Electronic Filing Instructions for your 2013 Federal Tax Return

Important: Your taxes are not finished until all required steps are completed.

Robert W & Heidi J Meyer

835 Woodlawn Ave
Chesterton, IN 46304-0000
|
Balance | Your federal tax return (Form 1040A) shows a refund due to you in the
Due/ | amount of $7,787.00. Your tax refund will be direct deposited into
Refund | your account. The account information you entered - Account Number:
| 7233094700 Routing Transit Number: 071923909.
|
______________________________________________________________________________________
|
When Will | The IRS issued more than 9 out of 10 refunds to taxpayers in less
You Get | than 21 days last year. The same results are expected in 2014. To
Your | get your estimated refund date from TurboTax, log into My TurboTax at
Refund? | www.turbotax.com. If you do not receive your refund within 21 days,
| or the amount you get is not what you expected, contact the Internal
| Revenue Service directly at 1-800-829-4477. You can also check
| www.irs.gov and select the "Where's my refund?" link.
|
______________________________________________________________________________________
|
What You | Your Electronic Filing Instructions (this form)
Need to | Printed copy of your federal return
Keep |
|
______________________________________________________________________________________
|
2013 | Adjusted Gross Income $ 84,433.00
Federal | Taxable Income $ 64,433.00
Tax | Total Tax $ 8,771.00
Return | Total Payments/Credits $ 16,558.00
Summary | Amount to be Refunded $ 7,787.00
| Effective Tax Rate 10.39%
|
______________________________________________________________________________________

Page 1 of 1
Hi Robert and Heidi,

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matter what life throws at you.

Here's the final wrap up for your 2013 taxes:

Your federal refund is: $ 7,787.00

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event you get audited.

Many happy returns from TurboTax.

Form Department of the Treasury—Internal Revenue Service
1040A U.S. Individual Income Tax Return (99) 2013 IRS Use Only—Do not write or staple in this space.
Your first name and initial Last name OMB No. 1545-0074
Your social security number
Robert W Meyer 307 62 9766
If a joint return, spouse’s first name and initial Last name Spouse’s social security number
Heidi J Meyer 306 76 4252
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above
c
835 Woodlawn Ave and on line 6c are correct.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
Chesterton IN 46304-0000 Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign country name Foreign province/state/county Foreign postal code a box below will not change your tax or
refund. You Spouse

Filing 1 Single 4 Head of household (with qualifying person). (See instructions.)

status 2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent,
Check only 3 Married filing separately. Enter spouse’s SSN above and enter this child’s name here. a
one box. full name here. a 5 Qualifying widow(er) with dependent child (see instructions)

}
Exemptions 6a Yourself. If someone can claim you as a dependent, do not check Boxes
checked on
box 6a. 6a and 6b 2
b Spouse No. of children
on 6c who:
c Dependents: (4)  if child under
(3) Dependent’s
(2) Dependent’s social • lived with
age 17 qualifying for
If more than six security number you
relationship to you child tax credit (see
dependents, see (1) First name Last name instructions) • did not live
instructions. with you due to
divorce or
separation (see
instructions)
Dependents
on 6c not
entered above

Add numbers
on lines
d Total number of exemptions claimed. above a 2
Income
7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7 84,384.
Attach
Form(s) W-2 8a Taxable interest. Attach Schedule B if required. 8a 21.
here. Also b Tax-exempt interest. Do not include on line 8a. 8b
attach
Form(s) 9a Ordinary dividends. Attach Schedule B if required. 9a 28.
1099-R if tax b Qualified dividends (see instructions). 9b 28.
was 10 Capital gain distributions (see instructions). 10
withheld. 11a IRA 11b Taxable amount
If you did not distributions. 11a (see instructions). 11b
get a W-2, see 12a Pensions and 12b Taxable amount
instructions.
annuities. 12a (see instructions). 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 13

14a Social security 14b Taxable amount
benefits. 14a (see instructions). 14b

15 Add lines 7 through 14b (far right column). This is your total income. a 15 84,433.
Adjusted
gross 16 Educator expenses (see instructions). 16
income 17 IRA deduction (see instructions). 17
18 Student loan interest deduction (see instructions). 18

