2009 temp

8/8/2019 2009 Temp PDF File

http://slidepdf.com/reader/full/2009-temp-pdf-file 1/12

File by Mail Instructions for your 2009 Federal Tax ReturnImportant: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions formore information.)JANET A WHITE180 GRAPEVIENE ROADWHARTON, WV 25208

of 1

|

Balance | Your federal tax return (Form 1040A) shows you are due a refund ofDue/ | $3,355.00.Refund |

______________________________________________________________________________________||

What You | Your tax return - The official return for mailing is included inNeed to | this printout. Remember to sign and date the return.Mail |

| Attach the first copy or Copy B of Forms W-2 and 1099-R to the front| of your Form 1040A.|| Mail your return and attachments to:| Department of the Treasury

| Internal Revenue Service Center| Kansas City, MO 64999-0015|| Deadline: Postmarked by Thursday, April 15, 2010|| Note: Your state return may be due on a different date. Please| review your state filing instructions.|| Don’t forget correct postage on the envelope.

______________________________________________________________________________________||

What You | Keep these instructions and a copy of your return for your records.Need to | If you did not print one before closing TurboTax, go back to theKeep | program and select Print & File tab, then select the Print for Your

| Records category. ______________________________________________________________________________________|

|2009 | Adjusted Gross Income $ 14,472.00Federal | Taxable Income $ 0.00Tax | Total Tax $ 0.00Return | Total Payments/Credits $ 3,355.00Summary | Amount to be Refunded $ 3,355.00

| Effective Tax Rate -15.92% ______________________________________________________________________________________|

|

Changed | You can still file electronically. Just go back to TurboTax, selectYour Mind | the Print & File tab, then select the E-file category. We’ll walkAbout | you through the process. Once you file, we will let you know if youre-filing? | return is accepted (or rejected) by the Internal Revenue Service.

______________________________________________________________________________________|



Hi JANET,

We just want to thank you for using TurboTax this year! It’s our goal to makeyour taxes easy and accurate, year after year.

With TurboTax Premier:Your Head Start On Next Year:

When you come back next year, taxes will be so easy! All yourinformation will be saved and ready to transfer in to your new return.We’ll ask you questions about what changed since we last talked, andwe’ll be ready to get you the credits and deductions you deserve, nomatter what life throws at you.

Here’s the final wrap up for your 2009 taxes:Your federal refund is: $ 3,355.00

You qualified for these important credits:

- Child Tax Credit- Earned Income Credit

Your Guarantee of Accuracy:Breathe easy. The calculations on your return are backed with our100% Accuracy Guarantee.- We double checked your return for errors along the way.- We helped with step-by-step guidance to get your answers on the right

IRS forms.- If you sold investments, our Cost Basis Lookup calculated cost

basis for those sales.- We helped you out with extra guidance for rental property income,

expenses, and refinancing.- We made sure you didn’t miss a deduction even if something in your life

changed, like a new job, new house - or more kids!Also included:

- We provide the Audit Support Center free of charge, in the unlikelyevent you get audited.

Many happy returns from TurboTax.



FDIA1312 11/16/09

Department of the Treasury ' Internal Revenue Service

Form 1040A U.S. Individual Income Tax Return (99) 2009 IRS Use Only ' Do not write or staple in this space.

Boxeschecked on6a and 6b

No. of childrenon 6c who:? livedwith you

? did notlive withyou due todivorce orseparation (seeinstructions)

Dependentson 6c notentered above

Add numberson lines above

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

b Spouse

c Dependents:

(1) First name Last name

(2) Dependent’ssocial security

number

(3) Dependent’srelationship

to you

(4) c ifqualifyingchild forchild tax

creditIf more than sixdependents,see instructions.

d Total number of exemptions claimed

Income7 Wages, salaries, tips, etc. Attach Form(s) W-2 78 a Taxable interest. Attach Schedule B if required 8 a

b Tax-exempt interest.Do not include on line 8a 8 b9 a Ordinary dividends. Attach Schedule B if required 9 a

Attach Form(s)W-2 here. Alsoattach Form(s)1099-R if taxwas withheld. b Qualified dividends (see instructions) 9 b

10 Capital gain distributions (see instructions) 1011 a IRA distributions 11 a 11 b Taxable amount 11 b12 a Pensions and annuities 12 a 12 b Taxable amount 12 b

13 Unemployment compensation in excess of $2,400 per recipient and AlaskaPermanent Fund dividends (see instructions) 13

14 a Social securitybenefits 14 a 14 b Taxable amount 14 b

If you did notget a W-2,see instructions.

