MISSOURI

Form MO-1040A
Single/Married (Income From One Spouse) Short Form

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File Electronically!
Last year, more than 2 million Missouri Individual Income Tax Returns were filed electronically.
See page 2 for details.

See page 4 for extensions. http://dor.mo.gov/personal

Tax Deadline April 17

Visit our web site at

ELECTRONIC FILING OPTIONS

MISSOURI FEDERAL/STATE E-FILE: Missouri,incooperationwiththeInternalRevenueService (IRS),offersajointfederal/statefilingofindividualincometaxreturns.Therearetwo waysthatyoumaye-fileyourfederalandstateincometaxreturns: 1) oucanelectronicallyfileyourfederalandstatereturnsonlinefromwebsites Y providedbyapprovedsoftwareproviders.Manyprovidersofferfreefilingifyou meetcertainconditions.Alistofapprovedproviderscanbefoundat http://dor.mo.gov/personal/individual/. 2) oucanhaveataxpreparer(ifapprovedbytheIRS)electronicallyfileyourfederal Y andstatereturnsforyou,usuallyforafee.Alistofapprovedtaxpreparerscanbe foundathttp://dor.mo.gov/personal/individual/.

BENEFITS OF ELECTRONIC FILING

Convenience:Youcanelectronicallyfile24hoursaday,7daysaweek. Security: Yourtaxreturninformationisencryptedandtransmittedoversecurelinesto ensureconfidentiality. Accuracy:Electronicfiledreturnshaveupto13percentfewererrorsthanpaperreturns. Direct Deposit: Youcanhaveyourrefunddirectdepositedintoyourbankaccount. Proof of Filing:Anacknowledgmentisissuedwhenyourreturnisreceivedandaccepted.

Visit our web site at

http://dor.mo.gov/personal
etanswerstofrequentlyasked G questions seourFill-inFormsthatCalculate U ownloadMissouriandFederaltaxforms D

In addition to electronic filing information found on our web site, you can:
-mailus E etthestatusofyourrefundor G balancedue ayyourtaxesonline P

2-D Barcode Returns-Ifyouplanonfilingapaper

return,youshouldconsider2-Dbarcodefiling.Thesoftware encodesallyourtaxinformationintoa2-Dbarcode,which allowsyourreturntobeprocessedinafractionofthetimeittakestoprocessatraditionalpaper return.Ifyouusesoftwaretoprepareyourreturn,checkourwebsiteforapproved2-Dbarcode softwarecompanies.Also,checkouttheDepartmentsfill-informsthatcalculateandhavea2-D barcode.YoucanhaveyourrefunddirectdepositedintoyourbankaccountwhenyouusetheDepartmentsfill-informs.Ifyourformhasa2-Dbarcode,theREFUNDreturnsshouldbemailedto: Department of Revenue, P.O. Box 3222, Jefferson City, MO 65105-3222andreturnswithabalance dueshouldbemailedto:Department of Revenue, P.O. Box 3370, Jefferson City, MO 65105-3370.
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Whats Inside?
ElectronicFilingOptions/BenefitsofElectronicFiling. . . . . . .2 DoYouHavetheCorrect/WrongTaxBook? . . . . . . . . . . . . . . . . .3 ImportantFilingInformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5 FrequentlyAskedQuestions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5,6 InformationtoCompleteFormMO-1040A . . . . . . . . . . . . . . . . . 6-9 MissouriItemizedDeductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 FormMO-1040A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11,13 TaxTable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12,14 FormMO-1040V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 DiagramofFormW-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ConsumersUseTax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 TaxAssistanceCenters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Do You Have the Correct Tax Book?

You MAY USEthis tax book to file your 2011 Missouri individualincometaxreturnifyou: Are a one income filer (have income from one spouseif married,oraresingle); ereaMissouriresident,nonW resident, or part-year resi ent d withMissouriincomeonly; Claimthestandardoritemized deductions;and onothaveanytaxcreditsor D modificationstoyourincome. YouCANNOT USEthistaxbook if at least one of the following specialfilingsituationsapply: Youarefilinganamendedreturn; Youandyourspousebothhave income; Youhaveincomefromanother state; You have military pay that is nottaxabletoMissouri; Youhaveanetoperatingloss; Youhaveanyofthefollowing Missourimodifications:

a. ositiveornegativeadjustP ments from partnerships, fiduciaries,Scorporations, orothersources; b. onqualified distribution N receivedfromtheMissouri SavingsforTuitionProgram (MOST), Missouri Higher EducationDepositProgram, orotherqualified529Plan; c. xempt contributions E madetoorearningsfrom the Missouri Savings for Tuition Program (MOST), MissouriHigherEducation DepositProgram,orother qualified529plan; d.nterestfromfederalexempt I obligations; e. nterest from state and I localobligations; f. Capitalgainexclusion; g. egativebonusdepreciaN tionadjustments;or h. ailroadretirementmodiR fications. ouareclaiming: Y a.Pensionorsocialsecurity/ social security disability/ militaryexemption;
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b. iscellaneous tax credits M (FormMO-TC); c. roperty tax credit (Form P MO-PTC or Form MOPTS); d. redit made with the C filing of a Form MO-60, Ap li aion for Extension p c t ofTimetoFile; e. deduction for other A federal tax (from Federal Form1040,Lines45,47, 58,59b,andanyrecapture taxesincludedonLine61); f. A deduction for depen dentsage65orolder;or g. health care sharing A ministrydeductionornew jobsdeduction. ouoweapenaltyforunderY paymentofestimatedtax; ouowetaxonalumpsum Y distri utionincludedonyour b FederalForm1040,Line44; ouowerecapturetaxonlow Y incomehousingcredit;or ouareafiscalyearfiler. Y

Do You Have the Wrong Tax Book?

Ifyoudonotqualifytousethis shortform,visitourwebsiteat http://dor.mo.gov/personal/ individual/toobtainthecorrect form. To Obtain Forms: Gotohttp://dor.mo.gov/personal/ individual/. Call Forms-by-Fax System at (573)751-4800fromyourfax machine handset. The system willtakeyouthroughthesteps tofaxacopyoftheform(s)you need. Ifyouneedtoobtainfederalforms, youcangototheIRSwebsiteat www.irs.gov.

IMPORTANT FILING INFORMATION

This information is for guidance only and does not state the complete law.

FILING REQUIREMENTS
YoudonothavetofileaMissouri return if you are not required to file a federal return. If you are required to file a federal return, youmaynothavetofileaMissouri returnifyou: rearesidentandhavelessthan a $1,200 of Missouri adjusted grossincome; reanonresidentwithlessthan a $600ofMissouriincome;or ave Missouri adjusted gross h in omelessthantheamountof c your standard deduction plus theexempionamountforyour t filingstatus. Note: If you are not required to file a Mis ouri return, but you s receivedaFormW-2statingyou had Missouri tax withheld, you must file your Missouri return to getarefundofyourMissouriwithholding. If you are not required to file a Missouri return and you do not anticipate an increase in income, you may consider changingyourFormMOW-4to exempt so your employer will notwithholdMissouritax.

Filing Status IfyoumarkedBox1or2onthe FederalForm1040NR;orBox1 on Federal Form 1040NR-EZ, checkBoxAonFormMO-1040A. IfyoumarkedBox3,4or5and did not claim your spouse as an exemption on Federal Form 1040NR, or if you marked box 2 on Federal Form 1040NR-EZ, checkBoxDonFormMO-1040A. IfyoumarkedBox3,4or5and claimedyourspouseasanexemption on Federal Form 1040NR, checkBoxEonFormMO-1040A. IfyoumarkedBox6onFederal Form1040NR,checkBoxGon FormMO-1040A. Itemized Deductions Nonresidentalienswhoarerequired toitemizetheirdeductionsforfederal purposes must also itemize deductionsontheirMissourireturn. For more detailed information, visithttp://dor.mo.gov/personal/ individual/. Federal Tax Deduction Enter on Form MO-1040A, Line 5theamountfromFederalForm 1040NR,Line52minusLine43, and any amounts from Forms 8801,8839and8885includedon Line67,ortheamountfromFederalForm1040NR-EZ,Line15. Attach a complete copy of your federal return and all supporting documentation. ForallotherlinesofFormMO1040A, see instructions starting onpage6.