19 Tuition and fees. Attach Form 8917. 19

20 Add lines 16 through 19. These are your total adjustments. 20

21 Subtract line 20 from line 15. This is your adjusted gross income. a 21 84,433.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA Form 1040A (2013)
REV 01/27/14 TTO
Form 1040A (2013) Page 2
Tax, credits, 22 Enter the amount from line 21 (adjusted gross income). 22 84,433.
and
payments
23a Check
if: {
You were born before January 2, 1949,
Spouse was born before January 2, 1949,
Blind Total boxes
Blind checked a 23a }
b If you are married filing separately and your spouse itemizes
Standard deductions, check here a 23b
Deduction
for— 24 Enter your standard deduction. 24 12,200.
• People who 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25 72,233.
check any
box on line 26 Exemptions. Multiply $3,900 by the number on line 6d. 26 7,800.
23a or 23b or
who can be 27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
claimed as a This is your taxable income. a 27 64,433.
dependent,
see 28 Tax, including any alternative minimum tax (see instructions). 28 8,771.
instructions.
29 Credit for child and dependent care expenses. Attach
• All others:
Single or Form 2441. 29
Married filing 30 Credit for the elderly or the disabled. Attach
separately,
$6,100 Schedule R. 30
Married filing 31 Education credits from Form 8863, line 19. 31
jointly or
Qualifying 32 Retirement savings contributions credit. Attach
widow(er),
$12,200 Form 8880. 32
Head of 33 Child tax credit. Attach Schedule 8812, if required. 33
household,
$8,950 34 Add lines 29 through 33. These are your total credits. 34
35 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. This is
your total tax. 35 8,771.
36 Federal income tax withheld from Forms W-2 and
1099. 36 16,558.
If you have
37 2013 estimated tax payments and amount applied
a qualifying from 2012 return. 37
child, attach 38a Earned income credit (EIC). 38a
Schedule
EIC. b Nontaxable combat pay
election. 38b
39 Additional child tax credit. Attach Schedule 8812. 39
40 American opportunity credit from Form 8863, line 8. 40
41 Add lines 36, 37, 38a, 39, and 40. These are your total payments. a 41 16,558.
42 If line 41 is more than line 35, subtract line 35 from line 41.
Refund This is the amount you overpaid. 42 7,787.
Direct 43a Amount of line 42 you want refunded to you. If Form 8888 is attached, check here a 43a 7,787.
deposit?
See a b
Routing a c Type: Checking Savings
instructions number 0 7 1 9 2 3 9 0 9
and fill in
43b, 43c, a d
Account
and 43d or number 7 2 3 3 0 9 4 7 0 0
Form 8888. 44 Amount of line 42 you want applied to your
2014 estimated tax. 44
Amount 45 Amount you owe. Subtract line 41 from line 35. For details on how to pay,
you owe see instructions. a 45
46 Estimated tax penalty (see instructions). 46
Third party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No
Designee’s Phone Personal identification
designee name a no. a number (PIN) a

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other
than the taxpayer) is based on all information of which the preparer has any knowledge.
here Your signature Date Your occupation Daytime phone number
F

Joint return?
See instructions. Steelworker (219)926-3731
Keep a copy Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection
for your records. PIN, enter it
Retired here (see inst.)
Print/type preparer's name Preparer’s signature Date PTIN
Paid Check a if
self-employed
preparer Firm's name a Firm's EIN a
Self-Prepared
use only Firm's address a Phone no.
REV 01/27/14 TTO Form 1040A (2013)
 ELECTRONIC POSTMARK - CERTIFICATION OF ELECTRONIC FILING

Taxpayer: Robert W & Heidi J Meyer

Primary SSN: 307-62-9766

Federal Return Submitted: February 03, 2014 06:01 AM PST

Federal Return Acceptance Date:

Your return was electronically transmitted on 02/03/2014

The Intuit Electronic Postmark shows the date and time Intuit received your federal tax return. The Intuit
Electronic Postmark documents the filing date of your income tax return, and the electronic postmark
information should be kept on file with your tax return and other tax-related documentation.

There are two important aspects of the Intuit Electronic Postmark:

1. THE INTUIT ELECTRONIC POSTMARK.

The electronic postmark shows the date and time Intuit received the federal return, and is deemed the
filing date if the date of the electronic postmark is on or before the date prescribed for filing of the
federal individual income tax return.

