Form Br 1040ez - Attach To 1040 Form - Individual Return

BR 1040EZ

ATTACH A COPY OF THE FRONT OF FEDERAL 1040 FORM

2015

RefeR to instRuctions on back to see who can use this foRm

INDIVIDUAL RETURN

Due Date: april 30, 2016

last name

Your Social Security number

B. RESiDEnCY

a. First name and initial

RESiDEnt

inside City limits

nOn-RESiDEnt

if Joint First name of Spouse

Spouse’s Social Security number

township of

Big Rapids

green

Present home address

Colfax

grant

Barton

norwich

home

City, State and Zip Code

Other_______________________

(Please specify)

D. EXEMPtiOnS

C. Filing StatuS

number______________________x $600.00 = $______________

a. _____ Single

D. name of Deceased:

if you are claimed as a dependent on someone else’s Big Rapids return, check

B. _____ Married, Filing Jointly

__________________________________

this box and do not take the exemption.

C. _____ Married, Filing Separately

Spouse’s name__________________________________________________

if you are a FSu student with permanent home other than Big Rapids, check

Social Security number __________________________________________

this box and claim yourself.

1. total Wages, Salaries, and tips......................................................................................................................

2. interest and/or Dividends income ..................................................................................................................

3. Exemptions

............................................................................................................................

(From D above)

(if you are a student and your parents do not file a City of Big Rapids return, check this box

and claim yourself)

4. taxable income (line 1 + line 2 - line 3) ......................................................................................................

5. tax (multiply amount on line 4 by one of the following)..................................................................................

a: RESiDEnt OnlY -1% (.01)

B: nOn-RESiDEnt OnlY - 1/2% (.005)

6. Voluntary Contribution to Big RaPiDS COMMunitY POOl and/or COMMunitY liBRaRY (Please circle) ..

7. total of lines 5 and 6 ....................................................................................................................................

OFFiCE uSE OnlY

Payment received

8. tax Withheld

with Return

______________________

2015 Estimated Payments

______________________

Credit from previous year over payment

______________________

total Payments

9. tax Due (line 7 minus line 8) ........................................................................................................................

10. Penalty and interest......................................................................................................................................

10.

11. Balance Due ................................................................................................................................................

11.

12. Overpayment /amount of Refund (line 8 minus line 7)................................................................................

12.

i declare, under penalty of perjury, that the information on this return and attachments is true and complete.

i authorize the City to discuss my

DO nOt discuss my

i declare, under penalty of perjury, that this return

claim and attachments with my

claim with my preparer.

is based on all information of which i have knowledge.

preparer

Filer’s Signature ______________________________________________ Date __________________