Form Nyc 1127 - Form For Nonresident Employees Of The City Of New York - 2004

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FORM FOR NONRESIDENT EMPLOYEES
NYC
OF THE CITY OF NEW YORK HIRED
1127
ON OR AFTER JANUARY 4, 1973
F I N A N C E
NEW YORK
THE CITY OF NEW YORK
DEPAR TMENT OF FINANCE
n y c . g o v / f i n a n c e
-
DO NOT WRITE IN THIS SPACE
FOR OFFICIAL USE ONLY
2004
AMENDED RETURN
PRINT OR TYPE
First names and initials of employee and spouse
Last name
EMPLOYEE'S SOCIAL SECURITY NUMBER
Home address (number and street)
Apt. no.
City and State
Zip Code
SPOUSE'S SOCIAL SECURITY NUMBER
NYC Department or
Employee
Spouse
Agency where employed
Daytime telephone number
EMPLOYEE
SPOUSE
Date current employment with the City of New York began:
.................................................................................................
A
Were you an employee of the City of New York for all of 2004?
........................................................................................
YES
NO
YES
NO
If "NO", enter period of 2004 employment by the City of New York:
.................................................................................
from: _____________ to: _____________
from: _____________ to: _____________
Were you a resident of New York City during any part of 2004?
........................................................................................
B
YES
NO
YES
NO
If "YES", enter period for which you were a New York City resident
.................................................................................
from: _____________ to: _____________
from: _____________ to: _____________
Did you earn any additional income in 2004 other than from the City of New York?
............................................
YES
NO
YES
NO
C
If "YES", state amount and include below in appropriate line (
W-2'
)
.........................................
ATTACH COPIES OF
S
$: ______________________
$ _________________________
FILING STATUS
A.
B.
C.
MARRIED FILING JOINTLY OR SURVIVING SPOUSE
HEAD OF HOUSEHOLD
SINGLE OR MARRIED FILING SEPARATELY
Payment Enclosed
A.
Payment
Pay amount shown on line 56 - Make check payable to: NYC Department of Finance
COLUMN B
FEDERAL INCOME AND ADJUSTMENTS
COLUMN A
- Complete the federal amount (column A) enter-
1127
SECTION
EMPLOYEE
ing the items as they appear on your New York State Income Tax Return (Form IT-200, IT-201 or IT-203).
FEDERAL AMOUNT
(
)
SEE INSTRUCTIONS
1. Wages, salaries, tips, etc. (attach copies of W-2's)
1a.
. .................................................
1b.
2. Taxable interest income
..................................................................................................
2a.
2b.
3. Dividend income
...............................................................................................................
3a.
3b.
4. Taxable refunds of state and local income taxes
(also enter on line 23 below) .......
4a.
4b.
5. Alimony received
5a.
5b.
..............................................................................................................
6. Business income (or loss) (attach copy of federal Schedule C or C-EZ)
............
6a.
6b.
7. Capital gain (or loss
(attach copy of federal Schedule D)
)
.....................................
7a.
7b.
8. Other gains (or losses
(attach copy of federal Form 4797)
)
...................................
8a.
8b.
9. Taxable amounts of IRA distributions
9a.
9b.
...........................................................................
10. Taxable amounts of pensions and annuities
10b.
...............................................................
10a.
11. Rents, royalties, partnerships, estates, trusts, etc.
(attach copy of federal Sch. E) ..........
11a.
11b.
12. Farm income (or loss) (attach copy of federal Schedule F)
...................................
12a.
12b.
13. Unemployment compensation (insurance)
..................................................................
13a.
13b.
14. Taxable amount of social security benefits
14a.
14b.
(also enter on line 25 below) ..................
15. Other income (attach list)
...............................................................................................
15a.
15b.
16. Total (add lines 1 through 15)
.......................................................................................
16a.
16b.
17. Total federal adjustments to income (attach list of items)
.......................................
17a.
17b.
18.
(line 16 less line 17)
18b.
18a.
FEDERAL ADJUSTED GROSS INCOME
.....................................
NEW YORK ADJUSTED GROSS INCOME
NEW YORK ADDITIONS
19a.
19. Interest income on state and local bonds other than NYS and its localities
.........
19b.
20. Public employee 414(h) retirement contributions
20b.
.....................................................
20a.
21. Other (attach list)
21b.
21a.
.............................................................................................................
22. Add lines 18 through 21
22b.
.................................................................................................
22a.
a.
NEW YORK SUBTRACTIONS
23. Taxable refunds of New York State and local income taxes
23a.
(from line 4 above) .........
23b.
24. Pensions of NYS and local governments and the federal government ..............
24a.
24b.
25. Taxable social security benefits
25b.
25a.
(from line 14 above) ...................................................
26. Interest income on United States government bonds
26a.
26b.
...............................................
27. Pension and annuity income exclusion
27a.
........................................................................
27b.
28. Other (attach list)
28a.
28b.
..............................................................................................................
29. Total subtractions (add lines 23 through 28)
29a.
29b.
...............................................................
30.
(line 22a less line 29a) (transfer amount from
TOTAL NEW YORK INCOME
column B to line 45
30a.
30b.
)
................................................................
(for line 30b, see instructions)
ATTACH A COMPLETE COPY OF YOUR NEW YORK STATE INCOME TAX RETURN INCLUDING ALL SCHEDULES
80010493
NYC-1127 2004

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