TIMELY FILING:
For your federal return to be considered filed on time, your return must be postmarked on or before
midnight April 15, 2014. Intuit’s electronic postmark is issued in the Pacific Time (PT) zone. If you are
not filing in the PT zone, you will need to add or subtract hours from the Intuit Electronic Postmark time
to determine your local postmark time. For example, if you are filing in the Eastern Time (ET) zone and
you electronically file your return at 9 AM on April 15, 2014, your Intuit electronic postmark will indicate
April 15, 2014, 6 AM. If your federal tax return is rejected, the IRS still considers it filed on time if the
electronic postmark is on or before April 15, 2014, and a corrected return is submitted and accepted
before April 20, 2014. If your return is submitted after April 20, 2014, a new time stamp is issued to
reflect that your return was submitted after the IRS deadline and, consequently, is no longer considered
to have been filed on time.

If you request an automatic six-month extension, your return must be electronically postmarked by
midnight October 15, 2014 If your federal tax return is rejected, the IRS will still consider it filed on time
if the electronic postmark is on or before October 15, 2014, and the corrected return is submitted and
accepted by October 20, 2014.

2. THE ACCEPTANCE DATE.

Once the IRS accepts the electronically filed return, the acceptance date will be provided by the Intuit
Electronic Filing Center. This date is proof that the IRS accepted the electronically filed return.
Electronic Filing Instructions for your 2013 Indiana Tax Return
Important: Your taxes are not finished until all required steps are completed.

Robert W & Heidi J Meyer

835 Woodlawn Ave
Chesterton, IN 46304-0000
|
Balance | Your Indiana state tax return (Form IT-40) shows a refund due to you
Due/ | in the amount of $173.00. Your tax refund will be direct deposited
Refund | into your account. The account information you entered - Account
| Number: 7233094700 Routing Transit Number: 071923909.
|
______________________________________________________________________________________
|
Where's My | Before you call the Indiana Department of Revenue with questions
Refund? | about your refund, give them 21 days processing time from the date
| your return is accepted. If then you have not received your refund,
| or the amount is not what you expected, contact the Indiana
| Department of Revenue directly at 1-317-233-4018.
|
______________________________________________________________________________________
|
What You | Sign and date Form IT-8453-OL within 1 day of acceptance. Since you
Need to | are married filing jointly, your spouse must also sign and date the
Sign | form.
|
______________________________________________________________________________________
|
Do Not | Do not mail a paper copy of your tax return. Since you filed
Mail | electronically, the Indiana Department of Revenue already has your
| return.
|
______________________________________________________________________________________
|
What You | Your Electronic Filing Instructions (this form)
Need to | - Form IT-8453-OL
Keep | Printed copy of your state and federal returns
|
______________________________________________________________________________________
|
2013 | Taxable Income $ 79,933.00
Indiana | Total Tax $ 3,118.00
Tax | Total Payments/Credits $ 3,291.00
Return | Amount to be Refunded $ 173.00
Summary |
|
______________________________________________________________________________________

Page 1 of 1
 Form Indiana Full-Year Resident Due April 15, 2014
IT-40
State Form 154
2013 Individual Income Tax Return
(R12 / 9-13) If filing for a fiscal year, enter the dates (see instructions) (MM/DD/YYYY):

from to:

Your Social Spouse’s Social

Security Number 307 62 9766 Security Number 306 76 4252

Place “X” in box if applying for ITIN Place “X” in box if applying for ITIN
Your first name Initial Last name Suffix

ROBERT W MEYER
If filing a joint return, spouse’s first name Initial Last name Suffix

HEIDI J MEYER
Present address (number and street or rural route)
Place “X” in box if you are
835 WOODLAWN AVE married filing separately.
City State Zip/Postal code

CHESTERTON IN 463040000
Foreign country 2-character code (see pg. 6 ) School corporation number (see pages 55 and 56 )

