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Federal Electronic Filing Instructions

Tax Ye ar 2014
These instructions are provided to help you understand and complete the final
steps for electronically filing your Federal Return. We HIGHLY recommend you
print this for your reference.
You are responsible for confirming the status of your e lectronically file d
re turn. You can confirm the status of your return by going to efstatus.taxact.com.
You will need to enter the Primary Social Security Number and Last Name on the
return along with your ZIP Code.
Self Se lect PIN: You do not need to mail any paper signature forms to the IRS.
Your return has been successfully filed once you receive your acceptance from
the IRS.
**If you are unable to complete the above instructions, or you need assistance in
completing them contact us at: efilesupport@taxact.com.

Federal Electronic Filing Instructions - 10/29/15

02:35 PM

Page 1

Form

Department of the Treasury - Internal Revenue Service

1040

(99)

U.S. Individual Income Tax Return

2014

For the year Jan. 1-Dec. 31, 2014, or other tax year beginning

OMB No. 1545-0074 IRS Use Only - Do not write or staple in this space.
See separate instructions.

, ending

Your first name and initial

Last name

saed

Your social security number

bawatneh

If a joint return, spouse's first name and initial

661-10-2404

Last name

zareefa

Spouse's social security number

shalout

214-69-5467

Home address (number and street). If you have a P.O. box, see instructions.

Apt. no.

Make sure the SSN(s) above


and on line 6c are correct.

8000 morrison rd
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Presidential Election Campaign

new orleans, LA 70126


Foreign country name

Foreign province/state/county

Foreign postal code

Check here if you, or your spouse if filing


jointly, want $3 to go to this fund. Checking
a box below will not change your tax or
refund.

You

Filing Status

1
2

Check only one


box.

Exemptions

6a

Married filing separately. Enter spouse's SSN above


and full name here.

X
X

Dependents:

Income
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a W-2,
see instructions.

Adjusted
Gross
Income

7
8a
b
9a
b

Qualifying widow(er) with dependent child

Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Dependent's
social security number

(3) Dependent's
relationship to you

Last name

(4) X if child
under age 17
qualifying for
child tax credit
(see instr.)

390-27-5705Son
080-61-9295Daughter
494-87-2566Daughter

Total number of exemptions claimed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . .

Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . .

8a

Tax-exempt interest. Do not include on line 8a . . . . . . .


Qualified dividends . . . . . . . . . . . . . . . . . . . . .

0
0

Dependents on 6c
not entered above

Add numbers on
lines above

9a

Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . .

10

11

Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

12

Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . . . . .

12

13

Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . .

13

14

Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . .

15a

IRA distributions . . . . .

15a

b Taxable amount . . . . . . .

15b

16a

Pensions and annuities . .

16a

b Taxable amount . . . . . . .

16b

17

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . .

17

18

Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . .

18

19

Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20a

Social security benefits . .

21

Other income. List type and amount

22

Combine the amounts in the far right column for lines 7 through 21. This is your total income

23

Educator expenses . . . . . . . . . . . . . . . . . . . . .

24

Certain business expenses of reservists, performing artists, and

b Taxable amount . . . . . . .

See Attached

14

19
20b

2,104.
2,104.

21
22

23

fee-basis government officials. Attach Form 2106 or 2106-EZ .

24

25

Health savings account deduction. Attach Form 8889 . . . . .

25

26

Moving expenses. Attach Form 3903

. . . . . . . . . . . .

26

27

Deductible part of self-employment tax. Attach Schedule SE . .

27

28

Self-employed SEP, SIMPLE, and qualified plans . . . . . . .

28

29

Self-employed health insurance deduction . . . . . . . . . .

29

30

Penalty on early withdrawal of savings . . . . . . . . . . . .

30

31a

Alimony paid

31a

32

IRA deduction . . . . . . . . . . . . . . . . . . . . . . .

32

33

Student loan interest deduction . . . . . . . . . . . . . . .

33

34

Tuition and fees. Attach Form 8917 . . . . . . . . . . . . .

34

35

Domestic production activities deduction. Attach Form 8903 . .

35

36

Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36

37

Subtract line 36 from line 22. This is your adjusted gross income . . . . . . . . . . .