If you wish to file a Missouri extension,anddonotexpectto owe Missouri income tax, you may file an extension by filing Form MO-60, Appli aion c t for Exen ion of Time to File. t s Anauto aticextensionoftime m to file will be granted until October15,2012.Ifyoureceive anextensionoftimetofileyour federal income tax return, you will automatically be granted anextensionoftimetofileyour Missouri income tax return, provided you do not expect to owe any additional Missouri income tax. Attach a copy of your federal extension (Federal Form 4868) with your Missouri incometaxreturnwhenyoufile. If you expect to owe Missouri income tax, file Form MO-60 withyourpaymentbytheoriginalduedateofthereturn. Remember: An extension of time to file does not extend the time to pay. A 5 percent addition to tax will apply if the tax is not paid by the original returns due date.

LATE FILING AND PAYMENT

Simple interest is charged on all delinquent taxes. The interest rate will be updated annually and can be found on the DepartmentofRevenueswebsite at http://dor.mo.gov/personal/ individual/. For timely filed returns, an addition to tax charge of 5 per ent (of the unpaid tax) is c addedifthetaxisnotpaidby thereturnsduedate. Forreturnsnotfiledbythedue date, an addition to tax of 5 percent per month (of the unpaid tax) is added for each month the return is not filed. The addition to tax cannot exceed25percent.

NONRESIDENT ALIEN SPECIAL FILING INSTRUCTIONS

Ifyoudonothaveasocialsecuritynumber,enteryouridentifyingnumberinthesocialsecurity number space provided. Enter onFormMO-1040A,Line1the amount from Federal Form 1040NR, Line 36 or Federal Form1040NR-EZ,Line10.

WHEN TO FILE
The 2011 returns are due April 17,2012.

EXTENSION OF TIME TO FILE

You are not required to file an extension if you do not expect to owe additional income tax or if you anticipate receiving a refund.
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Note:Ifyoufileanexen ion,a t s 5percentadditiontotaxcharge will still apply if the tax is not paidbytheoriginalreturnsdue date, provided your return is filedbytheextensiondate.Ifyou areunabletopaythetaxowedin fullontheduedate,pleasevisit the Department of Revenues web site at http://dor.mo.gov/ personal/individual/ for your paymentoptions.

informationandletusdothemath foryou.Nocalculationerrorsmeans fasterprocessing.Justprint,sign,and mailthereturn.Theseformscontain a 2-D barcode at the top right portion of the form. This allows quickerprocessingofyourreturn.

MISSOURI RETURN INQUIRY

To check the status of your current year return 24 hours a day, please visit our web site http://dor.mo.gov/personal/ individual/ or call our automatedindividualincometaxinquirylineat(573)526-8299.To obtainthestatusofyourreturn, youmustknowthefollowinginformation:1)thefirstsocialsecurity number on the return; 2) the filing status shown on your return;and3)theexactamount oftherefundorbalanceduein wholedollars.

purchase is subject to Missouri sales tax or otherwise exempt. A purchaser is required to file a use tax return if the cumulative purchases on which tax was not paidtothesellerexceed$2,000in acalendaryear.Youcanusethe Form4340,ConsumersUseTax Return located on page 15. The due date for Form 4340 is April 17, 2012.

WHERE TO MAIL YOUR RETURN

Ifyouareduearefundorhave no amount due,mailyourreturn andallrequiredattachmentsto: Department of Revenue P.O. Box 500 Jefferson City, MO 65106-0500 Ifyouhaveabalance due,mail your return, payment, and all requiredattach entsto: m Department of Revenue P.O. Box 329 Jefferson City, MO 65107-0329 2-D barcode returns, see page 2.

TAXPAYER BILL OF RIGHTS

ToobtainacopyoftheTaxpayer Bill of Rights,gotoourwebsite athttp://dor.mo.gov/personal/ individual/.

Frequently Asked Questions

Can I file my return now, but pay later? Yes, we encourage youtofileyourreturnasearlyin thetaxfilingseasonaspossible. Youmaypayatanytimeproviding the payment is postmarked no later than April 17, 2012. SeePage8,Line19forpay ent m options. How do I determine my federal tax deduction?Thetaxonyour federalreturnisyourfederaltax amountlesscertaincredits.This amountmaynotexceed$5,000 forasinglefilerand$10,000for acombinedfiler.SeetheinformationandchartonPage6,Line 5toassistyouindeterminingthe taxfromyourfederalreturn. How do I calculate my Missouri tax? If your taxable income is less than $9,000, you can use thetaxtableonthebackofForm MO-1040A, to determine your tax. If your taxable income is greater than $9,000, use the worksheetbelowthetaxtableto calculatethetax.

ADDRESS CHANGE
If you move after filing your return,notifyboththepostoffice servingyouroldaddressandthe Department of Revenue of your address change. Official address change forms can be obtained athttp://dor.mo.gov/personal/ individual/. Address change requests should bemailedto: Department of Revenue, P.O. Box 2200, Jefferson City, MO 65105-2200 Thiswillhelpforwardanyrefund checkorcorrespondencetoyour newaddress.

DOLLARS AND CENTS

Roundingisrequiredonyourtax return.Zeroshavebeenplaced in the cents column on your return. For 1 cent through 49 cents,rounddowntothepreviouswholedollaramount.For50 centsthrough99cents,roundup tothenextwholedollaramount. Example: Round$32.49downto$32.00 Round$32.50upto$33.00

AMENDED RETURN
You must use Form MO-1040 (long form) for the year being amended. See information on page 3 on how to obtain Form MO-1040andinstructions.

CONSUMERS USE TAX

Usetaxisimposedonthestorage, use or consumption of tangible personal property in this state. The state use tax rate is 4.225 percent.Citiesandcountiesmay impose an additional local use tax.Usetaxdoesnotapplyifthe
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FILL-IN FORMS THAT CALCULATE

Gotohttp://dor.mo.gov/personal/ individual/ to enter your tax

Can I claim myself or my spouse as a dependent?No,youcannot includeyourselforyourspouseas dependents.Youcanonlyinclude dependentsclaimedonyourfederalreturn(FederalForm1040A or 1040, Line 6c). See page 7, Line7formoreinformation.

FORM MO-1040A
INFORMATION TO COMPLETE FORM MO-1040A

Youmaycheckthenon-obligated spouse box if your spouse owes the state of Missouri any child supportpay ents,backtaxes,stum dent loans, etc., and you do not want your portion of the refund usedtopaytheamountsowedby your spouse. Debts owed to the InternalRevenueService(IRS)are excludedfromthenon-obligated spouseapportionment. LINE 1 FEDERAL ADJUSTED GROSS INCOME Usethechartbelowtolocateyour incomeonyourfederalreturn.
FEDERAL FORM Federal Form 1040 Federal Form 1040A Federal Form 1040EZ Federal Form 1040X LINE Line 37 Line 21 Line 4 Line 1

NAME, ADDRESS, ETC.

