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                          Form
                                     2023 Individual Income Tax Return  
  MO-1040A                           Single/Married (One Income)

Print in BLACK ink only and DO NOT STAPLE.
For Privacy Notice, see Instructions.

                          Federal Extension - Select this box if you have an approved federal 
                          extension. Attach a copy Federal Extension (Form 4868).                            Vendor Code                  Department Use Only

                           Department of Social Services Eligibility form attached.                            0 0 1

                              Single             Claimed as a            Married Filing            Married Filing                Head of               Qualifying 
                                                 Dependent               Combined                  Separately                    Household             Widow(er)
             Filing Status
                                                        Age 65 or Older                      Blind                      100% Disabled      Non-Obligated Spouse
Select the appropriate 
boxes that apply.                                    Yourself Spouse                Yourself      Spouse       Yourself          Spouse    Yourself     Spouse

                                                                                        Deceased                                                        Deceased
                          Social Security Number                                        in 2023   Spouse’s Social Security Number                                in 2023

                                         -              -                                                               -          -
                          First Name                                     M.I.           Last Name                                                                  Suffix

             NameName
                          Spouse’s First Name                            M.I.           Spouse’s Last Name                                                         Suffix

                          In Care Of Name (Attorney, Executor, Personal Representative, etc.) Attach form if applicable.

                          Present Address (Include Apartment Number or Rural Route)

                          City, Town, or Post Office                                                                    State      ZIP Code
             Address                                                                                                                                   _

                          County of Residence

You may contribute to any one or all of the trust funds on Line 16. See instructions for more trust fund information.

                                                                                                                                                        Kansas 
                                                                                        Workers    LEAD                           General               City  
                                                                                                                                  Revenue               Regional 
                                                        Elderly Home     Missouri       Workers’   Childhood   Missouri Military                        Law            Soldiers  
                              Children’s      Veterans  Delivered Meals  National Guard Memorial  Lead Testing Family Relief     General  Organ Donor  Enforcement     Memorial   
Medal of Honor                Trust Fund     Trust Fund       Trust Fund Trust Fund     Fund       Fund        Fund              Revenue  Program Fund Memorial        Military Museum 
Fund                                                                                                                              Fund                 Foundation Fund in St. Louis Fund

                                                                         *23334010001*
                                                                                        23334010001
                                                                                                                                                         MO-1040A Page 1
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                   1.  Federal adjusted gross income from federal return (see page 6 of the instructions)..................                     1                . 00

      Income       2.  Any state income tax refund included in federal adjusted gross income ....................                               2                . 00

                   3.  Total Missouri adjusted gross income...............................................                                      3                . 00

                 4a. Tax from federal return. Do not enter federal income tax withheld.                                      4a                 . 00

                 4b.  Federal tax percentage – Enter the percentage based on your Missouri
                 Adjusted Gross Income, Line 3. Use the chart below to find your
                 percentage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b                 %

                 Missouri Adjusted Gross Income Range, Line 3:      Federal Tax Percentage:
                 $25,000 or less ........................................................................35%
                 $25,001 to $50,000.................................................................. 25%
                 $50,001 to $100,000................................................................15%
                 $100,001 to $125,000............................................................... 5%
                 $125,001 or more .....................................................................0%

                 4c.  Federal income tax deduction – Multiply Line 4a by the percentage on Line 4b. Enter this 
      Deductions  amount not to exceed $5,000 for an individual or $10,000 for combined filers .  .  .  .  .  .  .  .  .  .  .  .               4c               . 00

                 5.  Missouri standard deduction or itemized deductions.
                        • Single or Married Filing Separate - $13,850
                        •  Head of Household - $20,800
                        •  Married Filing Combined or Qualifying Widow(er) - $27,700
                 If age 65 or older, blind, or claimed as a dependent, see federal return or page 6.  
                 If itemizing, see page 14 ........................................................                                             5                . 00

                   6.  Additional Exemption for Head of Household and Qualifying Widow(er) ....................                                 6                . 00

                   7.  Long-term care insurance deduction ...............................................                                       7                . 00

                 8.  Total Deductions - Add Lines 4c through 7 ..........................................                                       8                . 00

