Form Gr-1040 Nr - City Of Grand Rapids Income Tax

CITY OF GRAND RAPIDS INCOME TAX

GR-1040 NR

2009 NR

INDIVIDUAL RETURN - NONRESIDENT - DUE April 30. 2010

Your social security number

Your first name

Initial Last name

Your occupation

Spouse's soc sec number

If joint return, spouse's first name Initial Last name

Spouse's occupation

PLEASE

TYPE

If married, is spouse filing

Present home address (Number and street including apartment number)

Enter name and address used on

a separate return?

2008 return. If same as this year, print

"Same." If none filed, give reason.

YES

City, town or post office, state and zip code

Check box if you DO NOT need a

return form mailed to you next year.

EXEMPTIONS

1a.

Yourself

65 or over

Blind 1b.

Spouse

65 or over

Blind

Number of boxes checked.

2. List first names of your dependent children who live with you:

Number of children listed.

3. Number of other dependents. (Same as federal) GO TO PAGE 2, LINE 23e

Number of other dependents.

4. Total number of exemptions. Add lines 1, 2, and 3

Total number of exemptions.

5. ENTER ALL WAGES, TIPS AND OTHER COMPENSATION INCLUDING SICK PAY, ETC.

INCOME

COLUMN B

If you worked for an employer in Grand Rapids only, put total wages in column C.

COLUMN A

COLUMN C

GR TAX

WAGES ETC. EARNED

If you worked in and outside of Grand Rapids for an employer, go to page 2, Line 24.

TOTAL WAGES

EMPLOYER FEDERAL ID #

ADDRESS OF ACTUAL WORK STATION

WITHHELD

EMPLOYER'S NAME

(W-2 FORM, BOX 1)

IN GRAND RAPIDS

5a.

5b.

5c.

5d.

5e.

ATTACH

5f.

COPY OF

Total compensation and Grand Rapids tax withheld. Add lines 5a through 5f

FORMS

GRW-2 OR

Business Income. From page 2, line 25f (ATTACH FEDERAL SCHEDULE C)

W-2 HERE

Income from sales and exchanges of tangible property located in Grand Rapids. (ATTACH FED. SCH. D AND FORM 4797) (See instructions)

Income from rentals, partnerships and other sources. From page 2, line 27e (ATTACH FED. SCH. E, FORMS K-1 AND 8582)

10.

Total income. Add lines 6c through 9

COLUMN 1

COLUMN 2

COLUMN 3

DEDUCTIONS

If you worked only in Grand Rapids put nothing in column 1 or column 2 and

FEDERAL

COL. 1 TIMES

enter the full amount in column 3. See instructions for additional information.

AMOUNT

COLUMN 2

11a. IRA deduction. (ATTACH PG. 1 OF FEDERAL RETURN & EVIDENCE OF PAYMENT)

11a

11b. Employee business expenses. (SEE INSTRUCTIONS AND ATTACH FEDERAL 2106 OR LIST)

11b

11c. Moving expenses. (Into Grand Rapids area only) (ATTACH FEDERAL 3903 OR LIST)

11c

11d. Alimony Paid. DO NOT INCLUDE CHILD SUPPORT (ATTACH COPY PAGE 1 OF FED. RET.)

11d

11e. Renaissance Zone Deduction. (ATTACH SCHEDULE RZ OF GR1040R OR GR-1040NR)

11e

11f.

Total deductions. Add column 3, lines 11a through 11e

11f

12.

Total income after deductions. Subtract line 11f from line 10

13. Amount for exemptions. (Number of exemptions from line 4 above ________ times $750)

14.

Total income subject to tax. Subtract line 13 from line 12

15.

City of Grand Rapids Tax at 0.65%.

(MULTIPLY LINE 14 BY .0065)

PAYMENTS AND CREDITS

(If line 17 exceeds $100 see instructions for making estimated tax payments.)

16a. Tax withheld by your employer from line 6b above. (ATTACH GRW-2 OR W-2 FORMS)

16a

16b. Payments on 2009 Declaration of Estimated Income Tax, payments with an extension and credits forward.

16b

ENCLOSE

16c. Credit for tax paid by partnerships and other credits. (EXPLAIN IN ATTACHED STATEMENT)

16c

CHECK OR

MONEY

16d.

Total payments and credits. Add lines 16a through 16c

16d

ORDER

17. If tax (line 15) is larger than payments (line 16d) you owe tax. ENTER TAX DUE AND PAY WITH RETURN.

FOR TAX

Enclose check or money order payable to the Grand Rapids City Treasurer. Or pay with an electronic

TAX DUE

DUE

funds withdrawal: mark Pay Tax Due box on line 22, enter effective date and complete line 22 a, b & c.

(DO NOT

18. If payments (line 16d) are larger than tax (line 15) ENTER OVERPAYMENT.

STAPLE TO

OVERPAYMENT

RETURN)

19. Overpayment to be HELD and APPLIED TO YOUR 2010 ESTIMATED TAX.

CREDIT TO 2010

20a

20. Overpayment donation:

20a

DONATION 1

American flags for veterans' graves in Grand Rapids.

All or any portion of

20b

DONATION 2

DONATION

Grand Rapids Children's fund.

overpayment may be

donated to any fund.

20c

DONATION 3

Grand Rapids Parks' fund.

21. Overpayment refund. For direct deposit mark Refund box on line 22 and complete 22 a, b & c.

REFUND

22. Mark one:

Pay tax due - Electronic

Electronic funds withdrawal

> >

ELECTRONIC

Refund - Direct deposit

funds withdrawal

effective date:

REFUND OR

(If blank, default is date return processed.)

a. Routing number

PAYMENT

INFORMATION

b. Account number

c. Account type:

Checking

Savings

2009 GR-1040NR PAGE 1

MAIL TO: GRAND RAPIDS INCOME TAX DEPARTMENT, PO BOX 2528, GRAND RAPIDS, MI 49501-2528

Form Gr-1040 Nr - City Of Grand Rapids Income Tax - 2009

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