If all the address information is correct on the preprinted label (if available), attach the label to the Form MO-1040A and printortypeyoursocialsecurity number(s)inthespacesprovided. If you did not receive a book withapeel-offlabel,orthelabel is incorrect, print or type your name(s), address, and social securitynumber(s)inthespaces providedonthereturn. Ifthetaxpayerorspousediedin 2011,checktheappropriatebox. If a refund is due to a deceased taxpayer,attachacopyofFederal Form1310anddeathcertificate. 65 OR OLDER, BLIND, 100 PERCENT DISABLED, NON-OBLIGATED SPOUSE If you or your spouse were age 65 or olderorblindandqualifiedforthesedeductionsonyour 2011 federal return, check the appropriateboxes. Youmaycheckthe100 percent disabled box if you are unable to engage in any substantial gainfulactivitybyreasonofany medicallydeterminablephysical or mental impairment that can beexpectedtoresultindeathor haslastedorcanbeexpectedto lastforacontinuousperiodofnot lessthan12months.

b)yourspousehadnoincome andisnotrequiredtofilea federalreturn;and c)your spouse was claimed as an exemption on your return and was not a dependentofsomeoneelse. You must attach a copy of your federal return if you claim this filing status. Only one box may be checked onLine4,BoxesAthroughG. Enter on Line 4 the amount of exemption claimed for your filingstatusonBoxesAthrough G. The amounts are listed on FormMO-1040A. LINE 5 TAX FROM FEDERAL RETURN Usethefollowingcharttolocate yourtaxonyourfederalreturn. This amount is limited based on your filing status, and may not exceed $5,000 for a single filer or $10,000 for combined filers.Do not enter your federal income tax withheld as shown on your Forms W-2 or federal return.
FEDERAL FORM 1040 LINE NUMBERS Line 55 minus Lines 45, 64a, 66, 67, and amounts from Forms 8801, 8839 and 8885 included on Line 71 Line 35 minus Lines 38a and 40 and any alternative minimum tax included on Line 28 Line 10 minus Line 8a Line 8 minus Lines 13 and 14, except amounts from Forms 2439 and 4136

LINE 2 STATE INCOME TAX REFUND Subtract any state income tax refund included in your federal adjusted gross income (Federal Form1040,Line10). LINE 4 FILING STATUS AND EXEMPTION AMOUNT Check the box applicable to your filing status. You must use the same filing status as on your federalreturnwithtwoexceptions: 1.Box Bmustbecheckedifyou are claimed as a dependent on an ther persons federal o tax return and you checked either box on Federal Form 1040EZ,Line5,oryouwere notallowedtocheckBox6a on Federal Forms 1040 or 1040A.If you checked Box B, enter 0. 2.Box Emaybecheckedonly ifallofthefollowingapply: a)youcheckedBox3(married filing separate return) on yourFederalForm1040or 1040A;
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1040A

1040EZ 1040X

If you have an earned income credit, you must subtract the creditfromthetaxonyourfederalreturn.Ifanegativeamount iscalculated,enter0. Ifyouusedamethodotherthan the federal tax table to determineyourfederaltax,attachthe appropriateschedule.

LINE 6 STANDARD OR ITEMIZED DEDUCTIONS Standard Deductions: If you claimed the standard deduction on your federal return, enter the standard deduction amount for yourfilingstatus.Theamountsare listedonFormMO-1040A,Line6. Use the chart below to determine your standard deduction if you or your spouse marked any of the boxes for: 65 or older, blind or claimed as a dependent.
FEDERAL FORM 1040 1040A 1040EZ 1040X LINE NUMBERS Line40 Line24 *Seefollowingnote L ine2

*Note:IfyoufiledaFederalForm 1040EZ, and checked one or both boxes on Line 5, refer to the Federal Standard De ucion d t WorksheetforDependents. If you did not check either box onFederalForm1040EZ,Line5, enter$5,800ifsingleor$11,600 ifmarried. Itemized Deductions: If you itemized on your federal return, youmaywanttoitemizeonyour Missourireturnortakethestandard deduction,whicheverre ultsina s higher deduction. If you were required to itemize on your federal return, you must itemize onyourMissourireturn.Tofigure your itemized deductions, complete the Itemized Deductions Section on the back of Form MO-1040A. Attach a copy of your federal return (pages 1 and 2) and Federal Schedule A. LINE 7 DEPENDENTS Do not include yourself or your spouse as dependents.Multiply thetotalnumberofdependents you claimed on your federal returnby$1,200.Onlyinclude dependents claimed on Federal Form1040Aor1040,Line6c.

LINE 8 LONG-TERM CARE INSURANCE DEDUCTION Ifyoupaidpremiumsforqualifiedlong-termcareinsurancein 2011, you may be eligible for a deduction on your Missouri income tax return. Qualified long-termcareinsuranceisdefined asinsurancecoverageforatleast 12 months for long-term care expenses should such care become necessary because of a chronichealthconditionorphysicaldis bilityincludingcognitive a impairment or the loss of functionalcapacity,thusren erngan d i individualunabletocareforthemselveswithoutthehelpofanother person. Complete the following work heetonlyifyoupaidpremis umsforaqualifiedlong-termcare in ur ncepolicy;andthepolicyis s a foratleast12monthscoverage. Note: You cannot claim a deduction for amounts paid towards death benefits or extended riders. A. Entertheamountpaidfor qualifiedlong-termcare insurance.A)$________ fyouitemizedonyourfederal I returnandyourfederalitemizeddeductionsincluded medicalexpenses,gotoLine B.Ifnot,skiptoH. B. ntertheamountfrom E FederalScheduleA,Line4. B)$_________ C. Entertheamountfrom FederalScheduleA, Line1.C)$_________ D. ntertheamountofqualified E long-termcareincludedin LineC.D)$_________ E. SubtractLineDfromLineC. E)$_________ F. SubtractLineEfromLineB. If amount is less than zero, enter 0.F)$_________ G.SubtractLineFfrom LineA.G)$_________
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H.EnterLineG(orLineAif youdidnothaveto completeLinesBthroughG) onFormMO-1040A,Line8. Attach a copy of your federal return and Federal Schedule A (if you itemized your deductions). LINE 11 TAX IfyourMissouritaxableincome is less than $9,000, use the tax table on the back of the Form MO-1040A. If your Missouri taxable income is more than $9,000,usetheworksheetbelow thetaxtabletocalculatethetax. LINE 12 MISSOURI WITHHOLDING IncludeonlyMissouriwithholding as shown on your Forms W-2,1099,and1099-R.Do not include withholding for federal taxes, local taxes, city earnings taxes, or another states withholding. Attach a copy of all Forms W-2 and 1099. LINE 13 ESTIMATED TAX PAYMENTS Include any estimated tax paymentsmadeonyour2011return and any overpayment applied fromyour2010Missourireturn. LINE 16 APPLY OVERPAYMENT TO NEXT YEARS TAXES You may apply any portion of yourrefundtonextyearstaxes. LINE 17 TRUST FUNDS You may donate part or all of your overpaid amount or contribute additional payments to any of the trust funds listed on Form MO-1040A and any two additionalfunds. Additional Funds:Ifyouchooseto give to any of the additional funds, enter the two-digit code in the spaces provided on Line 17.Ifyouwanttogivetomore than two additional funds, please sub it a contribution m directlytothefund.

See the Departments web site at http://dor.mo.gov/personal/ individual/foradditionalinformation. Funds Codes American Cancer Society Heartland Division, Inc., Fund . . 01 American Diabetes Association Gateway Area Fund . . . . . . 02 American Heart Association Fund . . . . . . . . . . . . . . . . . . 03 American Lung Association of Missouri Fund. . . . . . . . . . . 04 American Red Cross Trust Fund. . 15 Amyotrophic Lateral Sclerosis (ALSLou Gehrigs Disease) Fund . . . . . . . . . . . . . . . . . . 05 Arthritis Foundation Fund. . . . 09 Breast Cancer Awareness Fund . . 13 Cervical Cancer Fund. . . . . . . 12 Developmental Disibilities Waiting List Equity Trust Fund. . 16 Foster Care and Adoptive Recruitment and Retention Fund . . 14 March of Dimes Fund . . . . . . 08 Muscular Dystrophy Association Fund . . . . . . . . . . . . . . . . . . 07 National Multiple Sclerosis Society Fund. . . . . . . . . . . . 10 Puppy Protection Trust Fund . . 17 The minimum contribution is $2, or $4 if married filing combined for the following funds: ChildrensTrustFund,Veterans TrustFund,ElderlyHomeDeliveredMealsTrustFund,Missouri NationalGuardTrustFund,and OrganDonorProgramFund. The minimum contribution is $1, or $2 if married filing com bined for the following funds: WorkersMemorialFund,Childhood Lead Testing Fund, MissouriMilitaryFamilyReliefFund, General Revenue Fund, AfterSchool Retreat Reading and AssessmentGrantProgramFund, BreastCancerAwarenessFund, Foster Care and Adoptive RecruitmentandRetentionFund, American Red Cross Trust Fund, Developmental Disabilities Waiting List Equity Trust Fund, andPuppyProtectionTrustFund.