Enclose, butdo not attach,any payment.Also, pleaseuse Form 1040-V. 15 Add lines 7 through 14b (far right column). This is your total income 15

Your first name and initial Last name OMB No. 1545-0074

Your social security numberLabel(See instructions.)

If a joint ret urn, spouse’s first name and init ial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apartment no.

Use theIRS label.Otherwise,please printor type. J You must enter

your SSN(s) aboveJ

City, town or post office. If you have a foreign address, see instructions. State ZIP code

PresidentialElectionCampaign G

1 Single 4 Head of household (with qualifying person). (See instructions.Filingstatus 2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependen

3 Married filing separately. Enter spouse’s SSN above and enter this child’s name herefull name here 5 Qualifying widow(er) with dependent childCheck only

one box. (see instructions)

Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see instructions) You Spouse

16 Educator expenses (see instructions) 1617 IRA deduction (see instructions) 1718 Student loan interest deduction (see instructions) 1819 Tuition and fees deduction. Attach Form 8917 19

Adjustedgrossincome

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 21BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040A (2009)

Checking a box below willnot change your

tax or refund

JANET A WHITE 295-32-9704

180 GRAPEVIENE ROAD

WHARTON WV 25208

X

X1

1

2

6,784.

7,550.

21,881. 138.14,472.

14,472.

JORDAN N TUTTLE 235-41-2722 Grandchild X



Form 1040A (2009) Page 222 Enter the amount from line 21 (adjusted gross income) 2223 a Check You were born before January 2, 1945, Blind

if: Spouse was born before January 2, 1945, BlindTotal boxeschecked 23 a

Tax, credits,andpayments

b If you are married filing separately and your spouse itemizes deductions,see instructions and check here 23 b

24 a Enter your standard deduction (see left margin) 24 ab If you are increasing your standard deduction by certain real estate taxes or

new motor vehicle taxes, attach Schedule L and check here (see instrs) 24 b25 Subtract line 24a from line 22. If line 24a is more than line 22, enter -0- 25

26 Exemptions. If line 22 is over $125,100 or less and you did not provide housing to a Midwestern displacedindividual, multiply $3,650 by the number on line 6d. Otherwise, see instructions 26

27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is yourtaxable income 27

28 Tax, including any alternative minimum tax(see instructions) 28

29 Credit for child and dependent care expenses. Attach Form 2441 2930 Credit for the elderly or the disabled. Attach Schedule R 3031 Education credits from Form 8863, line 29 3132 Retirement savings contributions credit. Attach Form 8880 3233 Child tax credit (see instructions) 3334 Add lines 29 through 33. These are your total credits 3435 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0- 35

36 Advance earned income credit payments from Form(s) W-2, box 9 3637 Add lines 35 and 36. This is your total tax 3738 Federal income tax withheld from Forms W-2 and 1099 38

2009 estimated tax payments and amount applied from392008 return 39

40 Making work pay and government retiree credits. Attach Schedule M 4041 a Earned income credit (EIC) 41 a

b Nontaxable combat pay election. 41b42 Additional child tax credit. Attach Form 8812 4243 Refundable education credit from Form 8863, line 16 4344 Add lines 38, 39, 40, 41a, 42, and 43. These are yourtotal payments 44

45 If line 44 is more than line 37, subtract line 37 from line 44.This is the amount you overpaid 45Refund

46 a Amount of line 45 you want refunded to you. If Form 8888 is attached, check here 46 aG b Routing

number G c Type: Checking SavingsDirect deposit?See instructionsand fill in 46b,46c, and 46d orForm 8888.

G d Accountnumber

47 Amount of line 45 you want applied to your 2010estimated tax 47

Amountyou owe

48 Amount you owe. Subtract line 44 from line 37. For details on how to pay,see instructions 48

49 Estimated tax penalty (see instructions) 49Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. NoThird party

designeeDesignee’sname G

Phoneno. G

Personalidentificationnumber (PIN) G

If you havea qualifyingchild, attachSchedule EIC.