                 9.  Missouri Taxable Income - Subtract Line 8 from Line 3.................................                                     9                . 00
            Tax
                10.  Tax - Use the tax chart on page 10 to figure the tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10               . 00
                11.  Missouri tax withheld from Form(s) W-2 and 1099. 
                   Attach copies of Form(s) W-2 and 1099 .................................................                                      11               . 00

                12.  Missouri estimated tax payments made for 2023. 
                   Include overpayment from 2022 applied to 2023......................................                                          12               . 00

                13.  Total Payments - Add Lines 11 and 12 .............................................                                         13               . 00

                14.  If Line 13 is more than Line 10, enter the difference. This is your overpayment. 
                   If Line 13 is less than Line 10, skip to Line 19 ........................................                                    14               . 00
      Refund
                15.  Amount from Line 14 that you want applied to your 2024 estimated tax ....................                                  15               . 00

                16.  Enter the amount of your donation in the trust fund boxes below (see instructions for trust fund codes.)
                                                                                                            Elderly Home                        Missouri 
                      Children’s                 Veterans                                                   Delivered Meals                     National Guard 
                 16a. Trust Fund    . 00    16b. Trust Fund             . 00 16c.                           Trust Fund          . 00 16d.       Trust Fund     . 00

                                                 Childhood                                                  Missouri 
                      Workers’                   Lead                                                       Military Family                     General 
                 16e. Memorial Fund . 00    16f. Testing Fund           . 00 16g.                           Relief Fund         . 00 16h.       Revenue Fund   . 00
                 *23334020001*                                            2                                                                                     MO-1040A Page 2
                                 23334020001

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Kansas City Soldiers
Regional Law Memorial
Enforcement Military
Organ Donor Memorial Museum in
16i. Program Fund . 00 16j. Foundation Fund 00 16k. St. Louis Fund 00 16l. Medal of Honor 00

Additional Additional Additional Additional
Fund Fund Fund Fund
16m. Code Amount . 00 16n. Code Amount . 00

Total Donation - Add amounts from Boxes 16a through 16n and enter here ................ 16 . 00

17. Amount from Line 14 to be deposited into a Missouri 529 Education Plan (MOST)
17 00
Refund (continued) account. Enter amount from Line E of Form 5632..................................... .

18. REFUND - Subtract Lines 15, 16, and 17 from Line 14 and enter here..................... 18 . 00

Reserved

19. AMOUNT DUE - If Line 13 is less than Line 10, enter the difference here ................ 19 . 00
Due
Amount
If you pay by check, you authorize the Department to process the check electronically. Any returned check 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. By signing or entering my name in the “Signature” field(s) below, I am providing
the Department of Revenue with my signature as required under Section 143.561, RSMo. Declaration of preparer (other than taxpayer) is
based on all information of which he or she has 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 Date (MM/DD/YY)

Spouse’s Signature (If filing combined, BOTH must sign) Date (MM/DD/YY)

E-mail Address Daytime Telephone

Signature Preparer’s Signature Date (MM/DD/YY)

Preparer’s FEIN, SSN, or PTIN Preparer’s Telephone

Preparer’s Address State ZIP Code

I authorize the Director of Revenue or delegate to discuss my return and attachments with the preparer
or any member of the preparer’s firm ........................................................ Yes No

Did you pay a tax return preparer to complete your return, but the preparer failed to sign the return or provide
an Internal Revenue Service preparer tax identification number? If you marked yes, please insert the
preparer’s name, address, and phone number in the applicable sections of the signature block above....... Yes No

Department Use Only

A FA E10 DE F .
MO-1040A Page 3
*23334030001* 3
23334030001

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                                                                                                                                                                                     •  Complete this section only if you itemized deductions on your federal return (see the information on pages 6, 8 and 9). 
                                                                                                                                                                                     •  Attach a copy of your Federal Form 1040 or 1040-SR (pages 1 and 2) and Federal Schedule A.  
                                                                                                                                                                                     •  If you are subject to “additional Medicare tax”, attach a copy of Federal Form 8959.