The following has no minimum contribution and is an irrevocable fund: CervicalCancerFund. The minimum contribution is $1, not to exceed $200, for the following irrevocable trust funds: American Cancer Society HeartlandDivision,Inc.,Fund,AmericanDiabetesAsso i ionGateway c at Area Fund; American Heart Association Fund; American Lung AssociationofMissouriFund;ALS Lou Gehrigs Disease Fund; ArthritisFoundationFund;Marchof DimesFund;MuscularDysrophy t Association Fund; and National MultipleSclerosisSocietyFund. LINE 18 REFUND Subtract Lines 16 and 17 from Line15andenteronLine18. Note: If you have any other liability due the state of Missouri, such as child support payments, or a debt with the Internal Revenue Service, your income tax refund may be applied to that liability in accordance with Section 143.781, RSMo. You will be notified if your refund is offset against any debt(s). LINE 19 AMOUNT DUE Iftheamountdueisgreaterthan $500, you may owe an underpayment of estimated tax penalty.CompleteFormMO-2210, UnderpaymentofEstimatedTax forIndividuals,thatcanbefound on our web site at http://dor. mo.gov/personal/individual/.If you owe a penalty, you cannot file a Form MO-1040A. You must file a Form MO-1040 and attachFormMO-2210. Payments must be postmarked by April 17, 2012, to avoid interestandlatepaymentcharges. The Department of Rev ue en offers several payment options. Check or money order:Attach a check or money order (U.S. fundsonly),payableto:Missouri DepartmentofRevenue.
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Bysubmittingpaymentbycheck, youauthorizetheDepartmentof Revenue to process the check electronicallyuponreceipt.Do not postdate. The De art ent p m of Revenue may electronically resubmit checks returned for insufficientoruncollectedfunds. If you mail your payment after your return is filed, attach your paymenttotheFormMO-1040V foundonpage10. Electronic Bank Draft (E-Check): By entering your bank routing number, checking account number, and your next check number, you can pay onine at l http://dor.mo.gov/personal/ individual/, or by calling (888) 929-0513.Therewillbea$.60 handling fee per filing period/ transactiontousethisservice. Credit Card: The Department accepts MasterCard, Dis over, c Visa,andAmericanExpress.You canpayonlineathttp://dor.mo. gov/personal/individual/, or by calling (888) 929-0513. The convenience fees listed below will be charged to your accountforprocessingcreditcard payments: Note: Theconveniencefeesfor these transactions are paid to the third party vendor, not to the Missouri Department of Revenue. By accessing this paymentsystem,theuserwillbe leavingMissouriswebsiteand connectingtothewebsiteofthe third party vendor, which is a secureandconfidentialwebsite.
Tax Paid Convenience Fee

$0.00$33.00 $33.01$100.00 $100.01$250.00 $250.01$500.00 $500.01$750.00 $750.01$1,000.00 $1,000.01$1,500.00 $1,500.01$2,000.00 $2,000.01 or more

$1.00 3.00% 2.95% 2.85% 2.85% 2.80% 2.75% 2.70% 2.60%

SIGN RETURN Youmust signFormMO-1040A. Both spouses must sign a combined return. If you use a paid preparer, the preparer must also signthereturn.Ifyouwishtoauthorize the Director of Revenue to release information regarding yourtaxaccounttoyourpreparer oranymemberofyourpreparers firm, indicate by checkng the i yesboxabovethesignatureline. ATTACHMENTS AllFormsW-2and1099 opy of federal return and C Federal Schedule A. if you itemized your deductions on Line 6, Missouri Itemized Deductions if you have an entry on Line 8, Long-term Care Insurance Deduction MAIL FORM MO-1040A, ATTACHMENTS, AND PAYMENT (IF NECESSARY) TO: Ifyouareduearefundorhave no amount due,mailyourreturn andallrequiredattachmentsto: Department of Revenue P.O. Box 500 Jefferson City, MO 65106-0500 Ifyouhaveabalance due,mail your return, payment, and all re uiredattach entsto: q m Department of Revenue P.O. Box 329 Jefferson City, MO 65107-0329 2-D barcode returns, see page 2.

LINE 1 FEDERAL ITEMIZED DEDUCTIONS Include your total federal itemized deductions from Federal Form 1040, Line 40, and any approvedculturalcontributions (literary, musical, scholastic, or artistic)toataxexemptagency or institution that is operated on a not-for-profit basis. Cash contributions do not qualify. LINE 2 SOCIAL SECURITY TAX (FICA) Socialsecuritytaxistheamount inthesocialsecuritytaxwithheld boxonFormsW-2.The amount cannot exceed $4,486.Medicare istheamountintheMedicaretax withheldboxonyourFormsW-2. EnterthetotalonLine2.Seediagramonpage16. LINE 3 RAILROAD RETIREMENT TAX Include the amount of railroad retirement tax withheld from your wages, Tier I and Tier II, during 2011. The amount cannot exceed $7,575. (Tier I maximumof$4,486andTierII maximumof$3,089.) If you have both FICA and railroad retirement tax, the maximum deduction allowed is the amount withheld as shown on the Forms W-2 less, either the amount entered on Federal Form 1040, Line 69, or, if only one employer, the amount refunded by the employer. LINE 4 SELF-EMPLOYMENT TAX IncludetheamountfromFederal Form1040,Line56minusLine 27 or Federal Form 1040NR, Line54minusLine27.

LINE 6 STATE AND LOCAL INCOME TAXES Include the amount of income taxes from Federal Form 1040, ScheduleA,Line5.Theamount you paid in state income taxes includedinyourfederalitemized deductions, must be subtracted to determine Missouri itemized deductions. LINE 7 EARNINGS TAXES If you entered an amount on Line 6 and you live or work in theKansasCityorSt.Louisarea, you may have included earnings taxes. Include on Line 7 the amount of earnings taxes withheldshownonFormsW-2. Seediagramonpage16. LINE 9 TOTAL MISSOURI ITEMIZED DEDUCTIONS If your total Missouri itemized deductions are less than your standard deduction (see Page 7, Line 6), you should take the standarddeductiononthefront of Form MO-1040A, Line 6, unless you were required to itemizeyourfederaldeductions.

Missouri Itemized Deductions

You cannot itemize your Missouri deductions if you took the standard deduction on your federal return. See Page 7, Line 6. You must itemize your Missouri deductions if you were required to itemize on your federal return.