StandardDeductionfor '? People whochecked anybox on line

23a, 23b, or24b or whocan beclaimed as adependent,see instrs.? All others:Single orMarried filingseparately,$5,700

Married filing jointly orQualifyingwidow(er),$11,400

Head ofHousehold,$8,350

SignhereUnder penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, theyare 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 allinformation of which the preparer has any knowledge.

Your signature Date Your occupation Daytime phone numberJoint return?See instructions.

Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupationKeep a copyfor your records.

A

Date Preparer’s SSN or PTINPreparer’ssignature A

Check ifself-employedPaid

preparer’suse only A EIN

Firm’s name(or yours if self-employed),address, andZIP code Phone

no.

Form 1040A (2009)FDIA1312 11/16/09

JANET A WHITE 295-32-970414,472.

X1

9,750.

4,722.

7,300.

0.

0.

0.0.0.

0.333.

150.2,304.

568.

3,355.

3,355.

3,355.

XXXXXXXXX

XXXXXXXXXXXXXXXXX

X

LIBRARIAN

Self-Prepared



Qualifying Child Information Child 1 Child 2 Child 3

1 Child’s name First name Last name First name Last name First name Last name

If you have more than three qualifyingchildren, you only have to list three to getthe maximum credit

2 Child’s SSNThe child must have an SSN as defined in theForm 1040A or Form 1040 instructions unless

the child was born and died in 2009. If yourchild was born and died in 2009 and did nothave an SSN, enter ’Died’ on this line andattach a copy of the child’s birth certificate,death certificate, or hospital medical records.

3 Child’s year of birth Year Year Year

If born after 1990 AND the child was younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5.



4 a Was the child under age 24 at the end of2009, a student, and younger than you (oryour spouse, if filing jointly)? Yes. No. Yes. No. Yes. No.

Go to line 5. Continue. Go to line 5. Continue. Go to line 5. Continue.

b Was the child permanently and totallydisabled during any part of 2009? Yes. No. Yes. No. Yes. No.

Continue. The childis not aqualifying child.



5 Child’s relationship to you

(for example, son, daughter, grandchild,niece, nephew, foster child, etc)

6 Number of months child lived with you in theUnited States during 2009? If the child lived with you for more than

half of 2009 but less than 7 months,enter ’7’.

? If the child was born or died in 2009 andyour home was the child’s home for theentire time he or she was alive during2009, enter ’12’ months months months

Do not enter more than 12 months.



FDIA7401 11/06/09

SCHEDULE EIC OMB No. 1545-0074

(Form 1040A or 1040)Earned Income CreditQualifying Child Information 2009

Department of the TreasuryInternal Revenue Service

Complete and attach to Form 1040A or 1040 only if you have a qualifying child.

AttachmentSequence No. 43

Name(s) shown on return Your social security number

Before you begin: ? See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and64b, to make sure that (a) you can take the EIC and (b) you have a qualifying child.

? Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s socialsecurity card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name orSSN on the child’s social security card is not correct, call the Social Security Administration at 1-800-772-1213.

? If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See theinstructions for details.CAUTION!

? It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.

BAA For Paperwork Reduction Act Notice, see Form 1040A or 1040 instructions. Schedule EIC (Form 1040A or 1040) 2009


NJORDAN TUTTLE

235-41-27221993

Grandchild

12



OMB No. 1545-0074Form 8812 Additional Child Tax Credit

2009Department of the TreasuryInternal Revenue Service (99) Complete and attach to Form 1040, Form 1040A, or Form 1040NR. Attachment

Sequence No. 47Name(s) shown on return Your social security number

Part I All Filers1 1040 filers:

1040A filers:

1040NR filers:

Enter the amount from line 6 of your Child Tax Credit Worksheet (see theInstructions for Form 1040, line 51).Enter the amount from line 6 of your Child Tax Credit Worksheet (see theInstructions for Form 1040A, line 33).Enter the amount from line 6 of your Child Tax Credit Worksheet (see theInstructions for Form 1040NR, line 47). 1

If you used Pub 972, enter the amount from line 8 of the worksheet on page 4 of the publication.

2 Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 47 23 Subtract line 2 from line 1. If zero, stop; you cannot take this credit 34 a Earned income (see instructions) 4 a

b Nontaxable combat pay (see instructions) 4 b5 Is the amount on line 4a more than $3,000?

