paid    21. Pension/retirement income exclusion

22. Moving expense deduction    23. Iowa capital gain deduction

24. Other adjustments    25. Total adjustments

26. NET INCOME    27. Federal income tax refund / overpayment received in 2010

28. Self-employment/household employment taxes    29. Addition for federal taxes

30. Total    31. Federal tax withheld

32. Federal estimated tax payments made in 2010    33. Additional federal tax paid in 2010 for 2009 and prior years

34. Deduction for federal taxes    35. BALANCE

STEP 7 Taxable Income

36. BALANCE from side 1, line 35    37. Total itemized deductions from federal Schedule A

38. Iowa income tax if included in line 5 of federal Schedule A    39. BALANCE

40. Other deductions    41. Deduction: Itemized   Standard    42. TAXABLE INCOME

STEP 8 Tax, Credits and Checkoff Contributions

43. Tax from tables or alternate tax    44. Iowa lump-sum tax

45. Iowa minimum tax    46. Total tax

47. Total exemption credit amount(s) from Step 3, side 1    48. Tuition and textbook credit for dependents K-12

49. Total credits    50. BALANCE

51. Credit for nonresident or part-year resident    52. BALANCE

53. Other nonrefundable Iowa credits    54. BALANCE

55. School district surtax/EMS surtax    56. Total Tax

57. Total tax before contributions

58. Contributions: Fish/Wildlife   State Fair   Firefighters/Veterans   Child Abuse Prevention   Enter total

59. TOTAL TAX AND CONTRIBUTIONS

STEP 9 Credits

60. Iowa income tax withheld    61. Estimated and voucher payments made for tax year 2010

62. Out-of-state tax credit    63. Motor fuel tax credit

64. Check one: Child and dependent care credit OR Early childhood development credit

65. Iowa earned income tax credit    66. Other refundable credits

67. TOTAL    68. TOTAL CREDITS

STEP 10 Refund or Amount You Owe

69. If line 68 is more than line 59, this is the amount you overpaid

70. Amount of line 69 to be refunded

71. Amount of line 69 to be applied to your 2011 estimated tax

72. If line 68 is less than line 59, this is the AMOUNT OF TAX YOU OWE

73. Penalty for underpayment of estimated tax    Check if annualized income method is used.

74a. Penalty    74b. Interest    74. Total

75. TOTAL AMOUNT DUE

STEP 11 Political Checkoff

YOURSELF: $1.50 to Republican Party   $1.50 to Democratic Party   $1.50 to Campaign Fund

SPOUSE: $1.50 to Republican Party   $1.50 to Democratic Party   $1.50 to Campaign Fund

STEP 12 Next Year

Would you like to receive a booklet? Yes   No

STEP 13 Please Sign Here

I (We), the undersigned, declare under penalty of perjury that I (we) have examined this return, including all accompanying schedules and statements, and, to the best of my (our) knowledge and belief, it is a true, correct, and complete return.

Additional Information

This return is due May 2, 2011.