MISSOURI DEPARTMENT OF REVENUE

INDIVIDUAL INCOME TAX PAYMENT VOUCHER INSTRUCTIONS

What Is Form MO-1040V and Why Should I Use It? Form MO-1040V, Individual Income Tax Payment Voucher, is the voucher you send with your payment when you do not make the payment with your income tax return. It is similar to vouchers returned with loan, utility, and credit card payments. Form MO-1040V ensures that your payment will be processed more efficiently and accurately. Form MO-1040V allows you to file your completed income tax return and send your payment at a later date. Your income tax return and payment are due no later than April 17, 2012. When Should I Use Form MO-1040V? If you have an amount due on an electronically filed return, or do not submit payment in full when you file your income tax return, send Form MO-1040V with your payment. How Do I Fill In the Payment Voucher? Complete the name(s) and address block. Use the label from the front cover of your book if the address information on the label is correct. Line 1 Enter your social security number (SSN) on Line 1. If you are filing a combined return, enter on Line 1 the first SSN as shown on your return. Line 2 Enter the first four letters of your last name on Line 2. See examples. NAME ENTER John Brown BROW Juan De Jesus DEJE Please use capital Joan A. Lee LEE letters as shown. Jean McCarthy MCCA John ONeill ONEI Pedro Torres-Lopez TORR Line 3 If you are filing a combined return, enter on Line 3 your spouses SSN. Line 4 Enter the first four letters of your spouses last name on Line 4. See examples for Line 2, above. Line 5 Enter the amount of your payment in whole dollars on Line 5. How Do I Make My Payment? Make your check or money order payable to the Missouri Department of Revenue. Do not send cash (U.S. funds only). Do not postdate your check; it will be cashed upon receipt. The Department of Revenue may collect checks returned for insufficient or uncollected funds electronically. Write your name, address, SSN, daytime telephone number, and 2011 MO Income Tax on your check or money order. Detach the payment voucher at the perforation, and mail with your payment. Please mail your Form MO-1040V and payment to: Missouri Department of Revenue P.O. Box 371 Jefferson City, MO 65105-0371 Please print as shown below in black or dark blue ink. Do not use red ink or pencil.

2 3 4

A B C D

Federal Privacy Notice

TheFederalPrivacyActrequirestheMissouriDepartmentofRevenue(Department)toinform taxpayersoftheDepartmentslegalauthorityforrequestingidentifyinginformation,including socialsecuritynumbers,andtoexplainwhytheinformationisneededandhowtheinformationwillbeused. Chapter143oftheMissouriRevisedStatutesauthorizestheDepartmenttorequestinformationnecessarytocarryoutthetaxlawsofthestateofMissouri.Federallaw42U.S.C.Section 405(c)(2)(C)authorizesthestatestorequiretaxpayerstoprovidesocialsecuritynumbers. TheDepartmentusesyoursocialsecuritynumbertoidentifyyouandprocessyourtaxreturns andotherdocuments,todetermineandcollectthecorrectamountoftax,toensureyouare complyingwiththetaxlaws,andtoexchangetaxinformationwiththeInternalRevenue Service,otherstates,andtheMultistateTaxCommission(Chapters32and143,RSMo).In addition,statutorilyprovidednon-taxusesare:(1)toprovideinformationtotheDepartment ofHigherEducationwithrespecttoapplicantsforfinancialassistanceunderChapter173, RSMoand(2)tooffsetrefundsagainstamountsduetoastateagencybyapersonorentity (Chapter143,RSMo).Informationfurnishedtootheragenciesorpersonsshallbeusedsolely forthepurposeofadministeringtaxlawsorthespecificlawsadministeredbytheperson havingthestatutoryrighttoobtainit[asindicatedabove].Inaddition,informationmaybe disclosedtothepublicregardingthenameofataxcreditrecipientandtheamountissuedto suchrecipient(Chapter135,RSMo).(FortheDepartmentsauthoritytoprescribeformsand torequirefurnishingofsocialsecuritynumbers,seeChapters135,143,and144,RSMo.) Youarerequiredtoprovideyoursocialsecuritynumberonyourtaxreturn.Failuretoprovideyoursocialsecuritynumberorprovidingafalsesocialsecuritynumbermayresultin criminalactionagainstyou.

MO 860-2715 (12-2011)

2011
INDIVIDUAL INCOME TAX PAYMENT VOUCHER
FORM

1. Social security number ............. 2. 3. 4.

MO-1040V

PLEASE PRINT. MAKE CHECK PAYABLE TO MISSOURI DEPARTMENT OF REVENUE. MAIL FORM MO-1040V AND PAYMENT TO THE MISSOURI DEPARTMENT OF REVENUE, P.O. BOX 371, JEFFERSON CITY, MO 65105-0371.
NAME

* Name control ............................ * Spouses social security number ............. * Spouses name control ........................... *
$

SPOUSES NAME

5. Amount of payment (U.S. funds only) ............

0 0

STREET ADDRESS

CITY

STATE ZIP CODE

FULL PAYMENT OF TAXES MUST BE SUBMITTED BY APRIL 17, 2012 TO AVOID INTEREST AND ADDITION TO TAX FOR FAILURE TO PAY. If you pay by check, you authorize the Department of Revenue to process the check electronically. Any returned check may be presented again electronically. PLEASE SEND CHECK OR MONEY ORDER (U.S. FUNDS ONLY)
MO 860-2715 (12-2011)

DOR USE ONLY

* *

10

MISSOURI INDIVIDUAL INCOME TAX RETURN SINGLE/MARRIED (INCOME FROM ONE SPOUSE)SHORT FORM
LAST NAME FIRST NAME

2011 FORM MO-1040A

SOFTWARE VENDOR CODE (Assigned by DOR)

MIDDLE INITIAL DECEASED SOCIAL SECURITY NUMBER 2011 MIDDLE INITIAL DECEASED SPOUSES SOCIAL SECURITY NUMBER 2011

SPOUSES LAST NAME

FIRST NAME

000

IN CARE OF NAME (ATTORNEY, EXECUTOR, PERSONAL REPRESENTATIVE, ETC.)

COUNTY OF RESIDENCE

PRESENT ADDRESS (INCLUDE APARTMENT NO. OR RURAL ROUTE)

CITY, TOWN, OR POST OFFICE, STATE, AND ZIP CODE

PLEASE CHECK THE APPROPRIATE BOXES THAT APPLY TO YOURSELF OR YOUR SPOUSE.

AGE 65 OR OLDER
YOURSELF SPOUSE

BLIND
YOURSELF SPOUSE

100% DISABLED
YOURSELF SPOUSE

NON-OBLIGATED SPOUSE
YOURSELF SPOUSE

1. Federal adjusted gross income from your 2011 Federal Forms 1040Line 37; 1040ALine 21; or 1040EZLine 4 .................................................................................................................... 2. Any state income tax refund included in your 2011 federal adjusted gross income ............................................. 3. Total Missouri adjusted gross income Subtract Line 2 from Line 1. ................................................................. 4. Mark your filing status box below and enter the appropriate exemption amount on Line 4. A. Single $2,100 (See Box B before checking.) B. Claimed as a dependent on another persons federal tax return $0.00 C. Married filing joint federal & combined Missouri $4,200 Check which spouse had income: Yourself Spouse 5. Tax from federal return (Do not enter federal income tax withheld.) 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

INCOME

1 2 3 =

00 00 00

DEDUCTIONS

00

Enter this amount on Line 5 or $5,000, whichever is less. If married filing combined, enter this amount on Line 5 or $10,000, whichever is less. ........................................... 5

6. Missouri standard deduction or itemized deductions. Single or Married Filing Separate $5,800; Head of Household $8,500; Married Filing a Combined Return or Qualifying Widow(er) $11,600. 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. ..................................................................................................................... 7. Number of dependents you claimed on your Federal Form 1040 or 1040A, Line 6c (Do not include yourself or your spouse.) ........................................................... x $1,200 = .............. 8. Long-term care insurance deduction ...................................................................................................................... 9. Total Deductions Add Lines 4 through 8............................................................................................................

