Form Al-1040x - Amended Albion Income Tax Return - 2001
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3AL-1040X
(Rev. 9-01)
AMENDED ALBION INCOME TAX RETURN
Issued under authority of P.A. 284 of 1964.
1. Enter calendar year or ending date of fiscal year (mo./day/yr.) of this return............... _________________ Tax Year
PART 1 - IDENTIFICATION
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2.
3.
Filer's First Name, Middle Initial and Last Name
Filer's Social Security Number
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4.
If a Joint Return, Spouse's First Name, Middle Initial and Last Name
Spouse's Social Security Number
Home Address (No., Street, P.O. Box or Rural Route)
Office Use
City or Town
State
ZIP Code
5.
Enter name and address on original return. (If same as above, write "same.") If changing from separate to joint return, enter names and
addresses used on original returns. (NOTE: you cannot change from joint to separate returns after the due date has passed for filing.)
F
Resident
Nonresident
Part-year Resident
RESIDENCY STATUS
Enter Dates:
6.
On Original Return
FROM: _______________
TO: ______________
FROM: _______________
TO: ______________
7.
On This Return
F
FILING STATUS
Single
Married - filing jointly
Married - filing separately
Enter Spouse's Name:
8.
On Original Return
9.
On This Return
EXEMPTIONS
Allowable federal exemptions
Allowable Albion Additional Exemptions
(Explain in Part 6
10.
On Original Return
on the back)
11.
On This Return
PART 2 - INCOME, ADDITIONS and DEDUCTIONS
A. On Original Return
B. Net Change C. Correct Amount
12.
Total income. Explain changes in Part 7 on page 2
12.
13.
Additions to total income
13.
14.
Income total. Add lines 12 and 13
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15.
Subtractions from total income
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16.
Balance. Subtract line 15 from line 14
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17.
Exemption allowance. Multiply number of exemptions by
applicable amount (see instructions)
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18.
Taxable income. Subtract line 17 from line 16
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19.
Tax. Multiply line 18 by tax rate (see instructions)
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PART 3 - NONREFUNDABLE CREDIT (Albion Residents Only)
20.
Credit for income tax paid to another municipality
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21.
Income tax. Subtract line 20 from line 19
21.
PART 4 - REFUNDABLE CREDITS and PAYMENTS
22.
Albion income tax withheld. (If amending, attach city copy of W-2.)
22.
23.
Albion estimated tax, credit forward and extension payments
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24.
Partnership credit
24.
.00
25.
Amount paid with original return, plus additional tax paid after filing
25.
.00
26.
Total credits and payments. Add lines 22 through 25 of column C
26.
PART 5 - REFUND or BALANCE DUE
.00
27.
Refund, if any, shown on original return
27.
.00
28.
Enter the difference between lines 26 and 27. (If a negative amount, see instructions.)
28.
29.
If line 21, column C, is greater than line 28, enter BALANCE DUE
.00
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Include interest ____________ and penalty ______________ (if applicable, see instructions)
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.
.00
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If line 21, column C, is less than line 28, enter REFUND to be received
30.
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