6470

Enter below the 2-digit county code numbers (found on the back of Schedule CT-40) for the county where you lived and
worked on January 1, 2013.
County where County where County where County where
you lived 64 you worked 64 spouse lived 64 spouse worked 64
Round all entries
1. Enter your federal adjusted gross income (AGI) from your federal tax return (from Form 1040,
line 37; Form 1040A, line 21; or from Form 1040EZ, line 4)___________________ Federal AGI 1 84433.00
2. Enter amount from Schedule 1, line 8, and enclose Schedule 1 ________ Indiana Add-Backs 2 .00
3. Add line 1 and line 2 ____________________________________________________________ 3 84433.00
4. Enter amount from Schedule 2, line 12, and enclose Schedule 2 _______ Indiana Deductions 4 2500.00
5. Subtract line 4 from line 3 __________________________________ Indiana Adjusted Income 5 81933.00
6. You must complete Schedule 3. Enter amount from Schedule 3, line 5,
and enclose Schedule 3 ______________________________________ Indiana Exemptions 6 2000.00
7. Subtract line 6 from line 5 _____________________________________ State Taxable Income 7 79933.00
8. State adjusted gross income tax: multiply line 7 by 3.4% (.034)
(if answer is less than zero, leave blank) ____________________ 8 2718.00
9. County tax. Enter county tax due from Schedule CT-40
(if answer is less than zero, leave blank) ____________________ 9 400.00
10. Other taxes. Enter amount from Schedule 4, line 4 (enclose sch.) 10 .00

11. Add lines 8, 9 and 10. Enter total here and on line 15 on the back ___________ Indiana Taxes 11 3118.00

REV 01/24/14 TTO 15113111555

12. Enter credits from Schedule 5, line 9 (enclose schedule) ____ 12 3291.00
13. Enter offset credits from Schedule 6, line 7 (enclose schedule) 13 .00

14. Add lines 12 and 13 ______________________________________________ Indiana Credits 14 3291.00

15. Enter amount from line 11___________________________________________ Indiana Taxes 15 3118.00
16. If line 14 is equal to or more than line 15, subtract line 15 from line 14 (if smaller, skip to line 23) 16 173.00
17. Amount from line 16 to be donated to the Indiana Nongame Wildlife Fund ______________ 17 .00
18. Subtract line 17 from line 16 _________________________________________ Overpayment 18 173.00
19. Amount from line 18 to be applied to your 2014 estimated tax account (see instructions on page 10).

Enter your county code county tax to be applied _ $ a .00

Spouse’s county code county tax to be applied _ $ b .00
Indiana adjusted gross income tax to be applied _________ $ c .00
Total to be applied to your estimated tax account (a + b + c; cannot be more than line 18)_____ 19d .00
20. Penalty for underpayment of estimated tax from Schedule IT-2210 or IT-2210A (enclose sch.) _ 20 .00
21. Refund: Line 18 minus lines 19d and 20. Note: If less than zero, see line 23 ___ Your Refund 21 173.00
22. Direct Deposit (see page 12)

a. Routing Number 071923909

b. Account Number 7233094700
c. Type: Checking Savings Hoosier Works MC

d. Place an “X” in the box if refund will go to an account outside the United States

23. If line 15 is more than line 14, subtract line 14 from line 15. Add to this any amount on line 20
(see instructions on page 12) ____________________________________________________ 23 .00

24. Penalty if filed after due date (see instructions) ______________________________________ 24 .00
25. Interest if filed after due date (see instructions) ______________________________________ 25 .00
26. Amount Due: Add lines 23, 24 and 25______________________________ Amount You Owe 26 .00
Do not send cash. Please make your check or money order payable to:
Indiana Department of Revenue. Credit card payers must see instructions.

Sign and date this return after reading the Authorization statement on Schedule 7. You must enclose Schedule 7.

_____________________________________________________ _________________________________________________
Your Signature Date Spouse’s Signature Date

• If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN 46207-7224.
• Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.