No. Leave line 5 blank and enter -0- on line 6.Yes. Subtract $3,000 from the amount on line 4a. Enter the result 5

6 Multiply the amount on line 5 by 15% (.15) and enter the result 6Next. Do you have three or more qualifying children?

No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller ofline 3 or line 6 on line 13.

Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on line 13.Otherwise, go to line 7.

Part II Certain Filers Who Have Three or More Qualifying Children

7 Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6.If married filing jointly, include your spouse’s amounts with yours. If you workedfor a railroad, see the instructions 7

8 1040 filers: Enter the total of the amounts from Form 1040,lines 27 and 57, plus any taxes that you identified usingcode ’UT’ and entered on the dotted line next to line 60. 8

1040A filers: Enter -0-.

1040NR filers: Enter the total of the amounts from Form 1040NR, line 53,plus any taxes that you identified using code ’UT’ andentered on the dotted line next to line 57.

9 Add lines 7 and 8 9

10 1040 filers: Enter the total of the amounts from Form 1040, lines64a and 69.

1040A filers: Enter the total of the amount from Form 1040A, line 41a,plus any excess social security and tier 1 RRTA taxeswithheld that you entered to the left of line 44(see instructions). 10

1040NR filers: Enter the amount from Form 1040NR, line 63.

11 Subtract line 10 from line 9. If zero or less, enter -0- 11

12 Enter the larger of line 6 or line 11 12

Next, enter the smaller of line 3 or line 12 on line 13.

Part III Additional Child Tax Credit

13 This is your additional child tax credit 13

Enter this amount on Form 1040, line 65, or Form 1040A, line 42, or Form 1040NR, line 61.

BAA For Paperwork Reduction Act Notice, see instructions. FDIA3001 10/28/09 Form 8812 (2009)


1,000.

0.1,000.

6,784.

X 3,784.568.

X

568.



SCHEDULE M OMB No. 1545-0074

(Form 1040A or 1040)Making Work Pay and Government

Retiree Credits 2009Department of the TreasuryInternal Revenue Service (99) G Attach to Form 1040A, 1040, or 1040NR. G See separate instructions. Attachment

Sequence No. 166Name(s) shown on return Your social security number

1 a Important: See the instructions if you can be claimed as someone else’s dependent or are filing Form1040NR. Check the ’No’ box below and see the instructions if (a) you have a net loss from a business, (b) youreceived a taxable scholarship or fellowship grant not reported on a Form W-2, (c) your wages include payfor work performed while an inmate in a penal institution, (d) you received a pension or annuity from anonqualified deferred compensation plan or a nongovernmental section 457 plan, or (e) you are filing Form2555 or 2555-EZ.

Do you (and your spouse if filing jointly) have 2009 wages of more than $6,451 ($12,903 if marriedfiling jointly)?

Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly) on line 4 and go to line 5.No. Enter your earned income (see instructions) 1 a

b Nontaxable combat pay included on line 1a(see instructions) 1 b

2 Multiply line 1a by 6.2% (.062) 2

3 Enter $400 ($800) if married filing jointly) 3

4 Enter the smaller of line 2 or line 3 (unless you checked ’Yes’ on line 1a) 4

5 Enter the amount from Form 1040, line 38*, or Form 1040A, line 22 5

6 Enter $75,000 ($150,000 if married filing jointly) 6

7 Is the amount on line 5 more than the amount on line 6?No. Skip line 8. Enter the amount from line 4 on line 9 below.Yes. Subtract line 6 from line 5 7

8 Multiply line 7 by 2% (.02) 8

9 Subtract line 8 from line 4. If zero or less, enter -0- 9

10 Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2009? You may havereceived this payment if you received social security benefits, supplemental security income, railroadretirement benefits, or veterans disability compensation or pension benefits (see instructions).

No. Enter -0- on line 10 and go to line 11.Yes. Enter the total of the payments received by you (and your spouse, if filing jointly). 10

Do not enter more than $250 ($500 if married filing jointly)

11 Did you (or your spouse, if filing jointly) receive a pension or annuity in 2009 for services performed as anemployee of the U.S. Government or any U.S. state or local government from work not covered by socialsecurity? Do not include any pension or annuity reported on Form W-2.

