Government of the
District of Columbia
20
13
 
D-40EZ  Income Tax Return 
 
 
for Single and Joint Filers 
   
 
with No Dependents
2013 
D-40EZ
Revised 09/13
Income T
ax Return
STAPLE W-2s AND ANY OTHER WITHHOLDING STATEMENTS HERE  
2
 
$
 
.
00
3
 
$
 
.
00
4
 
$
 
.
00
Signature
 
Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on the information available to the preparer.
Your signature
 
Date
 
Preparer’s signature
 
Date
Spouse’s/domestic partner’s signature if filing jointly
 
Date
 
Preparer’s Tax Identification Number (PTIN)
 
        
PTIN 
telephone number
STAPLE OTHER DOCUMENTS IN UPPER LEFT IN BACK 
1
 
Total wages, salaries, tips, unemployment compensation, etc.
2
 
Taxable interest and ordinary dividends.
 (If more than $1500, file form D-40.) 
3
 
DC adjusted gross income.
  
Add Lines 1 and 2. 
4
 
Standard deduction 
plus
 exemption.
  
, 
 
 
5
 
DC taxable income.
 
Line 3 minus Line 4. If Line 4 is equal to or more than Line 3, make no entry.
6
 
Tax. 
 
Use the tax tables on pages 53-62 to find the tax on the Line 5 amount.
7
      
DC Low Income Credit.
 
7a
 
Enter number of exemptions claimed on your federal return
 
                                            
7a
8
 
Net tax.
  
Subtract Line 7 from Line 6. If Line 7 is equal to or more than Line 6, make no entry.
9a
 
Contribution to Public Fund for Drug Prevention and Children at Risk.
9b
 
Contribution to DC Statehood Delegation Fund.
9c
 
Contribution to Anacostia River Cleanup and Protection Fund.
9d
 
                                                            
RESERVED
10
 
Tax and/or contribution(s).
  
Add Lines 8, 9a, 9b, 9c and 9d.
11
 
Total DC income tax withheld,
 
shown on Forms W-2 and 1099 – attach these forms.
12
 
Tax paid with extension of time to file or with original return if this is an amended return. 
13
 
DC Earned Income Tax Credit.
 
Enter your federal earned income credit
 
13a
 
                         
   
14 
 
Total tax payments and credits.
  
Add lines 11–13.
15
 
Refund. 
If Line 14 is the larger, subtract Line 10 from Line 14.
16
     
Amount  owed. 
If Line 10 is the larger, subtract Line 14 from Line 10. 
See payment options in instructions.
17
     
Penalty 
Interest 
See instructions. 
 
Enter results
18
 
TOTAL AMOUNT DUE. 
Add lines 16 and 17.
19
 
TOTAL REFUND. 
Subtract Line 17 (results) from Line 15 and enter here.                                                          
Home address (number, street and apartment number if applicable)
 
City                
 
State
 
Zip  Code
Your first name
 
M.I.
 
Last name
Spouse’s/registered domestic partner’s first name
 
M.I.
 
Last name
Print in CAPITAL letters using black ink.
Third party designee 
To authorize another person to discuss this return with the OTR, fll in here         and enter the name and phone number of that person. See instructions.
Designee’s 
name
 
      
 
 
Phone 
number
1
 
$
 
.
00
If more than $100,000 file form D-40.
5
 
$
 
.
00
6
 
     
$
 
.
00
7
 
     
$
 
.
00
 
8
 
     
$
 
.
00
 
9a
 
     
$
 
.
00
 
9b
 
     
$
 
.
00
 
9c
 
     
$
 
.
00
 
9d
 
     
$
 
.
00
 
13
 
     
$
 
.
00
 
18
 
     
$
 
.
00
See instructions.
19
    
 
$
 
.
00
$
 
           .
00 
X .40 =
10
    
 
$
 
.
00
11
    
 
$
 
.
00
14
     
$
 
.
00
15
 
     
$
 
.
00
16
    
 
$
 
.
00
17
 
     
$
 
.
00
12
     
$
 
.
00
Your social security number (SSN)                   
and
      and
 
Personal information
                  
 
  
     
Your telephone number 
               
 
      .
Filing status:
         
Single,
        
Married filing jointly,
        
Registered domestic partners filing jointly,
        
                            
Dependent claimed by someone else
             
Fill in if Amended Return 
Date of Birth (MMDDYYYY)
                           
Spouse’s/registered domestic partner’s SSN
Will the refund you requested go to an account outside the US?
         
Yes
          
No
    
               
               
              
      Routing Number
                                                           
Account Number
$
                                     
.00 
$
                                   
.00   
Enter number of qualified EITC children
                                                                
13a
Date of Birth (MMDDYYYY)
Use Calc. LIC/EITC to see if LIC or EITC is a greater benefit.
See instructions.
Use Calc. LIC/EITC to see if EITC is greater. Leave blank if you took Line 7 LIC credit.
otr.dc.gov/refundprepaidcards.
or if claimed as a dependent on another’s tax return, enter $4100
If single, enter $5775.
 If fling jointly, enter $7450
Refund Options: For information on the tax refund card and program limitations, visit our website 
Direct Deposit Account Type
Checking
OR
Savings
To deposit your refund, check the box and enter bank routing and account numbers. See instructions
Mark one refund choice:  
Direct deposit  
Tax refund card  
Paper check
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