REV 01/24/14 TTO 15113121555

 Schedule 2 Schedule 2: Deductions Enclosure
Form IT-40, State Form 53996
(R4 / 9-13)
Instructions begin on page 19 2013 Sequence No. 02

Name(s) shown on Form IT-40 Your Social Security Number

ROBERT W & HEIDI J MEYER 307 62 9766

1. Renter’s deduction
Address where rented if different from the one on the front page (enter below)

Amount of rent paid

Landlord’s name and address (enter below)
$ .00
Round all entries

Number of months rented Enter the lesser of $3,000 or amount of rent paid 1 .00
2. Homeowner’s residential property tax deduction
Address where property tax was paid if different from front page (enter below)

Number of months lived there 12 Amount of property tax paid $ 2849 .00
Enter the lesser of $2,500 or the amount of property tax paid _____________________________ 2 2500.00
3. State tax refund reported on federal return ___________________________________________ 3 .00

4. Interest on U.S. government obligations _____________________________________________ 4 .00

5. Taxable Social Security benefits____________________________________________________ 5 .00
6. Taxable railroad retirement benefits _________________________________________________ 6 .00
7. Military service deduction: $5,000 maximum for qualifying person _________________________ 7 .00
8. Non-Indiana locality earnings deduction: $2,000 maximum per qualifying person _____________ 8 .00
9. Insulation deduction: $1,000 maximum ______________________________________________ 9 .00

10. Nontaxable portion of unemployment compensation (from line 7 of Unemployment Comp. Worksheet) 10 .00
11. Other Deductions: See instructions (attach additional sheets if necessary)

a. Enter deduction name code no. 11a .00

b. Enter deduction name code no. 11b .00

c. Enter deduction name code no. 11c .00
12. Add lines 1 through 11. Enter total here and on line 4 of Form IT-40. Total Deductions 12 2500.00

REV 01/24/14 TTO 22913111555

 Schedules 3 & 4 Schedule 3: Exemptions Enclosure
Form IT-40, State Form 53997
(R4 / 9-13)
(Schedule 4 begins after line 5 below) 2013 Sequence No. 03

Name(s) shown on Form IT-40 Your Social Security Number

ROBERT W & HEIDI J MEYER 307 62 9766

Round all entries

1. Number of exemptions claimed on your federal return 2 x $1,000 ____________________ 1 2000.00

• If you did not claim an exemption on your federal return, enter “1” in the box above.
• See instructions on page 26 if you did not file a federal return.

2. Claim an additional exemption for each dependent child

• who is a son, stepson, daughter, stepdaughter and/or foster child,
• who was under the age of 19 by Dec. 31, 2013, or a full-time student
who was under the age of 24 by Dec. 31, 2013, and
• who you are eligible to claim as a dependent on your federal tax return.

Enter number you are eligible to claim x $1500: you MUST enclose Schedule IN-DEP __ 2 .00

3. Place “X” in box(es) below if, by December 31, 2013

You were age 65 or older and/or blind

Spouse was 65 or older and/or blind

Total number of boxes with Xs x $1000 _____________________________________ 3 .00

4. If age 65 or older, enter amount from Form IT-40, line 1 $
If this amount is less than $40,000, place “X” in box(es) below if:

You were age 65 or older

Spouse was 65 or older

Total number of boxes with Xs x $500 ______________________________________ 4 .00

5. Add lines 1, 2, 3 and 4. Enter here and on Form IT-40, line 6. Total Exemptions 5 2000.00

Schedule 4: Other Taxes

Instructions begin on page 27

1. Use tax on out-of-state purchases from line 4 of Sales/Use Tax Worksheet __________________ 1 .00
2. Household employment taxes. Enclose Schedule IN-H __________________________________ 2 .00
3. Recapture of Indiana’s CollegeChoice 529 credit. Enclose Schedule IN-529R ________________ 3 .00

4. Add lines 1 through 3. Enter here and on Form IT-40, line 10. Total Other Taxes 4 .00

REV 01/24/14 TTO

23013111555
 Schedule 5 Schedule 5: Credits Enclosure
Form IT-40, State Form 53998
(R4 / 9-13)
Instructions begin on page 28 2013 Sequence No. 04

Name(s) shown on Form IT-40 Your Social Security Number

ROBERT W & HEIDI J MEYER 307 62 9766

Round all entries

1. Indiana state tax withheld: enclose W-2s, 1099s showing state tax withholding amounts ________ 1 2869.00
2. Indiana county tax withheld: enclose W-2s, 1099s showing county tax withholding amounts _____ 2 422.00
3. Estimated tax paid for 2013: include any extension payment made with Form IT-9 ____________ 3 .00
4. Unified tax credit for the elderly ____________________________________________________ 4 .00