37

b Recipient's SSN

9b

10

20a

Boxes checked
on 6a and 6b
No. of children
on 6c who:
lived with you
did not live with
you due to divorce
or separation
(see instructions)

8b

Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . .

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
UYA

child's name here.

Yourself. If someone can claim you as a dependent, do not check box 6a . . . . . . . .

omar bawatneh
kindah bawatneh
lujayn bawatneh

Spouse

Head of household (with qualifying person). (See instructions.) If


the qualifying person is a child but not your dependent, enter this

Married filing jointly (even if only one had income)

(1) First name

If more than four


dependents, see
instructions and
check here

Single

0.
2,104.
Form

1040 (2014)

Form 1040 (2014)

Tax and
Credits

saed bawatneh and zareefa shalout


38
39a
b

Standard
Deduction
forPeople who
check any
box on line
39a or 39b or
who can be
claimed as a
dependent,
see
instructions.
All others:
Single or
Married filing
separately,
$6,200
Married filing
jointly or
Qualifying
widow(er),
$12,400
Head of
household,
$9,100

41
42

If you have a
qualifying
child, attach
Schedule EIC.

Joint return?
See instr.
Keep a copy
for your
records.

Paid
Preparer
Use Only

45
46

47
48
49

Credit for child and dependent care expenses. Attach Form 2441 . .

49

50

50

51

Education credits from Form 8863, line 19 . . . . . . . . . . . . .


Retirement savings contributions credit. Attach Form 8880 . . . . .

52

Child tax credit. Attach Schedule 8812, if required . . . . . . . . .

52

53

Residential energy credits. Attach Form 5695 . . . . . . . . . . .


c
3800
8801

54

54

43

47

51
53

Add lines 48 through 54. These are your total credits . . . . . . . . . . . . . . . . . . . . .


Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . . . . . . . .

55

56
57

Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

57

58
59

Unreported social security and Medicare tax from Form: a


4137
b
8919 . . . . . . 58
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . . . 59
Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . 60a
First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . . . . . . . . 60b

60a

. . . . . . . . . . .

61

Health care: individual responsibility (see instructions) Full-year coverage

62

Taxes from:

63
64
65

Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . . . . . . . . . . .


Federal income tax withheld from Forms W-2 and 1099 . . . . . . 64
2014 estimated tax payments and amount applied from 2013 return
65

66a

Earned income credit (EIC) . . . . . . . . . . . . . NO


. . . . . .

Form 8959 b

Form 8960 c

Instructions; enter code(s)

b Nontaxable combat pay election. . 66b


67
Additional child tax credit. Attach Schedule 8812 . . . . . . .
68
American opportunity credit from Form 8863, line 8 . . . . .
69
Net premium tax credit. Attach Form 8962 . . . . . . . . . .
70
Amount paid with request for extension to file . . . . . . . .

.
.
.
.
Excess social security and tier 1 RRTA tax withheld . . . . . .
Credit for federal tax on fuels. Attach Form 4136 . . . . . . . .

75
76a

2439 b

.
.
.
.
.
.

61
63

0.

74

0.
0.
0.

66a
67
68
69
70
71
72
73

Routing number

Account number
Amount of line 75 you want applied to your 2015 estimated tax

77

.
.
.
.
.
.

0.
0.

56

62

Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . . . . . .
If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid . . . .
Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . . . .
c Type:

Checking

75
76a

Savings

77

0.

78

Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions
78
79
Estimated tax penalty (see instructions) . . . . . . . . . . . . . . 79
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete below.
Designee's
name

Phone
no.

No

Personal identification
number (PIN)

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature

Date

Spouse's signature. If a joint return, both must sign.

Date

Your occupation

Daytime phone number

unemployed

(714)262-7286

Spouse's occupation

If the IRS sent you an Identity Protection


PIN, enter it
here (see inst.)
PTIN

house wife
Print/Type preparer's name

Firm's name
Firm's address

UYA

42

Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . . . . . . . . .

73

Sign
Here

41

Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . . . . .


Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . 48

74

Amount
You Owe
Third Party
Designee

12,400.
-10,296.
19,750.
0.
0.

If your spouse itemizes on a separate return or you were a dual-status alien, check here

46

72

Direct deposit?
See
instructions.