                                                                                                                                                        1.  Total federal itemized deductions (from Federal Form 1040 or 1040-SR, Line 12)............                                    1                     . 00

                                                                                                                                                        2.  2023 Social security tax .........................................................                                            2                     . 00

                                                                                                                                                        3.  2023 Railroad retirement tax (Tier I and Tier II).......................................                                      3                     . 00

                                                                                                                                                        4.  2023 Medicare tax (see instructions on page 8 and 9) ...................................                                      4                     . 00

                                                                                                                                                        5.  2023 Self-employment tax (see instructions on page 9) ................................                                        5                     . 00

                                                                                                                                                        6.  Total - Add Lines 1 through 5.....................................................                                            6                     . 00
                                                                                                                                                         7.  State and local income taxes from Federal Schedule A, 
                                                                                                                                                      Missouri Itemized Deductions     Line 5a or Enter $0 if completing the worksheet below ..........  7                        .     00
                                                                                                                                                        8.  Earnings taxes included in Line 7 (see instructions on page 9)....                           8                        .     00

                                                                                                                                                        9.  Net state income taxes - Subtract Line 8 from Line 7 or enter Line 7 from worksheet below ....                                9                     . 00

                                                                                                                                                       10.  Missouri Itemized Deductions - Subtract Line 9 from Line 6. Enter here and on Form MO-1040A,
                                                                                                                                                                                       Line 5. ...........................................................................                10                    . 00

                                                                                                                                                                                                  Note: If Line 10 is less than your federal standard deduction, see information on page 6.

                                                                                                                                                                                    Complete this worksheet only if your total state and local taxes included in your federal itemized deductions
                                                                                                                                                                                    (Federal Schedule A, Line 5d) exceeds $10,000 (or $5,000 for married filing separate taxpayers).

                                                                                                                                                                                    1.  Enter the sum of your state and local taxes on Federal Form 1040 or 1040-SR, 
                                                                                                                                                                                     Schedule A, Line 5d. ..............................................................                  1                     . 00

                                                                                                                                                                                    2.  State and local income taxes from Federal Form 1040 or 1040-SR, Schedule A, Line 5a.    .......   2                     . 00

                                                                                                                                                                                    3.  Earnings taxes included on Federal Form 1040 or 1040-SR, Schedule A, Line 5a  ..........          3
                                                                                                                                                                                                                                                                                                                . 00
                                                                                                                                                                                    4.  Subtract Line 3 from Line 2. .....................................................                4
                                                                                                                                                                                                                                                                                                                . 00
                                                                                                                                                                                    5.  Divide Line 4 by Line 1.........................................................                  5                       %

                                                                                                                                                                                    6.  Enter $10,000 ($5,000 if married filing separately). ..................................           6                     . 00

                                                                                                                                                                                    7.  Multiply Line 6 by percentage on Line 5. Enter here and on Missouri Itemized Deductions,  
                                                                                                                                                                                     Line 9, above. ...............................................................                       7                     . 00

                                                                                                                                                                                                                   *23334040001*
                                                                           Worksheet for Net State Income tax, Line 9 of  Missouri Itemized Deductions
                                                                                                                                                                                                                                23334040001
                                                                                                                                                                                                                                                                                             Form MO-1040A (Revised 12-2023)
Mail to:                                                                                                                                                                             Balance Due:                  Refund or No Amount Due:                Fax:  (573) 522-1762
                                                                                                                                                                                     Missouri Department of Revenue  Missouri Department of Revenue        Email: incometaxprocessing@dor.mo.gov 
                                                                                                                                                                                     P.O. Box 329                  P.O. Box 500                            Submission of Individual Income Tax returns
                                                                                                                                                                                     Jefferson City, MO 65105-0329 Jefferson City, MO 65105-0500           Email:  income@dor.mo.gov
                                                                                                                                                                                     Phone:  (573) 751-5860        Phone:  (573) 751-3505                  Inquiry and correspondence 
                                                                                                                                                                                                                    
Ever served on active duty in the United States Armed Forces?                                                                                                                                                                                            Visit: dor.mo.gov/taxation/individual/tax-types/income/ 
If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible                                                                                                                                                                                for additional information.
military individuals. A list of all state agency resources and benefits can be found at 
veteranbenefits.mo.gov/state-benefits/.                                                                                                                                                                                         4                                                             MO-1040A Page 4

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