5. Earned income credit: enclose Schedule IN-EIC and enter amount from line A-3 _____________ 5 .00
6. Lake County residential income tax credit ____________________________________________ 6 .00
7. Economic development for a growing economy credit. Enter amount from Schedule IN-EDGE,
line 19 (enclose schedule) ________________________________________________________ 7 .00
8. Economic development for a growing economy retention credit. Enter amount from
Schedule IN-EDGE-R, line 19 (enclose schedule) ______________________________________ 8 .00

9. Add lines 1 through 8. Enter total here and on Form IT-40, line 12 ______________ Total Credits 9 3291.00

REV 01/24/14 TTO 23113111555

 Schedule 7 Schedule 7: Additional Required Information Enclosure
Form IT-40, State Form 54000
(R4 / 9-13)
Instructions begin on page 51 2013 Sequence No. 06

Name(s) shown on Form IT-40 Your Social Security Number

ROBERT W & HEIDI J MEYER 307 62 9766

1. Federal filing information
Are you filing a federal income tax return for 2013? Place “X” in appropriate box. Yes No

2. Out-of-state income Complete if you and/or your spouse (if filing a joint return) received any salary, wage, tip and/or commission
income from Illinois, Kentucky, Michigan, Ohio, Pennsylvania or Wisconsin. Enter two-digit code number from the back of Schedule CT-40
for state where you and/or your spouse worked.
State where you worked Your income State where spouse worked Spouse’s income

$ .00 $ .00

3. Extension of time to file

a. Place “X” in box if you have filed a federal extension of time to file, Form 4868.
b. Place “X” in box if you have filed an Indiana extension of time to file, Form IT-9, or online via ePay.

4. Farm / Fishing income

Place “X” in box if at least two-thirds of your gross income was made from farming or fishing.
Important: If you placed an “X” in the box, you MUST attach Schedule IT-2210.

5. Date of death
If any individual listed at the top of the IT-40 died during 2013, enter date of death (MM/DD) (see instructions on page 51 ).

Taxpayer’s date of death 2013 Spouse’s date of death 2013

Authorization Sign Form IT-40 after reading the following statement.
Under penalty of perjury, I have examined this return and all attachments and to the best of my knowledge and belief, it is true, com-
plete and correct. I understand that if this is a joint return, any refund will be made payable to us jointly and each of us is liable for all
taxes due under this return. Also, my request for direct deposit of my refund includes my authorization to the Indiana Department of
Revenue to furnish my financial institution with my routing number, account number, account type and Social Security number to ensure
my refund is properly deposited. I give permission to the Department to contact the Social Security Administration to confirm that the
Social Security number(s) used on this return is correct.

6. Your daytime Your

telephone number 2199263731 email address

I authorize the Department to discuss my return with my Paid Preparer: Firm’s Name (or yours if self-employed)
personal representative (see page 52 ).

Yes No If yes, complete the information below. SELF-PREPARED

Personal Representative’s Name (please print) IN-OPT on file with paid preparer if not filing electronically

PTIN
Telephone
number Address

Address City

City State Zip Code

Preparer’s
State Zip Code signature _________________________________________

REV 01/24/14 TTO 23313111555

 Schedule CT-40 County Tax Schedule for Enclosure
Form IT-40, State Form 47907
(R12 / 9-13) Full-Year Indiana Residents 2013 Sequence No. 07

Name(s) shown on Form IT-40 Your Social Security Number

ROBERT W & HEIDI J MEYER 307 62 9766

1. Enter the amount from IT-40, line 7. Note: If both you and
your spouse lived in the same county on January 1, enter the Column A - Yourself Column B - Spouse’s
entire amount from Form IT-40, line 7 on line 1A (do not
complete Column B). See instructions on page 52___________ 1A 79933 .00 1B .00
2. If you claimed a non-Indiana locality earnings deduction on
Schedule 2, line 8, enter the amount here. If not, leave blank__ 2A .00 2B .00

3. Add lines 1 and 2 (if less than zero, leave blank) ____________ 3A 79933 .00 3B .00
4. Enter the resident rate from the county tax chart on the back of
this schedule for the county where you lived on Jan. 1, 2013 __ 4A . 0050000 4B .