40

45

71

Refund

2,104.

44

44

Payments

38

Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . . . . .
(see instructions). Check if any from: a
Form(s) 8814 b
Form 4972 c

43

55

Other
Taxes

Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . . . . . .


Check
You were born before January 2, 1950,
Blind.
Total boxes
if:
Spouse was born before January 2, 1950,
Blind.
39a 0
checked
Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . . . . .
Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Exemptions.
.

40

Page

661-10-2404

Preparer's signature

Date

if
Check
self-employed
Firm's EIN
Phone no.

Form

1040

(2014)

Form

8965

Department of the Treasury


Internal Revenue Service

OMB No. 1545-0074

Health Coverage Exemptions

2014

Attach to Form 1040, Form 1040A, or Form 1040EZ.


Information about Form 8965 and its separate instructions is at www.irs.gov/form8965.

Name as shown on return

Attachment
Sequence No.

75

Your social security number

saed bawatneh and zareefa shalout

661-10-2404

Complete this form if you have a Marketplace-granted coverage exemption or you are claiming a coverage exemption
on your return.
Part I

Marketplace-Granted Coverage Exemptions for Individuals: If you and/or a member of your tax household
have an exemption granted by the Marketplace, complete Part I.
a
Name of Individual

b
SSN

c
Exemption Certificate Number

Part II
7a
b

Coverage Exemptions for Your Household Claimed on Your Return:

Are you claiming an exemption because your household income is below the filing threshold?.

Yes

No

Are you claiming a hardship exemption because your gross income is below the filing threshold?

Yes

No

Part III

Coverage Exemptions for Individuals Claimed on Your Return: If you and/or a member of your tax
household are claiming an exemption on your return, complete Part III.
a
Name of Individual

b
SSN

Exemption Full
Type
Year

e
Jan

f
Feb

g
Mar

h
Apr

i
j
k
May June July

l
Aug

m
Sept

n
Oct

o
Nov

p
Dec

10

11

12

13
For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions.
UYA

Form 8965 (2014)

2014

Other Income - Supporting Details for Form 1040, Line 21

Name(s) shown on Form 1040

Your social security number

saed bawatneh and zareefa shalout

661-10-2404

Enter sources of other income below:


1.
2.
3. Gambling Winnings reported on Form W-2G . . . . . . . . . . . . . .
Other winnings where a Form W-2G not received . . . . . . . . . . .
4. Jury Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Net Operating Loss carry forward from 2013 . . . . . . . . . . . . . .
6. Foreign earned income exclusion from Form 2555 . . . . . . . . . .
7. Other Income from Schedule K-1 . . . . . . . . . . . . . . . . . . . . .
8. Income from personal property rental . . . . . . . . . . . . . . . . . .
9. Child's income amount from Form 8814, line 12 . . . . . . . . . . . .
10. MSA Distributions, Form 8853 . . . . . . . . . . . . . . . . . . . . . . .
11. Medicare Advantage MSA Distributions, Form 8853 . . . . . . . . .
12. Long-term Care Distribution, Form 8853 . . . . . . . . . . . . . . . . .
13. Form 1099-MISC, Boxes 3 and 8 . . . . . . . . . . . . . . . . . . . . .
14. Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . .
15. Coverdell ESA or Qualified Tuition Program . . . . . . . . . . . . . .
16. Cancellation of a nonbusiness debt, Form 1099-C . . . . . . . . . . .
17. Cancellation of a business debt, Partnership Sch K-1 . . . . . . . . .
18. HSA Distributions, Form 8889 . . . . . . . . . . . . . . . . . . . . . . .
19. Reemployment trade adjustment assistance (RTAA) . . . . . . . . .
20. Recapture of prior year tuition and fees deduction . . . . . . . . . . .
21. Recapture of charitable contribution deduction of a
fractional interest in tangible personal property . . . . . . . . . . . . .
22. Recapture of charitable contribution deduction if no
exempt use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23. Income from Foreign Corporation, Form 5471 . . . . . . . . . . . . .
24. Hobby income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25. Income or loss, Form 8621 . . . . . . . . . . . . . . . . . . . . . . . . .
26. Loss on excess deferral distribution . . . . . . . . . . . . . . . . . . . .
27. Disaster relief payments . . . . . . . . . . . . . . . . . . . . . . . . . .
28. Medicaid waiver payments to care provider (NOTICE 2014-07) . . .
29. Credit adjustment from regular income, Form 6478 and Form 8864
Total Other Income . . . . . . . . . . . . . . . . . . . . . . .

saed

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2,104.