10. Missouri Taxable Income Subtract Line 9 from Line 3....................................................................................... 10 11. Tax Use the tax table on the back of this form to figure the tax......................................................................... 11 12. Missouri tax withheld from your Forms W-2 and Forms 1099. Attach copies of Forms W-2 and Forms 1099. .... 12 13. Any Missouri estimated tax payments made for 2011............................................................................................. 13 14. Total Payments Add Lines 12 and 13. ............................................................................................................... 14 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 19.) .......................................................................................... 15

0 2
DATE DAYTIME TELEPHONE

1 1

00

6 + 7 + 8 + 9 =

00 00 00 00 00 00 00 00 00 00 00
Additional Additional Fund Code Fund Code (See Instr.) (See Instr.) ______|______ ______|______

REFUND

TAX

16. Amount from Line 15 that you want applied to your 2012 estimated tax. ............................................................ 16 17. Enter the amount G Workers LEAD of your donation in R Missouri Missouri the trust fund boxes Childrens Military Childhood Elderly Home National Guard General Veterans After School Workers Trust Fund Delivered Meals Trust Fund Memorial Fund Lead Testing Family Relief Organ Donor Revenue Retreat to the right. See the Trust Fund Trust Fund Fund Fund Fund Fund Program Fund instructions for 00 00 00 00 00 00 00 00 00 00 fund codes. ........ 17.
eneral evenue

00

00 00 00

18. Subtract Lines 16 and 17 from Line 15 and enter here. This is your refund. Sign below and mail to: Department of Revenue, P.O. Box 500, Jefferson City, MO 65106-0500. ......................................... REFUND 18

AMOUNT DUE

19. 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 329, Jefferson City, MO 65107-0329. ........................AMOUNT YOU OWE 19

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.
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/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.

SIGNATURE

I authorize the Director of Revenue or delegate to discuss my return and attachments with the preparer or any member of the preparers firm. YES NO
SIGNATURE

E-MAIL ADDRESS

PREPARERS PHONE

(
PREPARERS SIGNATURE

)
FEIN, SSN, OR PTIN

SPOUSES SIGNATURE

PREPARERS ADDRESS AND ZIP CODE

DATE

)
For Privacy Notice, see instructions.
MO 860-2205 (12-2011)

11

FORM MO-1040A

PAGE 2

MISSOURI ITEMIZED DEDUCTIONS

ompletethissectiononlyifyouitemizeddeductionsonyourfederalreturn.(Seetheinformationonpage7.) C AttachacopyofyourFederalForm1040(pages1and2)andFederalScheduleA. 1. Total federal itemized deductions from Federal Form 1040, Line 40 . . . . . . . . . . . . . . . . . . . 2. 2011 (FICA) Social security $ ________________________ + Medicare $ ________________________ . . . . . . . . . . 3. 2011 Railroad retirement tax (Tier I and Tier II) $ ________________________ + Medicare $ ________________________ . . . . . . . . . . 4. 2011 Self-employment tax See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. TOTAL Add Lines 1 through 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. State and local income taxes See instructions on page 9. . . . . . . . 7. Earnings taxes included in Line 6 See instructions on page 9. . . . . 6 7 1 2 3 4 5

00 00 00 00 00

00 00
8 9

8. Net state income taxes Subtract Line 7 from Line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. MISSOURI ITEMIZED DEDUCTIONS Subtract Line 8 from Line 5. Enter here and on front of form, Line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

00 00

NOTE: IF LINE 9 IS LESS THAN YOUR FEDERAL STANDARD DEDUCTION, SEE INFORMATION ON PAGE 7.

2011 TAX TABLE

If Missouri taxable income from Form MO-1040A, Line 10, is less than $9,000, use the table to figure tax; if more than $9,000, use worksheet below or use the online tax calculator at http://dor.mo.gov/personal/individual/.
If Line 10 is But At less least than If Line 10 is But At less least than If Line 10 is But At less least than If Line 10 is But At less least than If Line 10 is But At less least than If Line 10 is But At less least than

Your tax is

Your tax is

Your tax is

Your tax is

Your tax is

Your tax is

0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400

100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500

$ 0 2 4 5 7 8 10 11 13 14 16 18 20 22 24

1,500 1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900

1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900 3,000

$ 26 28 30 32 34 36 39 41 44 46 49 51 54 56 59

3,000 3,100 3,200 3,300 3,400 3,500 3,600 3,700 3,800 3,900 4,000 4,100 4,200 4,300 4,400

3,100 3,200 3,300 3,400 3,500 3,600 3,700 3,800 3,900 4,000 4,100 4,200 4,300 4,400 4,500

$ 62 65 68 71 74 77 80 83 86 89 92 95 99 102 106

4,500 4,600 4,700 4,800 4,900 5,000 5,100 5,200 5,300 5,400 5,500 5,600 5,700 5,800 5,900

4,600 4,700 4,800 4,900 5,000 5,100 5,200 5,300 5,400 5,500 5,600 5,700 5,800 5,900 6,000

$109 113 116 120 123 127 131 135 139 143 147 151 155 159 163

6,000 6,100 6,200 6,300 6,400 6,500 6,600 6,700 6,800 6,900 7,000 7,100 7,200 7,300 7,400

6,100 6,200 6,300 6,400 6,500 6,600 6,700 6,800 6,900 7,000 7,100 7,200 7,300 7,400 7,500

$167 172 176 181 185 190 194 199 203 208 213 218 223 228 233

7,500 7,600 7,700 7,800 7,900 8,000 8,100 8,200 8,300 8,400 8,500 8,600 8,700 8,800 8,900 9,000

7,600 7,700 7,800 7,900 8,000 8,100 8,200 8,300 8,400 8,500 8,600 8,700 8,800 8,900 9,000

$238 243 248 253 258 263 268 274 279 285 290 296 301 307 312 315

Yourself/Spouse

Example $ 12,000 $ 9,000 = $ x = $ + $ = $ 3,000 6% 180 315 495

FIGURING TAX OVER $9,000

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

$ _______________ $ 9,000 = $ _______________ x 6% = $ _______________ + $ 315 = $ _______________

If more than $9,000, tax is $315 PLUS 6 percent of excess over $9,000.
Round to nearest whole dollar and enter on front of form, Line 11.

MO 860-2205 (12-2011)

12

MISSOURI INDIVIDUAL INCOME TAX RETURN SINGLE/MARRIED (INCOME FROM ONE SPOUSE)SHORT FORM
LAST NAME FIRST NAME

2011 FORM MO-1040A

SOFTWARE VENDOR CODE (Assigned by DOR)

MIDDLE INITIAL DECEASED SOCIAL SECURITY NUMBER 2011 MIDDLE INITIAL DECEASED SPOUSES SOCIAL SECURITY NUMBER 2011

SPOUSES LAST NAME

FIRST NAME

000

IN CARE OF NAME (ATTORNEY, EXECUTOR, PERSONAL REPRESENTATIVE, ETC.)

COUNTY OF RESIDENCE

PRESENT ADDRESS (INCLUDE APARTMENT NO. OR RURAL ROUTE)

CITY, TOWN, OR POST OFFICE, STATE, AND ZIP CODE

PLEASE CHECK THE APPROPRIATE BOXES THAT APPLY TO YOURSELF OR YOUR SPOUSE.

AGE 65 OR OLDER
YOURSELF SPOUSE

BLIND
YOURSELF SPOUSE

100% DISABLED
YOURSELF SPOUSE

NON-OBLIGATED SPOUSE
YOURSELF SPOUSE

1. Federal adjusted gross income from your 2011 Federal Forms 1040Line 37; 1040ALine 21; or 1040EZLine 4 .................................................................................................................... 2. Any state income tax refund included in your 2011 federal adjusted gross income ............................................. 3. Total Missouri adjusted gross income Subtract Line 2 from Line 1. ................................................................. 4. Mark your filing status box below and enter the appropriate exemption amount on Line 4. A. Single $2,100 (See Box B before checking.) B. Claimed as a dependent on another persons federal tax return $0.00 C. Married filing joint federal & combined Missouri $4,200 Check which spouse had income: Yourself Spouse 5. Tax from federal return (Do not enter federal income tax withheld.) 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

INCOME

1 2 3 =

00 00 00

DEDUCTIONS

00

Enter this amount on Line 5 or $5,000, whichever is less. If married filing combined, enter this amount on Line 5 or $10,000, whichever is less. ........................................... 5

6. Missouri standard deduction or itemized deductions. Single or Married Filing Separate $5,800; Head of Household $8,500; Married Filing a Combined Return or Qualifying Widow(er) $11,600. 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. ..................................................................................................................... 7. Number of dependents you claimed on your Federal Form 1040 or 1040A, Line 6c (Do not include yourself or your spouse.) ........................................................... x $1,200 = .............. 8. Long-term care insurance deduction ...................................................................................................................... 9. Total Deductions Add Lines 4 through 8............................................................................................................