No. Enter -0- on line 11 and go to line 12.Yes. ? If you checked ’No’ on line 10, enter $250 ($500 if married filing jointly and the

answer on line 11 is ’Yes’ for both spouses) 11? If you checked ’Yes’ on line 10, enter -0- (exception: enter $250 if filing jointly

and the spouse who received the pension or annuity did not receive aneconomic recovery payment described on line 10)

12 Add lines 10 and 11 1213 Subtract line 12 from line 9. If zero or less, enter -0- 13

14 Making work pay and government retiree credits. Add lines 11 and 13. Enter the result here and on Form1040, line 63, Form 1040A, line 40; or Form 1040NR, line 60 14

*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions.BAA For Paperwork Reduction Act Notice, see Form 1040A, 1040, or 1040NR instructions. Schedule M (Form 1040A or 1040) 2009

FDIA8501 10/27/09


X

400.

14,472.

75,000.

X

400.

X 250.

X

0.

250.150.

150.



File by Mail Instructions for your 2009 West V irginia Tax ReturnImportant: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions formore information.)JANET A WHITE180 GRAPEVIENE ROADWHARTON, WV 25208

Page 1 of 1

|

Balance | Your West Virginia state tax return (Form IT-140) shows you are due aDue/ | refund of $203.00. Your refund check should be mailed in one to twoRefund | weeks (this is only an estimate).

______________________________________________________________________________________||

What You | Your tax return - The official return for mailing is included inNeed to | this printout. Remember to sign and date the return.Mail |

| Enclose copies of your Form(s) W-2, 1099 or other withholding| statements with your return.|| Mail your return and attachments to:| West Virginia State Tax Dept

| P.O. Box 1071| Charleston, WV 25324-1071|| Deadline: Postmarked by April 15, 2010|| Don’t forget correct postage on the envelope.

______________________________________________________________________________________||

What You | Keep these instructions and a copy of your return for your records.Need to | If you did not print one before closing TurboTax, go back to theKeep | program and select Print & File tab, then select the Print for Your

| Records category. ______________________________________________________________________________________|

|2009 | Taxable Income $ 2,472.00West Virginia | Total Tax $ 0.00Tax | Total Payments/Credits $ 203.00Return | Amount to be Refunded $ 203.00Summary |

______________________________________________________________________________________||

Changed | You can still file electronically. Just go back to TurboTax, selectYour Mind | the Print & File tab, then select the E-file category. We’ll walkAbout | you through the process. Once you file, we will let you know if youre-filing? | return is accepted (or rejected) by the state taxing agency.

______________________________________________________________________________________|



2009 FORM IT-140W WEST VIRGINIA WITHHOLDING TAX SCHEDULE

Last Name Your Social Security Number

Do not send W-2s, 1099s, K-1s WV/NRW-2s or WV/NRSRs with your return. Enter WV withholding information below.

1 A - Employer or Payer Information B - Employee or Taxpayer Information C - WV Withholding Tax

.00Employer or payer ID number from W-2, 1099, K-1, WV/NRW-2 orID number of tranferor/seller from WV/NRSR

Name WV WITHHOLDING Check appropriate box

Employer or payer name Social Security Number W-2 1099 K-1 WV/NRW-2

WV/NRSR

Address

City, State, Zip Enter WV withholding only

State Abbreviation From DocumentChecked Above

.00Income subject to WV WITHHOLDING

Total WV withholding tax from column C above .00If you have WV withholding on multiple pages, add the totals together and enter the GRAND TOTAL on line 13, form IT-140 orline 2, Form IT-140NRS or line 5, Form IT-140NRC.

*I A 4 0 2 0 0 9 0 3*WVIA2501 09/09/09





WV/NRSR

Address








WV/NRSR

Address








WV/NRSR

Address




WHITE 295329704

203

55-0548546 WHITE A JANET 203

295-32-9704 XBOONE MADISON PUBLIC LIBRARY

375 MAIN STREET

6784WVMADISON WV 25130

52-6150908 JANET A WHITE 0

295-32-9704 X1974 PENSION TRUST

2121 K STREET NW SUTIE 350

7550WVWASHINGTON DC 20037



2009 FORM IT-140

WEST VIRGINIA INCOME TAX RETURN

Extended Due Date Fiscal Year Filers ONLY Check Box Year End

MM DD YYYY MM DD YYYY

Your Social Security NumberDeceasedPrime Date of Death *** Spouse’s Social Sec urity Number

