You may contribute to any of the following approved causes. Contributions will add to your tax due or reduce your refund. Once made, you cannot change a contribution on an amended return. Leave the entire Part 4 blank if you are not contributing to one or more of the accounts.
Write the code and amount of each contribution on the Part 4 lines. Total your contributions and enter the sum on line 28 of TC-40, page 2.
Each contribution is explained below.
Codes for Contributions
(02) Pamela Atkinson Homeless Account (UC §59-10-1306)-Contributions help fund services and programs to help Utahns become self-sufficient.
For more information, contact: Housing and Community Development Division Department of Workforce Services, 1385 S State Street, Salt Lake City, UT 84115, 801-468-0148
(03) Kurt Oscarson Children’s Organ Transplant Account (UC §59-10-1308)-Contributions provide financial help to families of children needing an organ transplant.
For more information, contact: Representative for the Department of Health, PO Box 144610, 44 N Mario Capecchi Dr., Salt Lake City, UT 84114, 801-584-8239
(05) School District and Nonprofit School District Foundation (UC §59-10-1307)-Contributions help fund private, nonprofit school district foundations established to promote partnership activities between schools and communities; charitable giving activities to specifi c educational programs; and opportunities for scientific, educational, literary, and improvement objectives.The contribution goes to the school district if there is no nonprofit foundation. Enter a code for the school district/ foundation (from the list below) in the SCHOOL DIST. CODE box to the right of the amount.
School District Codes for "SCHOOL DIST. CODE" box
01 Alpine 11 Grand 22 N. Sanpete 33 S. Summit
02 Beaver 12 Granite 23 N. Summit 34 Tintic
03 Box Elder 13 Iron 24 Ogden 35 Tooele
04 Cache 14 Jordan 25 Park City 36 Uintah
42 Canyons 15 Juab 26 Piute 41 Utah Assistive Technology
05 Carbon 16 Kane 27 Provo
06 Daggett 17 Logan 28 Rich 37 Wasatch
07 Davis 18 Millard 29 Salt Lake 38 Washington
08 Duchesne 19 Morgan 30 San Juan 39 Wayne
09 Emery 20 Murray 31 Sevier 40 Weber
10 Garfi eld 21 Nebo 32 S. Sanpete
(15) Clean Air Fund (UC §59-10-1319) Contributions are disbursed to the Utah Division of Air Quality to fund: 1. grants to individuals or organizations in Utah for activities to improve Utah air quality; or 2. public educational programs about the importance of air quality for the health, well-being and livelihood of Utah residents.
For more information, contact: Utah Division of Air Quality Department of Environmental Quality PO Box 144820 Salt Lake City, UT 84114-4820 801-536-0076
(16) Governor’s Suicide Prevention Fund (UC §59-10-1320) Contributions fund mental health crisis response improvements, suicide risk factor reductions and protection factors associated with suicide reduction.
For more information, contact: Utah Department of Human Services Division of Substance Abuse & Mental Health 195 N 1950 W Salt Lake City, UT 84116 801-538-3939