10. Missouri Taxable Income Subtract Line 9 from Line 3....................................................................................... 10 11. Tax Use the tax table on the back of this form to figure the tax......................................................................... 11 12. Missouri tax withheld from your Forms W-2 and Forms 1099. Attach copies of Forms W-2 and Forms 1099. .... 12 13. Any Missouri estimated tax payments made for 2011............................................................................................. 13 14. Total Payments Add Lines 12 and 13. ............................................................................................................... 14 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 19.) .......................................................................................... 15

0 2
DATE DAYTIME TELEPHONE

1 1

00

6 + 7 + 8 + 9 =

00 00 00 00 00 00 00 00 00 00 00
Additional Additional Fund Code Fund Code (See Instr.) (See Instr.) ______|______ ______|______

REFUND

TAX

16. Amount from Line 15 that you want applied to your 2012 estimated tax. ............................................................ 16 17. Enter the amount G Workers LEAD of your donation in R Missouri Missouri the trust fund boxes Childrens Military Childhood Elderly Home National Guard General Veterans After School Workers Trust Fund Delivered Meals Trust Fund Memorial Fund Lead Testing Family Relief Organ Donor Revenue Retreat to the right. See the Trust Fund Trust Fund Fund Fund Fund Fund Program Fund instructions for 00 00 00 00 00 00 00 00 00 00 fund codes. ........ 17.
eneral evenue

00

00 00 00

18. Subtract Lines 16 and 17 from Line 15 and enter here. This is your refund. Sign below and mail to: Department of Revenue, P.O. Box 500, Jefferson City, MO 65106-0500. ......................................... REFUND 18

AMOUNT DUE

19. 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 329, Jefferson City, MO 65107-0329. ........................AMOUNT YOU OWE 19

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.
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/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.

SIGNATURE

I authorize the Director of Revenue or delegate to discuss my return and attachments with the preparer or any member of the preparers firm. YES NO
SIGNATURE

E-MAIL ADDRESS

PREPARERS PHONE

(
PREPARERS SIGNATURE

)
FEIN, SSN, OR PTIN

SPOUSES SIGNATURE

PREPARERS ADDRESS AND ZIP CODE

DATE

)
For Privacy Notice, see instructions.
MO 860-2205 (12-2011)

13

FORM MO-1040A

PAGE 2

MISSOURI ITEMIZED DEDUCTIONS

ompletethissectiononlyifyouitemizeddeductionsonyourfederalreturn.(Seetheinformationonpage7.) C AttachacopyofyourFederalForm1040(pages1and2)andFederalScheduleA. 1. Total federal itemized deductions from Federal Form 1040, Line 40 . . . . . . . . . . . . . . . . . . . 2. 2011 (FICA) Social security $ ________________________ + Medicare $ ________________________ . . . . . . . . . . 3. 2011 Railroad retirement tax (Tier I and Tier II) $ ________________________ + Medicare $ ________________________ . . . . . . . . . . 4. 2011 Self-employment tax See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. TOTAL Add Lines 1 through 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. State and local income taxes See instructions on page 9. . . . . . . . 7. Earnings taxes included in Line 6 See instructions on page 9. . . . . 6 7 1 2 3 4 5

00 00 00 00 00

00 00
8 9

8. Net state income taxes Subtract Line 7 from Line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. MISSOURI ITEMIZED DEDUCTIONS Subtract Line 8 from Line 5. Enter here and on front of form, Line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

00 00

NOTE: IF LINE 9 IS LESS THAN YOUR FEDERAL STANDARD DEDUCTION, SEE INFORMATION ON PAGE 7.

2011 TAX TABLE

If Missouri taxable income from Form MO-1040A, Line 10, is less than $9,000, use the table to figure tax; if more than $9,000, use worksheet below or use the online tax calculator at http://dor.mo.gov/personal/individual/.
If Line 10 is But At less least than If Line 10 is But At less least than If Line 10 is But At less least than If Line 10 is But At less least than If Line 10 is But At less least than If Line 10 is But At less least than

Your tax is

Your tax is

Your tax is

Your tax is

Your tax is

Your tax is

0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400

100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500

$ 0 2 4 5 7 8 10 11 13 14 16 18 20 22 24

1,500 1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900

1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900 3,000

$ 26 28 30 32 34 36 39 41 44 46 49 51 54 56 59

3,000 3,100 3,200 3,300 3,400 3,500 3,600 3,700 3,800 3,900 4,000 4,100 4,200 4,300 4,400

3,100 3,200 3,300 3,400 3,500 3,600 3,700 3,800 3,900 4,000 4,100 4,200 4,300 4,400 4,500

$ 62 65 68 71 74 77 80 83 86 89 92 95 99 102 106

4,500 4,600 4,700 4,800 4,900 5,000 5,100 5,200 5,300 5,400 5,500 5,600 5,700 5,800 5,900

4,600 4,700 4,800 4,900 5,000 5,100 5,200 5,300 5,400 5,500 5,600 5,700 5,800 5,900 6,000

$109 113 116 120 123 127 131 135 139 143 147 151 155 159 163

6,000 6,100 6,200 6,300 6,400 6,500 6,600 6,700 6,800 6,900 7,000 7,100 7,200 7,300 7,400

6,100 6,200 6,300 6,400 6,500 6,600 6,700 6,800 6,900 7,000 7,100 7,200 7,300 7,400 7,500

$167 172 176 181 185 190 194 199 203 208 213 218 223 228 233

7,500 7,600 7,700 7,800 7,900 8,000 8,100 8,200 8,300 8,400 8,500 8,600 8,700 8,800 8,900 9,000

7,600 7,700 7,800 7,900 8,000 8,100 8,200 8,300 8,400 8,500 8,600 8,700 8,800 8,900 9,000

$238 243 248 253 258 263 268 274 279 285 290 296 301 307 312 315

Yourself/Spouse

Example $ 12,000 $ 9,000 = $ x = $ + $ = $ 3,000 6% 180 315 495

FIGURING TAX OVER $9,000

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

$ _______________ $ 9,000 = $ _______________ x 6% = $ _______________ + $ 315 = $ _______________

If more than $9,000, tax is $315 PLUS 6 percent of excess over $9,000.
Round to nearest whole dollar and enter on front of form, Line 11.

MO 860-2205 (12-2011)

14

MISSOURI DEPARTMENT OF REVENUE

FORM

TAX PERIOD

DUE DATE

2011 INDIVIDUAL CONSUMERS USE TAX RETURN

LAST NAME FIRST NAME SPOUSES LAST NAME FIRST NAME

4340
REV. 122011

Jan. Dec. 11 (201112)

04/17/2012
INITIAL SOCIAL SECURITY NO.

INITIAL

SPOUSES SOCIAL SECURITY NO.

ADDRESS

TAXABLE PURCHASES
STATE ZIP CODE

TAX RATE

CONSUMERS USE TAX

CITY

A. B.

1.

__ __ __ __ __
I have direct control, supervision, or responsibility for filing this return and payment of the tax due. Under penalties of perjury, I declare that this is a true, accurate, and complete return.
SIGNATURE(S) DATE

4.225%

2. 3.