DeceasedSpouse Date of Death

Last Name Suffix Your First Name MI

Spouse’s Last Name-Only if different from Last Name above Suffix Spouse’s First Name MI

First Line of Address Second Line of Address

City State Zip Code

Amended ReturnSee instructions on page 4

Net Operating Loss Filing As a Nonresident/Part-YearResident. See instructions on page 3

Form WV-8379 filed as aninjured spouse

* I A 4 0 2 0 0 9 0 1*

1 Federal Adjusted Gross Income 1 .00

2 Additions to Income (line 34 of Schedule M) 2 .00

3 Subtractions from Income (line 48 of Schedule M) 3 .00

4 West Virginia Adjusted Gross Income (line 1 plus line 2 minus line 3) 4 .00

5 Low-Income Earned Income Exclusion (see worksheet on page 41) 5 .00

6 Total Exemptions as shown above in Exemption Line 3 x $2,000 6 .00

7 West Virginia Taxable Income (line 4 minus lines 5 and 6). IF LESS THAN ZERO, ENTER ZERO 7 .00

8 Income Tax Due from (check one):

Tax Table Rate Schedule Nonresident/Part-Year Resident Calculation Sch Schedule T 8 .00

9 Family Tax Credit if applicable (see worksheet on page 40) 9 .00

10 Adjusted West Virginia Tax (line 8 minus line 9) 10 .00

11 West Virginia Use Tax Due on out-of-state purchases (see worksheet on page 42) 11 .00

12 Total Taxes Due (line 10 plus line 11) Enter here and on Line 12, Page 22 12 .00

Exemptions

1 Exemptions claimed on your federal return(See instructions if you marked Filing Status 3 )

2 Additional exemption if surviving spouse (See page 7)

Enter decedent’s SSN

Year spouse died

3 TOTAL EXEMPTIONS (add boxes 1 and 2)Enter here and on line 6 below. If box 3 iszero, enter $500 on line 6 below

Filing Status. Check only one.

1 Single 4 Married, Filing Jointly

2 Head of Household3 Married, Filing Separately 5

Widow(er) withdependent child

***Enter spouse’s SS#and name in the boxes above.

Telephone Number

? Enclose Payment - Do Not Attach ?

TAX DEPT USE ONLY

PYMTPLAN CORR SCTC

WVIA0112 09/17/09

295329704

WHITE JANET A

180 GRAPEVIENE ROAD

WHARTON WV 25208

2

X

2

14472

8000

6472

2 4000

2472

X 74

74

0

0



23 Overpayment (line 19 minus line 12 minus line 21) 23 .00

24 Amount of Overpayment to be Credited to 2010 Estimated Tax 24 .00West Virginia Children’s Trust Fundto help prevent child abuse and neglect.25

Enter the amount of yourcontribution: $5 $25 $100 Other $ 25 .00

26 Deductions from your Overpayment (lines 24 plus line 25) 26 .00

27 Refund Due You(line 23 minus line 26) (Refund of $2or less, see page 7) REFUND 27 .00

13 West Virginia Income Tax Withheld (MUST COMPLETE WITHHOLDING TAX SCHEDULE, FORM IT-140W) 13 .00

14 Estimated Tax Payments and Payments with Schedule L 14 .00

15 Credits from Tax Credit Recap Schedule (see schedule on page 20) 15 .00

16 Paid with Original Return (Amended Return Only) 16 .00

17 Payments and Credits (add lines 13 through 16) 17 .00

18 Overpayment Previously Refunded or Credited (Amended Return Only) 18 .00

19 Total Payments and Credits (line 17 minus line 18) 19 .00

20 Balance of Tax Due (line 12 minus line 19) 20 .00

21 Penalty Due from Form IT-210. CHECK IF REQUESTING WAIVER/ANNUALIZED WKST ATTACHED 21 .00

22 Balance Due the State (add lines 20 and 21) PAY THIS AMOUNT $ 22 .00

2009 FORM IT-140

WEST VIRGINIA INCOME TAX RETURN

PRIMARY LASTNAME SHOWNON FORM IT-140

SOCIALSECURITYNUMBER

12 Total Taxes Due (line 10 plus line 11) 12 .00

* I A 4 0 2 0 0 9 0 2*

DIRECTDEPOSITOF REFUND

TYPE

CHECKINGSAVINGS

ROUTINGNUMBER

ACCOUNTNUMBER

Under penalties of perjury, I declare that I have examined this return, accompanying schedules and statments, and to the best of my knowledge

and belief, i t is true, correct and complete. I authorize the State Tax Department to discuss my return with my preparer. YES NOSignHere Preparer’s Signature DateO Your Signature Date