5. Multiply line 3 by the rate on line 4 _______________________ 5A 400 .00 5B .00

6. Add lines 5A and 5B. Enter the total here. Note: Perry County residents: If you live in Perry
County and worked in the Kentucky counties of Breckinridge, Hancock or Meade, you must
complete lines 7 and 8. Otherwise, enter the total here and on line 9 below (see page 54 ) _____ 6 400.00
7. Enter the amount of income that was taxed by any of the Kentucky counties listed on line 6 above 7 .00

8. Multiply line 7 by .0056 and enter total here ____________________________________________ 8 .00

9. Enter total of line 6 minus line 8. Enter this amount on line 9 of Form IT-40 ___________________ 9 400.00

REV 01/24/14 TTO 16613111555

 Schedule IN-BAR Schedule IN-BAR: Barcode Enclosure
State Form 54083
(R4 / 9-13) 2013 Sequence No. 20

Name(s) shown on Form IT-40, IT-40EZ, IT-40PNR or IT-40RNR Your Social Security Number

ROBERT W & HEIDI J MEYER 307 62 9766

Designate the form with which Schedule IN-BAR is being filed:

1. IT-40

2. IT-40EZ

3. IT-40PNR

4. IT-40RNR

2013 INDIANA
Barcode Datasheet

Enclose Schedule IN-BAR as the last schedule.

Example. If filing an IT-40, Schedule 2, Schedule 3 and

Schedule 7, place Schedule IN-BAR behind Schedule 7.

Do NOT file this page alone.

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 Form Indiana Individual Income Tax Do Not Mail
IT-8453OL DECLARATION OF ELECTRONIC FILING This Form
State Form 46201
(R14 / 9-13)
For the tax year January 1 - December 31, 2013

Submission ID

First Name(s) and Middle Initial(s) Last Name Your Social Security Number Spouse’s Social Security Number
ROBERT W MEYER 307 62 9766 306 76 4252
Spouse’s First Name(s) and Middle Spouse’s Last Name Street Address
Initial(s) 835 WOODLAWN AVE
HEIDI J MEYER
City State Zip Code Daytime Telephone Number
CHESTERTON IN 463040000 2199263731

Part I Tax Return Information (See Instructions on Next Page)

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1. Federal Adjusted Gross Income ..................................................................................

2. Indiana Taxable Income ..............................................................................................

1.

2.
84433.
79933.

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3. Total Indiana Tax .........................................................................................................

4. Total State Tax Withheld .............................................................................................

3.

4.
3118.
2869.

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D a i l
5. Total County Tax Withheld ...........................................................................................

6. Total Indiana Tax Credits .............................................................................................

5.

6.
422.
3291.

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7. Refund ........................................................................................................................ 7. 173.
8. Amount You Owe ........................................................................................................ 8.

Part II Direct Deposit

W-2 Forms Here 

9. Routing number 0 7 1 9 2 3 9 0 9 Note: The first two digits of the routing number must be 01 - 12 or 21 - 32.

10. Account number 7 2 3 3 0 9 4 7 0 0 Do Not Mail

11. Type of account: □ Checking □ Savings □ Hoosier Works MC This Form
12. Place an “X” in the box if refund will go to an account outside the United States. □
Attach

My request for direct deposit of my refund includes my authorization for the Indiana Department of Revenue to furnish my
financial institution with my routing number, account number, account type, and social security number to insure my refund is
properly deposited.

Part III Declaration of Taxpayer

If I have filed a balance due return, I understand that if the IDOR does not receive full and timely payment of my tax liability, I I
will remain liable for the tax liability and all applicable interest and penalties.
Under penalties of perjury, I declare that the amounts in Part I above agree with the amounts on the corresponding lines of the
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electronic portion of my 2013 income tax return. To the best of my knowledge and belief, my return is true, correct and complete.
I consent to allow my transmitter to send my return, this declaration, and accompanying schedules and statements to the IDOR.
D
I also consent to the IDOR sending an acknowledgement of receipt of transmission and an indication of whether or not my return
is accepted, and, if rejected, the reason(s) for the rejection.
I
A
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Please sign here ► _________________________ ____________ __________________________ ___________
Taxpayer’s Signature Date Spouse’s Signature Date A
1555 REV 01/24/14 TTO