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2,104.

zareefa

Louisiana Electronic Filing Instructions


These instructions are provided to help you understand and complete the final
steps for electronically filing your Louisiana return. We highly recommend you
print this for your reference.
You are responsible for confirming the status of your e lectronically file d
re turn. You can confirm the status of your return by going to efstatus.taxact.com.
You will need to enter the Primary Social Security Number and Last Name on the
return along with your ZIP Code.
Refund: You have elected to receive your refund of $0 by paper check.
Louisiana Form 8453OL:
Do not mail Form 8453OL to the Louisiana Department of Rev e nue. For
your records, keep the signed Form 8453OL as well as the rest of your Louisiana
income tax return for a period of at least four years.
**If you are unable to complete the above instructions, or you need assistance in
completing them contact us at: efilesupport@taxact.com.

Louisiana Electronic Filing Instructions - 10/29/15

02:35 PM

Page 1

Louisiana

R-8453OL (1/15)

LA 8453OL

2014 Individual Income Tax Declaration for Electronic Filing

LOUISIANA

IRS DCN

DEPARTMENT of REVENUE
Your first name and initial

0 0 -

Last name

saed

bawatneh

Spouse's first name and initial

Last name

zareefa

shalout

Your Social
Security
Number

661-10-2404

Spouse's
Social Security
Number

214-69-5467

Daytime
Telephone
Number

Present home address (number and street including apartment number or rural route)

8000 morrison rd
City, town, or post office

LA

Part A

2014

(714)262-7286

State

new orleans

- 4

ZIP

70126
Tax Return Information

Balance Due

Refund due

Part B

Direct Deposit of Refund (Optional)

or Direct Debit (Optional)

Routing Number The first 2 digits of the routing


number must be 01 through 12 or 21 through 32.

Direct Debit Payment

Account Number

Withdrawal Date

MM
Type of Account:

Checking

Savings

DD

YY

Full Payment
Partial Payment
Payment made/will be made by credit card.

(Check one.)

PART C
Declaration of Taxpayer
I consent that my refund be directly deposited as designated in Part B, and declare that the information shown in Part B is correct.
If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund.

I do not want direct deposit of my refund or am not receiving a refund. I understand that by not having my refund direct deposited I
will receive my refund on an Electronic Access Card (prepaid card).
I authorize the Louisiana Department of Revenue and its designated Financial Agent to initiate an ACH electronic funds withdrawal
(direct debit) entry to the financial institution account indicated in Part B for payment of my State taxes owed on this return. I also
authorize the financial institutions involved in processing the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment.
I understand that if I have filed a balance due return and if the Louisiana Department of Revenue does not receive full and timely
payment of my tax liability, I will remain liable for the tax liability and all applicable interest and penalties.

I declare that I have examined my state income tax return prepared for electronic transmission to the State of Louisiana and, to
the best of my knowledge and belief, it is true and complete.
Please sign here.
Your signature

Date

Spouse's signature (if joint return)

Do Not Mail
You must retain this form along with the state copy of your supporting
W2s and 1099s for a minimum of 3 years. DO NOT MAIL.

Date

0202

DEV ID

IT-540-2D (Page 1 of 4)

2014 LOUISIANA RESIDENT - 2D


Name
Change

SAED BAWATNEH

Taxpayer SSN

661102404

Decedent
Filing

ZAREEFA SHALOUT

Spouse SSN

214695467

Spouse
Decedent

8000 MORRISON RD

Amended
Return

NEW ORLEANS

LA 70126

7142627286

Telephone

NOL
Carryback
Taxpayer DOB

08221978

FILING STATUS: Enter the appropriate number in the


filing status box. It must agree with your federal return.

Enter a " 1 " in box if single.

06081980

Spouse DOB

6 EXEMPTIONS:
6A

Yourself

65 or
older

Blind

Spouse

65 or
older

Blind

Qualifying
Widow(er)

Enter a " 2 " in box if married filing jointly.


