Form J1040 - Income Tax Individual Return - City Of Jackson

J1040

CHECK

RESIDENT

2011

CITY OF JACKSON, MI INCOME TAX

FOR CALENDAR

ONE

NONRESIDENT

OR FISCAL YEAR ENDING

BOX

PART-YEAR

INDIVIDUAL RETURN

DATE(S) OF BIRTH

FILING STATUS:

YOUR SOCIAL SECURITY NUMBER

SPOUSE'S SOCIAL SECURITY NUMBER

RESIDENT FROM _____ TO _____

FIRST NAME(S) AND INITIAL(S)

LAST NAME

TELEPHONE

SINGLE

JOINT

HOME (

)

WORK (

)

(STREET OR RURAL ROUTE) DO NOT USE P.O. BOX

Your Occupation

EMPLOYERS NAME & LOCAL ADDRESS

_____________________________

CITY, TOWN OR POST OFFICE

STATE

POSTAL ZIP CODE

Spouse's Occupation

_____________________________

EXEMPTIONS:

YOURSELF

65 & Over

SPOUSE

65 & Over

Children are allowed their

Blind

Paraplegic

Blind

Paraplegic

own exemption even if being

claimed on parents return:

NO. OF BOXES

Check

No. of

If age 2 or over dependent's

Dependents

CHECKED ON a

if under

Relationship

months

social security number

Name (first, initial, and last name)

Did you file a 2010 City

AND b

age 2

in your home

Return? . . . . . . . . . . . .

NO. OF OTHER

DEPENDENTS

Yes

LISTED ON c

If yes, are the Name(s)

TOTAL EXEMPTIONS

and Address the same?

ADD NUMBERS

ENTERED ON

Yes

BOXES ABOVE

If no, list name and

DO NOT ROUND

address used on previous

DROP CENTS

return: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1A. TOTAL INCOME:

(all W2's Schedules and / or documents to substantiate totals must be attached in order to process return)

1A.

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

RESIDENTS: enter total

gross income

for 2011.

1B.

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

NONRESIDENTS: enter gross wages from W-2, or Schedule 1, page 2

(If you have no additions or subtractions, carry this amount to line 4)

2. ADDITIONS TO INCOME:

. .

(from page 2 Schedule 2R line C for Residents or 2NR line E for Non-Residents) 1120-S income is not taxable on individual return.

3. SUBTRACTIONS FROM INCOME

(From page 2 schedule 2R line M for Residents/Schedule 2NR line

for Non-Residents) 1120-S loss not deductible on individual return.

ATTACH ALL SCHEDULES AND EXPLANATIONS

4. ADJUSTED INCOME (Add lines 1 and 2 less line 3.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. EXEMPTIONS: Multiply the number of exemptions claimed by $600.00. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. TAXABLE INCOME (line 4 less line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. TAX - Multiply amount on line 6 by one of the following:

A. RESIDENT ONLY - 1% (.01) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B. NONRESIDENT ONLY -

% (.005). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. PART-YEAR RESIDENT - Tax from Schedule 4, line M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ATTACH COPIES OF W2’S

PAYMENTS AND TAX CREDITS:

8. Jackson tax withheld (You must attach copies of all W2’s to obtain credit for withholding.)

9. 2011 Estimate payments (including carry forward credit from 2010 J-1040 . . . . . . . . . . .

10.

10. Credits for income tax paid to another Michigan municipality (Residents Only) or by

a partnership. *Attach copy of other municipalities return.

11.

11. TOTAL PAYMENTS AND CREDITS (Add lines 8, 9 and 10.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(Make checks payable to City Treasurer.)

12.

PAY WITH RETURN

12. BALANCE DUE: (line 7 larger than line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(No payment necessary if less than $1.00)

13. A. REFUND: (line 11 larger than 7.)

13A.

REFUND

. . . . . refunds will not be made for less than $1.00. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CREDIT

13B.

13. B. Credit to 2012 Estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13C.

13. C. Donate your refund to the City Parks and Recreation Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Interest and penalty,

will be assessed, after April 30th

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

14.

15. TOTAL AMOUNT DUE add lines 12 & 14 (Do not enter refunds) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15.

I declare that I have examined this return (including accompanying schedules and statements) and to the best of my knowledge and belief it is true, correct

and complete. If prepared by a person other than taxpayer, his declaration is based on all information of which he has any knowledge.

SIGN HERE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SIGN

(Taxpayer's signature and date)

(Signature of preparer other than taxpayer and date)

HERE

SIGN HERE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(Spouse's signature and date)

(Address)

(Telephone)

MAKE CHECKS PAYABLE TO: TREASURER, CITY OF JACKSON

MAIL RETURNS TO: CITY INCOME TAX DIVISION, 161 W. MICHIGAN AVE., JACKSON, MI 49201

Page 1

DUE ON OR BEFORE APRIL 30TH.