Iowa Department of Revenue
www.state.ia.us/tax 2004 TeleFile Worksheet
Prepare for your TeleFile call by completing this worksheet. Retain for your records. If you qualify to TeleFile,
This worksheet will not be processed if mailed. complete the worksheet and
then call TeleFile. You will
Your Social Security Number Spouse Social Security Number be given information on how
to continue filing.
1 Enter your filing status number, Single = 1, Married filing joint = 2 yes no
If filing status 1, were you claimed as a dependent on another persons Iowa income tax return
2 Enter the total number of W-2 forms (5 or fewer)
3 Enter your 2004 W-2 information in the appropriate boxes below
Employer ID Number Wages Federal Iowa
(without hyphen) (Including Tips) Tax Withheld Tax Withheld
1st W-2 $ $ $
, , , NOTE:
2nd W-2 $ $ $ Round all
, , , amounts
3rd W-2 $ $ $ to the
, , ,
4th W-2 $ $ $ nearest dollar.
, , , (ex: $57.50 = $58;
5th W-2 $ $ $ $57.49 = $57)
, , ,
4 Total taxable interest income from 1099s $
5 Total ordinary dividend income from 1099s $
Income Federal Tax Withheld Iowa Tax Withheld
6 Unemployment compensation $ , $ , $ ,
7 Federal income tax refund received in 2004 $ ,
8 Additional Federal tax paid in 2004 for 2003 and any prior years $ ,
9 2004 Federal earned income credit $ ,
TeleFile will calculate your return using the standard deduction amount and provide:
Iowa Amount of Amount
net income $ , your refund $ , you owe $ ,
10 To contribute to the Fish and Wildlife Fund, enter an amount.................. $ ,
To contribute to the State Fairgrounds Renovation, enter an amount..... $ ,
To contribute to the Keep Iowa Beautiful Fund, enter an amount............ $ ,
To contribute to the Firefighters Fund, enter an amount.......................... $ ,
TeleFile will tell you the amount of refund or the amount you owe after contributions.
Amount of refund after Amount of tax you owe after
contributions from line 10 ... $ , contributions from line 10 ... $ ,
11 Iowa Election SPOUSE $1.50 to Republican Party
$1.50 to Democratic Party YOURSELF
$1.50 to Republican Party
$1.50 to Democratic Party
Campaign Fund $1.50 to Campaign Fund $1.50 to Campaign Fund
To direct deposit your refund, the following information is needed:
12 Routing Transit Number (RTN) of your financial institution
Type of Account Depositing to: Checking Savings
Depositor Account Number
Confirmation Date Filed
Are you paying additional tax?
Pay online or mail payment to Iowa Income Tax - Document Processing, PO Box 9187, Des Moines IA 50306-9187
TeleFile is available beginning If you qualify to TeleFile, complete the
January 14, 2005, at 8am worksheet first and then call TeleFile.
and ends Are you a first-time filer?
May 2, 2005, at midnight You can’t TeleFile, but you can still
E-File. See our Web site for details.
IA 1040 Line Reference
Line 3: Employer ID Number: This is a 9-
You Can TeleFile If... digit number generally located in Box b of
You were an Iowa resident for all of 2004...
worked only in Iowa
2 Line 4: Interest Income must be $400 or less.
If any 1099 indicates state or Federal
filed a timely 2003 Iowa income tax return
withholding, you cannot TeleFile.
your address hasn’t changed since you last
filed 3 Line 5: Dividend Income must be $400 or
Your filing status is... less. If any 1099 indicates state or Federal
Single Married filing joint withholding, you cannot TeleFile.
NOTE: Your filing status must be the 27 Line 7: Federal Income Tax Refund: If you
same as it was last year for Iowa. If don’t know this amount, contact the IRS at
you are married, you must be married 1-800-829-1040. Any part of the Federal
to the same spouse as shown last year refund due to earned income credit should be
on the Iowa return. subtracted.
33 Line 8: Additional Federal Tax Paid: This is
Your income is...
deductible only in the year actually paid. Do
$100,000 or less of taxable income not include any penalty and/or interest paid.
5 or fewer W-2s
Line 9:Federal Earned Income Credit: This
amount comes from your 2004 Federal
Unemployment compensation return. The allowable Iowa earned income
Interest income of $400 or less credit will be automatically calculated for
Dividend income of $400 or less you.
NOTE: Do not use TeleFile if you were Direct Deposit: See the check sample below
65 years or older/blind on 12/31/04. to help locate the correct information
NOTE: School surtax, if applicable, is needed.
automatically calculated when filing.
TeleFile will confirm that your return has
been filed. Don’t hang up until you receive
this information. Enter the information in the
box provided on the TeleFile worksheet.
It is your proof of filing.
QUESTIONS? E-mail: email@example.com or call: 515/281-3114, Option 3
2 41-144 (9/29/04)