Enter a " 3 " in box if married filing separately.

6B

Total of
6A & 6B

Enter a " 4 " in box if head of household.


If the qualifying person is not your dependent, enter name here.

Enter a " 5 " in box if qualifying widow(er).

6C DEPENDENTS - Enter dependent information below. If you have more than 6 dependents, attach a statement to your return with the
required information. Enter the total number from Federal Form 1040A, Line 6c, or Federal Form 1040, Line 6c.

Dependent First and Last Name

Social Security Number

Relationship to you

6C

Birth Date

omar

bawatneh

390-27-5705

Son

04/21/2004

kindah

bawatneh

080-61-9295

Daughter

01/01/2007

lujayn

bawatneh

494-87-2566

Daughter

04/10/2010

IMPORTANT!
All four (4) pages of this return MUST be mailed

6D TOTAL EXEMPTIONS - Total of 6A, 6B, and 6C

6D

in together along with your W-2s and completed


schedules. Please paperclip. Do not staple.

61531

IT-540-2D (Page 2 of 4)
Social Security Number

If you are not required to file a federal return, indicate


wages here.

661102404

Mark this box and enter zero "0" on Lines 7 through 16.

FEDERAL ADJUSTED GROSS INCOME - If your Federal Adjusted Gross


Income is less than zero, enter "0."

From Louisiana
Schedule E
attached

2104

8A

FEDERAL ITEMIZED DEDUCTIONS

8A

8B

FEDERAL STANDARD DEDUCTION

8B

8C

EXCESS FEDERAL ITEMIZED DEDUCTIONS - Subtract Line 8B from Line 8A.

8C

FEDERAL INCOME TAX - If your federal income tax has been decreased by a federal disaster
credit allowed by IRS, complete Schedule H and mark box.

10

YOUR LOUISIANA TAX TABLE INCOME - Subtract Lines 8C and 9 from Line 7. If less than zero, enter "0."

10

2104

11

YOUR LOUISIANA INCOME TAX

11

12A FEDERAL CHILD CARE CREDIT

12A

12B 2014 LOUISIANA NONREFUNDABLE CHILD CARE CREDIT

12B

12C AMOUNT OF LOUISIANA NONREFUNDABLE CHILD CARE CREDIT CARRIED FORWARD FROM 2010
THROUGH 2013

12C

12D

12E

NONREFUNDABLE TAX CREDITS

12D 2014 LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT

12E AMOUNT OF LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT CARRIED FORWARD


FROM 2010 THROUGH 2013
13

EDUCATION CREDIT

13

14

OTHER NONREFUNDABLE TAX CREDITS - From Schedule G, Line 11

14

15

TOTAL NONREFUNDABLE TAX CREDITS - Add Lines 12B through 14.

15

16

ADJUSTED LOUISIANA INCOME TAX - Subtract Line 15 from Line 11. If the result is less than zero, or you
are not required to file a federal return, enter zero "0."

16

17

CONSUMER USE TAX

17

18

TOTAL INCOME TAX AND CONSUMER USE TAX - Add Lines 16 and 17.

18

No use tax due.

Amount from the Consumer Use


Tax W orksheet, Line 2.

BAWA

61532

IT-540 2D (Page 3 of 4)
Social Security Number

661102404

REFUNDABLE TAX CREDITS


19

19A Enter the qualified expense amount from the Refundable Child Care Credit Worksheet, Line 3.

19A

19B Enter the amount from the Refundable Child Care Credit Worksheet, Line 6.

19B

20

19

20

2014 LOUISIANA REFUNDABLE CHILD CARE CREDIT

2014 LOUISIANA REFUNDABLE SCHOOL READINESS CREDIT

21

EARNED INCOME CREDIT

21

22

LOUISIANA CITIZENS INSURANCE CREDIT

22

23

From Schedule F, Line 7


OTHER REFUNDABLE TAX CREDITS

23

PAYMENTS
24

AMOUNT OF LOUISIANA TAX WITHHELD FOR 2014 Attach Forms W-2 and 1099.