Preparer’s EIN

Spouse’s Signature Date

REFUND BALANCE DUEMailTo: WV State Tax Department WV State Tax Department

P.O. Box 1071 P.O. Box 3694 Address of Preparer Daytime Phone Number

Charleston, WV 25324-1071 Charleston, WV 25336-3694

WVIA0112 09/17/09

WHITE 295329704

0

203

0

203

203

203

0

203

Self-Prepared



Modifications INCREASING Federal Adjusted Gross Income (Additions)28 Interest or dividend income on federal obligations which is exempt from federal tax but subject to state tax 28 .00

29 Interest or dividend income on state and local bonds other than bonds from West Virginia sources 29 .00

30 Interest on money borrowed to purchase bonds earning income exempt from West Virginia tax 30 .00

31 Qualifying 402(e) lump-sum income NOT included in federal adjusted gross income but subject to state tax 31 .00

32 Other income deducted from federal adjusted gross income but subject to state tax 32 .00

33 Withdrawals from a WV Prepaid Tuition/SMART529 Savings Plan NOT used for payment of qualifying expenses 33 .00

34 TOTAL ADDITIONS (add lines 28 through 33). Enter here and on line 2 of Form IT-140 34 .00Modifications DECREASING Federal Adjusted Gross Income (Subtractions) Column A (You) Column B (Spouse)

35 Interest or dividends received on United States or West Virginia obligations included in federaladjusted gross income but exempt from state tax 35 .00 .00

36 Total amount of any benefit (including survivorship annuities) received from any West Virginia stateor local police, deputy sheriff’s or firemen’s retirement system 36 .00 .00

WVIA0701 08/25/09

2009 WEST VIRGINIA SCHEDULE M MODIFICATIONS TO ADJUSTED GROSS INCOME

*I A 4 0 2 0 0 9 0 4*

37 Up to $2,000 of benefits received from West Virginia Teachers Retirement System and West VirginiaPublic Employees Retirement System 37 .00 .00

38 Up to $2,000 of benefits received from Military Retirement and Federal Retirement Systems, (Title 4USC section 111)Combined amounts of Lines 37 and 38 must not exceed $2,000 38 .00 .00

39 Military Retirement Modification 39 .00 .00

40 Railroad Retirement Inc received 40 .00 .00

41 Refunds of state and local income taxes received and reported as income to the IRS 41 .00 .00

42 Payments to the West Virginia Prepaid Tuition/Savings Plan Trust Funds 42 .00 .00

43 Other deduction(s) i.e., Long-Term Care Insurance, PBGC 43 .00 .00

44 West Virginia ’EZ PASS’ deduction. Total of column A and B cannot exceed $1200 44 .00 .0045 Senior citizen or disability deduction (see instructions on page 13)

YOU SPOUSEYEAR OF BIRTH (IF 65 OROLDER)

YEAR OF DISABILITY

a Inc not included in lines 35-44 a .00 .00

b Maximum modification b $8,000 .00 $8,000 .00

c Add lines 35 through 39 abovec .00 .00

d Subtract line (c) from line (b) d .00 .00

(If less than zero, enter zero) Enter smaller of (a) or (d) 45 .00 .00

46 Surviving spouse deduction (see instructions on page 13) 46 .00 .00

47 Add lines 35 through 46 for each column 47 .00 .00

48TOTAL SUBTRACTIONS (line 47, Column A plus line 47, Column B). Enter here and on line 3 ofForm IT-140 48 .00

PRIMARY LASTNAME SHOWNON FORM IT-140

SOCIALSECURITYNUMBER

If you are claiming a disability modification on line 45, enclose Schedule H (page 27) with this return.

WHITE 295329704

1936

14472

8000

8000

8000

8000

2009 temp

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