Form L-1040 - City Of Lapeer Individual Income Tax Return - 2010

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2010 L-1040
CITY OF LAPEER INDIVIDUAL INCOME TAX RETURN
DUE May 2, 2011
TAXPAYER’S FIRST NAME, MIDDLE INITIAL, AND LAST NAME
YOUR SOCIAL SECURITY NUMBER
YOUR OCCUPATION
IF JOINT RETURN, SPOUSE’S FIRST NAME, MIDDLE INITIAL, AND LAST NAME
SPOUSE’S SOCIAL SECURITY NUMBER
SPOUSE’S OCCUPATION
CURRENT HOME ADDRESS (NUMBER AND STREET INCLUDING APARTMENT NUMBER)
IF MARRIED, IS SPOUSE FILING A SEPARATE RETURN? YES
NO
If Yes - Spouse’s Name and SSN:
CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE
ENTER NAME AND ADDRESS USED ON 2009 RETURN IF DIFFERENT
RESIDENCY STATUS:
RESIDENT
NONRESIDENT
PART-YEAR RESIDENT
FROM ________/_______/2010 TO _______/________/2010
EXEMPTIONS 1a
Yourself
65 or over
Blind
Disabled
Deaf 1b.
Spouse
65 or over
Blind
Disabled
Deaf
Name of Dependent
Social Security Number
Relationship
Date of Birth
Number of boxes checked
1c.
Number of dependents listed
1d.
1e.
Total Exemptions
1f.
(Enter on line 17)
INCOME
Resident-report all income earned regardless of where earned. Nonresident-report income earned in City.
Include Wages, Tips and other Compensation (Deferred compensation distributions, sick pay etc)
Wages from W-2, Box
Employer’s Name
Where you work
Income Tax Withheld
ATTACH
1
COPY OF
2a
.00
.00
PAGE 1 OF
2b
.00
.00
FEDERAL
2c
.00
.00
FORM 1040
TO
2d
.00
.00
BACK OF
2e Total for additional employers from attached sheet
.00
.00
THIS
3
TOTAL COMPENSATION AND LAPEER TAX WITHHELD
3a
.00
3b
.00
RETURN
4 Taxable interest – Attach copy of Page 1 of Federal 1040
4
.00
5 Ordinary dividends - Attach copy of Page 1 of Federal 1040
5
.00
6 Business and farming income – Attach copy of Federal Schedule C
6
.00
7 Capital gains or losses – Attach copy of Federal Schedule D
7
.00
ATTACH
8 Rental real estate, royalties, partnerships, trusts, etc. – Attach copy of Federal Schedule E
8
.00
W-2
FORMS
9 Other income total from Page 2, line 31f (UNEMPLOYMENT IS NOT TAXABLE INCOME TO THE CITY)
9
.00
HERE
10
TOTAL INCOME ADD LINES 3B THROUGH 9
10
.00
DEDUCTIONS
11 Individual Retirement Account – Attach copy of Page 1 of Federal 1040
11
.00
12 Employee business expenses – Attach copy of Federal Schedule 2106
12
.00
ENCLOSE
13 Moving expenses - Attach Federal Form 3903 or list
13
.00
CHECK OR
14 Alimony paid– DO NOT INCLUDE CHILD SUPPORT Attach copy of Page 1 of Federal 1040
14
.00
MONEY
ORDER
15
TOTAL DEDUCTIONS. ADD LINES 11 THROUGH 14
15
.00
FOR TAX
16
TOTAL INCOME AFTER DEDUCTIONS. SUBTRACT LINE 15 FROM LINE 10
16
.00
DUE
17 Amount for exemptions. Number of exemptions ________ times exemption amount of $600.00
17
.00
(DO NOT
18
TOTAL INCOME SUBJECT TO TAX. SUBTRACT LINE 17 FROM LINE 16
18
.00
STAPLE
TO
CALCULATE CITY OF LAPEER TAX :
RETURN)
19
Multiply Line 18 by .01 for Residents, .005 for Nonresidents or amount from Part-year resident Schedule P
19
.00
PAYMENTS AND CREDITS
(If line 24 exceeds $100 see instructions for making estimated tax payments)
20 Tax withheld by your employer from line 3a above
20
.00
21 Payments on 2010 Declaration of Estimated Income Tax, extension and credit forward
21
.00
22 Credit for tax paid to another city and/or for tax paid by a partnership. Attach copy of other city’s return
22
.00
23
TOTAL PAYMENTS AND CREDITS ADD LINES 20 THROUGH 22
23
.00
TAX DUE
24. If tax (line 19 is larger than payments (line 23)
>>>> PAY WITH RETURN
24
.00
Check, money order or for direct withdrawal mark 27 a ,c ,d, e, f below
OVERPAYMENT
25. If payments (line 23) are larger than tax (line 19)
>>>> REFUND
25
.00
For direct deposit mark 27 b, c, d, e, f below
CREDIT TO 2011
>>>> CREDIT FORWARD
26. Overpayment to be HELD and APPLIED TO NEXT YEAR ESTIMATED TAX
26
.00
ELECTRONIC REFUND OR PAYMENT INFORMATION
27 a. TAX DUE - DIRECT WITHDRAWAL
b. REFUND –DIRECT DEPOSIT
c. Electronic funds withdrawal effective date:
d. ROUTING NUMBER-- MUST BE 9 DIGITS ____ ____ ____ ____ ____ ____ ____ ____ ____
______/______/______
e. ACCOUNT # ____ _____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ _____ ____
(if blank, default is date return processed)
f. Account Type:
SAVINGS
CHECKING
SIGNATURES ARE REQUIRED ON PAGE 2
MAKE CHECK OR MONEY ORDER PAYABLE TO: CITY OF LAPEER OR PAY WITH ELECTRONIC FUNDS WITHDRAWAL
MAIL RETURN TO: Lapeer City Income Tax Department, 576 Liberty Park, Lapeer, MI 48446

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