Total Individual Consumers Use Tax Due (U.S. funds only) ...........
DAYTIME TELEPHONE

__/__/____

DOR (__ __ __) __ __ __ __ __ __ __ ONLY

MAKE CHECK PAYABLE TO: MISSOURI DEPARTMENT OF REVENUE. MAIL TO MISSOURI DEPARTMENT OF REVENUE, PO BOX 840, JEFFERSON CITY, MO 651050840. DO NOT SEND WITH INDIVIDUAL INCOME TAX RETURN. 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.
MO 860-2442 (12-2011)

MISSOURI DEPARTMENT OF REVENUE

INDIVIDUAL CONSUMERS USE TAX INSTRUCTIONS

What is Consumers Use Tax? Use tax is imposed on the storage, use, or consumption of tangible personal property in this state. You must pay consumers use tax on tangible personal property stored, used, or consumed in Missouri unless you paid tax to the seller or the property is exempt from tax. What is Taxable? If an out-of-state seller does not collect use tax from the purchaser, the purchaser is responsible for remitting the use tax to Missouri (unless the property is purchased for resale or otherwise exempt by statute). Also, a seller not engaged in business is not required to collect Missouri tax but the purchaser in these instances is responsible for remitting use tax to Missouri. A purchaser is required to file a use tax return if the cumulative purchases subject to use tax exceed $2,000 in a calendar year. Use tax is computed on the purchase price of the goods. Example: Mr. Smith, located in Unionville, Missouri, purchases cleaning supplies from two companies, Company X and Company Y. Company X and Company Y are both located in Des Moines, Iowa, and do all their business in Missouri strictly by mail order. During October 2011, Mr. Smith purchased $4,000 worth of merchandise from each company. Company X is registered with the Department of Revenue and collects the use tax on Mr. Smiths purchases. Company Y is not registered, does not collect the tax, and does not file a return with the state of Missouri. Mr. Smith must file a consumers use tax return indicating the amount of purchases ($4,000) from Company Y and pay the use tax on those purchases applicable for Unionville, MO ($4,000 x 4.225% = $169). He must send his use tax return, along with a check, to the Missouri Department of Revenue. Purchases which may be subject to use tax include: Catalog purchases Magazine subscriptions Crossborder purchases of goods TV marketing purchases Computer software and hardware Mailorder supply purchases Furniture and equipment purchases from outofstate sellers Purchases of goods bought over the Internet Purchases of goods bought over the telephone

This form is not intended for use by businesses. Businesses that have a use tax liability should contact the Department of Revenue. See the address and phone number below.
HOW TO FILE Compile a list of purchases made during 2011 for which you have not previously paid Missouri sales or use tax. This information is available from invoices, bills, credit card statements, cancelled checks, etc. The total of all purchases during the year that were not previously taxed must be used in computing the amount of use tax due on the above 2011 Individual Consumers Use Tax Return. The due date for filing the return is April 17, 2012. TAXABLE PURCHASES/TAX RATE The tax rate you must use to figure your consumers use tax due is determined by the use tax rate in effect where you reside. The use tax rate for Missouri is 4.225 percent unless the city or county for your residential location has enacted a local option use tax, which will increase the tax rate. The correct use tax rate can be found at: http://dor.mo.gov/business/sales/rates/2011/. Use the USE RATE column. If the use tax rate is greater than 4.225 percent, enter your taxable purchases on Line A and the applicable tax rate. If the use tax rate is 4.225 percent, enter your taxable purchases on Line B and compute the amount due at the state use tax rate of 4.225 percent. You may be required to use both Lines A and B if you resided in different locations during 2011. CONSUMERS USE TAX Multiply taxable purchases (Line(s) A and B) by the appropriate tax rate and enter the amount on Line(s) 1 and 2. TOTAL INDIVIDUAL CONSUMERS USE TAX DUE Add Lines 1 and 2 and enter the amount on Line 3. Make your remittance payable to Missouri Department of Revenue (U.S. funds only). Do not combine your use tax liability with your individual income tax liability or mail it with your individual income tax return. Do not send cash. You may not use your individual income tax refund to pay your use tax liability. Sign and date the return. MAIL TO: Department of Revenue P.O. Box 840 Jefferson City, MO 65105-0840 For questions regarding the Missouri consumers use tax, please e-mail salesuse@dor.mo.gov or call (573) 751-2836. Speech and hearing impaired may use TDD (800) 735-2966 or fax (573) 526-1881.

Why am I required to file? When you make purchases on which the seller is not required to collect the tax you must pay the tax directly to the state of Missouri.

The use tax rates may be found on the internet at http://dor.mo.gov/business/sales/rates/2011/. Use the USE RATE column to ensure correct rates.
For Privacy Notice, see instructions.
MO 860-2442 (12-2011)

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MISSOURI DEPARTMENT OF REVENUE JEFFERSON CITY, MO 65105-2200 Pleaseplacethislabel intheaddressarea ofyourreturn. Donotusethis labelifitisincorrect.

PRSRT STD U.S.POSTAGE PAID MissouriDept. ofRevenue

Missouri Department of Revenue Tax Assistance Centers

Public Office Hours are 8:00 a.m. to 5:00 p.m. Monday through Friday IndividualswithspeechorhearingimpairmentsmayuseTDD(800)735-2966orfax(573)526-1881. Cape Girardeau
3102BlattnerDr.,Suite102 (573)290-5850 (573)751-7191 (417)629-3070 (816)889-2944

Other Important Phone Numbers

Forms-by-Fax GeneralInquiryLine AutomatedRefund/BalanceDue/ 1099GInquiry ElectronicFilingInformation (573)751-4800 (573)751-3505 (573)526-8299 (573)751-3930

Jefferson City
301WestHighSt.,Room330

Joplin

1110East7thSt.,Suite400

Kansas City
615East13thSt.,RoomB-2

Springfield
149ParkCentralSquare,Room313 (417)895-6474

Download forms or check the status of your return on our web site: http://dor.mo.gov/personal/individual/. YoucanobtainacopyoftheTaxpayer BillofRightsonourwebsiteat http://dor.mo.gov/personal/individual/.

St. Louis
3256LacledeStationRd.,Suite101 (314)877-0177

St. Joseph
525Jules,Room314 (816)387-2230

Diagram 1: Form W-2

Federal Privacy Notice

TheFederalPrivacyActrequirestheMissouriDepartmentofRevenue (Department)toinformtaxpayersoftheDepartmentslegalauthorityfor requestingidentifyinginformation,includingsocialsecuritynumbers, andtoexplainwhytheinformationisneededandhowtheinformation willbeused. Chapter143oftheMissouriRevisedStatutesauthorizestheDepartment torequestinformationnecessarytocarryoutthetaxlawsofthestateof Missouri.Federallaw42U.S.C.Section405(c)(2)(C)authorizesthestates torequiretaxpayerstoprovidesocialsecuritynumbers. TheDepartmentusesyoursocialsecuritynumbertoidentifyyouand processyourtaxreturnsandotherdocuments,todetermineandcollectthecorrectamountoftax,toensureyouarecomplyingwiththe taxlaws,andtoexchangetaxinformationwiththeInternalRevenue Service,otherstates,andtheMultistateTaxCommission(Chapters32 and143,RSMo).Inaddition,statutorilyprovidednon-taxusesare:(1)to provideinformationtotheDepartmentofHigherEducationwithrespect toapplicantsforfinancialassistanceunderChapter173,RSMoand(2) tooffsetrefundsagainstamountsduetoastateagencybyapersonor entity(Chapter143,RSMo).Informationfurnishedtootheragenciesor personsshallbeusedsolelyforthepurposeofadministeringtaxlaws or the specific laws administered by the person having the statutory righttoobtainit[asindicatedabove].Inaddition,informationmay bedisclosedtothepublicregardingthenameofataxcreditrecipient andtheamountissuedtosuchrecipient(Chapter135,RSMo).(Forthe Departmentsauthoritytoprescribeformsandtorequirefurnishingof socialsecuritynumbers,seeChapters135,143,and144,RSMo). Youarerequiredtoprovideyoursocialsecuritynumberonyourtax return.Failuretoprovideyoursocialsecuritynumberorprovidinga falsesocialsecuritynumbermayresultincriminalactionagainstyou.

Missouri Taxes Withheld

Earnings Tax

2011
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