Form 481.0 - Individual Income Tax Return - 2004
ADVERTISEMENT
1
2
3Ovals must be filled in completely. Example
Form 481.0 Rev. 05.04
RETURN WITH CHECK (PLEASE ATTACH CHECK HERE)
SHORT FORM
Serial Number
2004
COMMONWEALTH OF PUERTO RICO
2004
DEPARTMENT OF THE TREASURY
Liquidator
R
M V1 V2 P1
INDIVIDUAL INCOME TAX RETURN
Reviewer
FOR CALENDAR YEAR 2004 OR TAXABLE YEAR BEGINNING ON
P2 N
D
E
A
G
RETURN:
AMENDED
DECEASED DURING THE YEAR
_______________, _______ AND ENDING ON ______________, _______
Social Security Number
Spouse's Social Security Number
Payment Stamp
Sex:
M
F
First Name
Initial
Last Name
Second Last Name
Taxpayer's Date of Birth
Postal Address
Day
Month
Year
Spouse's Date of Birth
Zip Code
Day
Month
Year
"Place Label here".
Change of Address:
Yes
No
Spouse's First Name and Initial
Last Name
Second Last Name
2005 Return:
Spanish
English
Home Telephone
Receipt Number:
Home Address (Town or Urbanization, Number, Street)
Amount:
Office Telephone
E-Mail Address
Zip Code
Part 1
NO
YES
HIGHEST SOURCE OF INCOME:
OCUPATION (Enter the Code):
Taxpayer
a.
¿United States Citizen?
g.
Government, Municipalities and
b.
¿Resident of Puerto Rico at the end of the year?
Public Corporations Employee
Spouse
c.
¿Tax exempt income from the Lottery of Puerto Rico?
Federal Government Employee
h.
d.
¿Income from racetrack winnings in Puerto Rico?
Private Business Employee
i.
Receipt Stamp
e.
¿Other exempt income?
Retired/Pensioner
j.
f.
¿Obligation to make payments to ASUME?
FILING STATUS AT THE END OF THE TAXABLE YEAR:
3.
Head of household (Not married)
Married living with spouse and filing jointly
1.
4.
Single
Married not living with spouse (Not head of household)
2.
(Submit spouse's name and social security number)
Part 2
B-Wages, Commissions, Allowances and Tips
Wages, Commissions, Allowances and Tips
A-Income Tax Withheld
1.
ATTACH ALL YOUR WITHHOLDING STATEMENTS
.
0
0
.
0
0
,
,
(Forms 499R-2/W-2PR, 499R-2c/W-2cPR or W-2,
as applicable).
00
.
0
0
.
0
0
,
,
.
0
0
.
0
0
,
,
.
0
0
.
0
0
,
,
.
.
0
0
0
0
,
,
01
Total (No. of withholding statements with this return) ............
Federal Wages
Income Tax Withheld
.
0
0
.
0
0
2. Federal Government Wages (See instructions) ..................................
,
,
(02)
(01)
.
0
0
,
3. Income from Annuities and Pensions (Schedule H Individual, Part II, line 12) ....................................................
(03)
.
0
0
4. Ajusted Gross Income (Add lines 1B, 2B and 3) ..................................................................................................
,
(10)
Conservation Period: Ten (10) Years
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial