For Calendar Year January 1 - December 31, 2021 2021 Individual Income Tax Return - Long Form Department Use Only Form MO-1040 Fiscal Year Beginning (MM/DD/YY) Fiscal Year Ending (MM/DD/YY) Age 62 through 64 Yourself Spouse Age 65 or Older Blind 100% Disabled Non-Obligated Spouse Yourself Spouse Yourself Spouse Yourself Spouse Yourself Spouse Amended Return Print in BLACK ink only and DO NOT STAPLE. Name Address If filing a fiscal year return enter the beginning and ending dates here. Composite Return Social Security Number Spouse’s Social Security Number - - M.I. In Care Of Name (Attorney, Executor, Personal Representative, etc.) County of Residence Present Address (Include Apartment Number or Rural Route) City, Town, or Post Office State ZIP Code Last Name in 2021 _ First Name Suffix Spouse’s Last Name Spouse’s First Name M.I. Suffix *21322010001* 21322010001 You may contribute to any one or all of the trust funds on Line 48. See pages 11-12 of the instructions for more trust fund information. Deceased Deceased in 2021 Name - - MO-1040 Page 1 0 Vendor Code 0 1 Single Married Filing Combined Married Filing Separately Head of Household Qualifying Widow(er) Claimed as a Dependent Filing Status (For use by S corporations or Partnerships) Federal Extension - Select this box if you have an approved federal extension. Attach a copy Federal Extension (Form 4868). Veterans Trust Fund Children’s Trust Fund Elderly Home Delivered Meals Trust Fund Missouri National Guard Trust Fund Workers Workers’ Memorial Fund LEAD Childhood Lead Testing Fund Missouri Military Family Relief Fund General Revenue General Revenue Fund Organ Donor Program Fund Soldiers Memorial Military Museum in St. Louis Fund Kansas City Regional Law Enforcement Memorial Foundation Fund

% 00 . % 6. Total Missouri adjusted gross income - Add columns 5Y and 5S . . . . . . . . . . . 7. Income percentages - Divide columns 5Y and 5S by total on Line 6. (Must equal 100%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Y 7S 6 Exemptions and Deductions 00 . 8. Pension, Social Security and Social Security Disability exemption (from Form MO‑A, Part 3,

Section D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 10. Other tax from federal return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Total tax from federal return. Do not enter federal income tax withheld. 12. Federal tax percentage – Enter the percentage based on your 00 . 9 00 . 10 00 . 11 12 00 . 14 14. Missouri standard deduction or itemized deductions. (If itemizing, See Form MO-A, Part 2) • Single or Married Filing Separate-$12,550 • Head of Household-$18,800 *21322020001* 21322020001 Income Yourself (Y) Spouse (S) 1. Federal adjusted gross income from federal return (see worksheet on page 7 of the instructions) . . . . . . . . . . . . . 2. Total additions (from Form MO‑A, Part 1, Line 7) . . . . . . . . . . 3. Total income - Add Lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . 4. Total subtractions (from Form MO‑A, Part 1, Line 18) . . . . . . 5. Missouri adjusted gross income - Subtract Line 4 from Line 3 . 00 . 1S 00 . 1Y 00 . 5S 00 . 5Y 00 . 4S 00 . 4Y 00 . 3S 00 . 3Y 00 . 2S 00 . 2Y MO-1040 Page 2 9. Tax from federal return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. Transportation facilities deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 20 19. Bring jobs home deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 19 15. Long-term care insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 15 16. Health care sharing ministry deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 16 17. Active Duty Military income deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 17 A. Port Cargo Expansion B. International Trade Facility C. Qualified Trade Activities 00 . 13. Federal income tax deduction – Multiply Line 11 by the percentage on Line 12. Enter this amount not to exceed $5,000 for an individual or $10,000 for combined filers. . . . . . . . . . . . . . . 13 Missouri Adjusted Gross Income, Line 6. Use the chart below to Missouri Adjusted Gross Income Range, Line 6: 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% find your percentage . . . . . . . . . . . . . . . . . . . . . . . . % 18. Inactive Duty Military income deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 18 • Married Filing Combined or Qualifying Widow(er)-$25,100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*21322030001* 21322030001 Tax 00 . 27S 00 . 27Y 27. Taxable income - Subtract Line 26 from Line 25 . . . . . . . . . . . 00 . 28S 00 . 28Y 28. Tax (see tax chart on page 26 of the instructions) . . . . . . . . . . 00 . 29S 00 . 29Y

income tax return(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29. Resident credit - Attach Form MO‑CR and other states’

completing Form MO-NRI. Attach Form MO-NRI and a 30. Missouri income percentage - Enter 100% unless you are

copy of your federal return if less than 100% . . . . . . . . . . . . . 00 . 31S 00 . 31Y

multiply Line 28 by percentage on Line 30 . . . . . . . . . . . . . . . 31. Balance - Subtract Line 29 from Line 28; OR 00 . 32S 00 . 32Y 32. Other taxes - Select box and attach federal form indicated. Lump sum distribution (Form 4972) Recapture of low income housing credit (Form 8611) 00 . 33S 00 . 33Y 33. Subtotal - Add Lines 31 and 32 . . . . . . . . . . . . . . . . . . . . . . . 00 . 34 34. Total Tax - Add Lines 33Y and 33S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payments and Credits 35. MISSOURI tax withheld - Attach Forms W‑2 and 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36. 2021 Missouri estimated tax payments - Include overpayment from 2020 applied to 2021 . . . . . . . . 37. Missouri tax payments for nonresident partners or S corporation shareholders - Attach Forms

MO-2NR and MO-NRP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 35 00 . 36 00 . 37 30S % 30Y % MO-1040 Page 3 40. Miscellaneous tax credits (from Form MO-TC, Line 13) - Attach Form MO-TC . . . . . . . . . . . . . . . 00 . 40 41. Property tax credit - Attach Form MO-PTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 41 42. Total payments and credits - Add Lines 35 through 41 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 42 39. Amount paid with Missouri extension of time to file (Form MO-60) . . . . . . . . . . . . . . . . . . . . . . . . 00 . 39 38. Missouri tax payments for nonresident entertainers - Attach Form MO-2ENT . . . . . . . . . . . . . . . 00 . 38 00 . 22 22. Long Term Dignity Savings Account Deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. Subtotal - Subtract Line 23 from Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 24 00 . 26S 00 . 26Y 26. Enterprise zone or rural empowerment zone income

modification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25. Multiply Line 24 by appropriate percentages (%) on 00 . 25S 00 . 25Y

Lines 7Y and 7S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. First Time Home Buyers deduction. A. B. 00 . 21 Deductions Continued 00 . 23 23. Total deductions - Add Lines 8 and 13 through 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Refund 46. If Line 42, or if amended return, Line 45, is larger than Line 34, enter the difference. 00 . 46

Amount of OVERPAYMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47. Amount of Line 46 to be applied to your 2022 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 47 48. Enter the amount of your donation in the trust fund boxes below. See instructions for additional trust fund codes. 49. Amount of Line 46 to be deposited into a Missouri 529 Education Plan (MOST) 00 . 49

account. Enter the total deposit amount from Form 5632 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *21322040001* 21322040001 00 . 48

Skip Lines 43 through 45 if you are not filing an amended return. 43. Amount paid on original return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 43 44. Overpayment as shown (or adjusted) on original return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 44 D. Correction other than A, B, or C . . . . . . Indicate Reason for Amending A. Federal audit . . . . . . . . . . . . . . . . . . . . . B. Net Operating Loss carryback . . . . . . . . C. Investment tax credit carryback . . . . . . . 45. Amended return total payments and credits - Add Lines 42 and 43; subtract Line 44. 00 . 45

Enter on Line 45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter date of federal amended return, if filed. (MM/DD/YY) Enter year of credit (YY) Enter year of loss (YY) Enter date of IRS report (MM/DD/YY)

Total Donation - Add amounts from Boxes 48a through 48m and enter here . . . . . . . . . . . . . . . . Amended Return MO-1040 Page 4 50. REFUND - Subtract Lines 47, 48, and 49 from Line 46 and enter here . . . . . . . . . . . . . . . . . . . . . 00 . 50 Reserved 00 . Children’s Trust Fund Veterans Trust Fund Elderly Home Delivered Meals Trust Fund 00 . 00 . Workers’ Memorial Fund Childhood Lead Testing Fund 00 . 00 . 00 . Organ Donor Program Fund 48a. 48b. 48c. 48e. 48f. 48i. 00 . 48l. Additional Fund Code Additional Fund Amount 00 . Kansas City Regional Law Enforcement Memorial Foundation Fund 48j. 00 . Soldiers Memorial Military Museum in St. Louis Fund 48k. 00 . Missouri National Guard Trust Fund 48d. 00 . 00 . General Revenue Fund Missouri Military Family Relief Fund 48g. 48h. 00 . 48m. Additional Fund Code Additional Fund Amount

Mail to: Balance Due: Refund or No Amount Due: Fax: (573) 522-1762

Missouri Department of Revenue Missouri Department of Revenue Email: income@dor.mo.gov

P.O. Box 329 P.O. Box 500

Jefferson City, MO 65105-0329 Jefferson City, MO 65105-0500

Phone: (573) 751-7200 Phone: (573) 751-3505

Ever served on active duty in the United States Armed Forces? If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible military individuals. A list of all state agency resources and benefits can be found at veteranbenefits.mo.gov/state-benefits/. Yes No Preparer’s Telephone Signature Preparer’s Signature Spouse’s Signature (If filing combined, BOTH must sign) Daytime Telephone Date (MM/DD/YY) Preparer’s Address ZIP Code State 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-mail Address Preparer’s FEIN, SSN, or PTIN Date (MM/DD/YY) Date (MM/DD/YY) *21322050001* 21322050001

electronically. Any returned check may be presented again electronically . . . . . . . . . . . . . . . . . . Amount Due 51. If Line 34 is larger than Line 42 or Line 45, enter the difference. 00 . 51

Amount of UNDERPAYMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52. Underpayment of estimated tax penalty - Attach Form MO-2210. Enter penalty amount here . . . 00 . 52 53. AMOUNT DUE - Add Lines 51 and 52. 00 . 53

If you pay by check, you authorize the Department of Revenue to process the check Signature FA E10 A DE Department Use Only F Select this box if you are a farmer exempt from the underpayment of estimated tax penalty. . MO-1040 Page 5

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

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.

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 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. . . . . . . Visit dor.mo.gov/taxation/individual/tax-types/income/ for additional information. Form MO-1040 (Revised 12-2021)