24

25

AMOUNT OF CREDIT CARRIED FORWARD FROM 2013

25

26

AMOUNT OF ESTIMATED PAYMENTS MADE FOR 2014

26

27

AMOUNT PAID WITH EXTENSION REQUEST

27

28

TOTAL REFUNDABLE TAX CREDITS AND PAYMENTS Add Lines 19 and 20 through 27. Do not include
amounts on Lines 19A and 19B.

28

29

OVERPAYMENT If Line 28 is greater than Line 18, subtract Line 18 from Line 28. Otherwise, enter zero "0" on
Lines 29 through 35 and go to Line 36.

29

30

UNDERPAYMENT PENALTY If you are a farmer, check the box.

30

31

ADJUSTED OVERPAYMENT If Line 29 is greater than Line 30, subtract Line 30 from Line 29 and enter the
result here. If Line 30 is greater than Line 29, enter zero "0" on Lines 31 through 35, subtract Line 29 from
Line 30, and enter the balance on Line 36.

31

32

TOTAL DONATIONS From Schedule D, Line 26

32

33

CREDIT

34

REFUND

35

REFUND DUE
33

SUBTOTAL Subtract Line 32 from Line 31. This amount of overpayment is available for credit or refund.

34

AMOUNT OF LINE 33 TO BE CREDITED TO 2015 INCOME TAX

35

AMOUNT TO BE REFUNDED Subtract Line 34 from Line 33.


Enter a "1" in box if you want to receive your refund on a MyRefund Card.
Enter a "2" in box if you want to receive your refund by paper check.
Enter a "3" in box if you want to receive your refund by direct deposit and complete
information below. If information is unreadable you will receive your refund by paper
check.
If you do not make a refund selection, you will receive your refund by paper check.
DIRECT DEPOSIT INFORMATION:
Type:
Routing
Number

Checking

Savings

Will this refund be forwarded to a financial


institution located outside the United States?

Yes

No

Account
Number

BAWA

61533

IT-540 2D (Page 4 of 4)
Social Security Number

661102404

AMOUNTS DUE LOUISIANA


36

AMOUNT YOU OWE If Line 18 is greater than Line 28, subtract Line 28 from Line 18 and enter the
balance here.

36

37

ADDITIONAL DONATION TO THE MILITARY FAMILY ASSISTANCE FUND

37

38

ADDITIONAL DONATION TO THE COASTAL PROTECTION AND RESTORATION FUND

38

39

ADDITIONAL DONATION TO THE NATIONAL MULTIPLE SCLEROSIS SOCIETY FUND

39

40

ADDITIONAL DONATION TO LOUISIANA FOOD BANK ASSOCIATION

40

41

ADDITIONAL DONATION TO THE SNAP FRAUD AND ABUSE DETECTION AND PREVENTION FUND

41

42

INTEREST

42

43

DELINQUENT FILING PENALTY

43

44

DELINQUENT PAYMENT PENALTY

44

45

UNDERPAYMENT PENALTY - If you are a farmer, check the box.

45

46

BALANCE DUE LOUISIANA - Add Lines 36 through 45.

46

PAY THIS AMOUNT.

DO NOT SEND CASH.

IMPORTANT!
All four (4) pages of this return
MUST be mailed in together along
with your W-2s and completed
schedules. Please paperclip.
Do not staple.

Status

Contribution and Donation

000

000000

I declare that I have examined this return, and to the best of my knowledge, it is true and complete. Declaration of paid preparer is based on all available information. If I made
a contribution to the START Savings Program, I consent that my Social Security Number may be given to the Louisiana Office of Student Financial Assistance to properly
identify the START Savings Program account holder. If married filing jointly, both Social Security Numbers may be submitted. I understand that by submitting this form I
authorize the disbursement of individual income tax refunds through the method as described on Line 35.
Your Signature

Date

Signature of paid preparer other than taxpayer

Spouse's Signature (If filing jointly, both must sign.)

Date

Telephone number of paid preparer

Name

BAWA

Address

8000

Individual Income Tax Return


Calendar year return due 5/15/2015

Date

FOR OFFICE USE ONLY


Field
Flag

Mail to:

Social Security Number, PTIN, or


FEIN of paid preparer

Department of Revenue

PO Box 3440
BATON ROUGE LA 70821-3440

SPEC
CODE

61534