Form Br 1040p - Individual Return - City Of Big Rapids Income Tax - 2012

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ATTACH A COPY OF THE FRONT OF FEDERAL 1040 FORM
PART YEAR FORM
BR 1040P
2012
INDIVIDUAL RETURN
Due Date: April 30, 2013
ciTy Of BiG RAPiDs incOMe TAX
last name
your social security number
A. first name and initial
B. ResiDency
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
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.
if you are a fsU student with per-
c. _____ Married, filing separately
manent home other than Big Rapids, check this box and claim yourself.
spouse’s name__________________________________________________
social security number __________________________________________
Dates from:______________________
Dates from:______________________
To:______________________
To:______________________
Use this form only if you had taxable income during 2012
PORTiOn Of incOMe eARneD in
Both as a Resident and non-Resident
All incOMe While A
BiG RAPiDs While
BiG RAPiDs ResiDenT
A nOn-ResiDenT
00
00
1.
1. GROss WAGes (Attach W-2)................................................................................
00
00
2.
2. ADDiTiOns (Attach schedule(s) and explain) ........................................................
00
00
3.
3. sUBTRAcTiOns (Attach schedules(s) and explain) ..............................................
00
00
4.
4. TOTAl incOMe - BOTh cOlUMns (add lines 1, 2 and less 3) ..........................
5. less eXeMPTiOns - Multiply number of exemptions claimed by $600.00,
00
00
5.
enter in column 1 (if more than line 4, carry excess to column 2) ........................
(if you are a student and your parents do not file a city of Big Rapids return,
check this box
and claim yourself)
00
00
6.
6. TAXABle incOMe - line 4, less line 5 ................................................................
00
7.
7. TAX - Residential income: Multiply line 6, column 1 by 1% (.01) ..................................................................................
00
8.
8. TAX - non-Residential income: Multiply line 6, column 2 by 1/2% (.005) ....................................................................
00
(Please circle)
9.
9. VOlUnTARy cOnTRiBUTiOn TO BiG RAPiDs cOMMUniTy POOl and/or cOMMUniTy liBRARy
00
10. TOTAl TAX - Add lines 7, 8 and 9 ............................................................................................................................
10.
PAyMenTs AnD TAX cReDiTs
Office Use Only
00
Payment received
11.
11. B
R
T
W
......................................................................................
iG
APiDs
AX
iThhelD
with Return
00
12.
12. 2012 e
P
....................................................................................
sTiMATeD
AyMenTs
_____________________
00
13.
_____________________
13. c
..............................................................
ReDiT fROM PReViOUs yeAR OVeR PAyMenT
00
_____________________
14.
14. c
i
T
M
M
(R
O
) ..........
ReDiTs fOR
ncOMe
AX PAiD TO AnOTheR
ichiGAn
UniciPAliTy
esiDenTs
nly
00
(Add lines 11, 12, 13 & 14) ...................................................................................................... 15.
15. T
P
c
OTAl
AyMenTs AnD
ReDiTs
00
16. TAX DUe (line 10 larger than line 15) .................................................................................................................................. 16.
00
17. PenAlTy AnD inTeResT (schedule 3 of BR 1040 Return) .................................................................................................. 17.
00
18. BAlAnce DUe (Add lines 16 and 17) .................................................................................................................................. 18.
00
19. OVeRPAyMenT (line 15 is larger than line 10 .................................................................................................................... 19.
Amount on line 19 is to be (checK One BOX Only)
A.
credited to 2013
B.
Refunded to you
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 __________________
PRePAReR’s siGnATURe & ADDRess
Birthdate ______________________________
spouse’s signature ____________________________________________ Date __________________
Phone (
)_______________________________
Birthdate ______________________________
MAil yOUR ReTURn FOR REFUND TO: ciTy Of BiG RAPiDs, incOMe TAX DiVisiOn, 226 nORTh MichiGAn AVe., BiG RAPiDs, Mi 49307
MAil yOUR ReTURn FOR PAYMENT TO: ciTy Of BiG RAPiDs, TReAsUReR’s Office, 226 nORTh MichiGAn AVe., BiG RAPiDs, Mi 49307

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