Alternative To 1040 Form - City Of Norwalk - 2004
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1****THIS FORM MUST BE COMPLETED ONLY IF YOU CHOOSE NOT TO SUBMIT A PHOTO COPY OF YOUR FEDERAL
1040, 1040A OR 1040EZ. IT IS FILED ALONG WITH YOUR CITY OF NORWALK FINAL INCOME TAX RETURN AND
ANY COPIES OF FEDERAL SCHEDULES C, C-EZ, E, F, IF APPLICABLE. SCHEDULES A AND 2106 ARE NECESSARY
IF TAXPAYER SEEKS EMPLOYEE BUSINESS EXPENSE DEDUCTION.****
2004
CITY OF NORWALK
ALTERNATIVE TO 1040 FORM
NAME__________________________________________ Your Social Security Number________________________
If a joint return, spouse’s first name, initial and Social Security Number ____________________________________
FILING STATUS (CHECK ONE)
___ Single
___ Married filing joint return (even if only one had income) ___ Married filing separate return. Enter
spouse’s social security number above and full name here. ______________________________________________
Head of household (with qualifying person). If the qualifying person is a child but not your dependent, enter the
child’s name here.______________________________________ Qualifying widow(er) with dependent child (year
spouse died)________________
ENTER THE EXACT FIGURES USED ON YOUR FEDERAL FORM 1040, 1040A, 1040EZ AND 1040TEL.
1040
1040A
1040EZ
1040TEL
Line
7
7
1
Wages, salaries, tips, etc. (attach Form(s) W-2)
If using 1040TEL, DO NOT INCLUDE INTEREST
_______________
Line
12
N/A
N/A
N/A
Business income or (loss) (attach Schedule C or C-EZ,
______________
including cost of goods manufactured and/or sold)
Line
14
______________
N/A
N/A
N/A
Other gains (losses) (attach Form 4797)
Line
17
N/A
N/A
N/A
Rental real estate, royalties, partnerships, S Corporations
______________
trusts, etc. (attach Schedule E)
Line
18
______________
N/A
N/A
N/A
Farm income or (loss) (attach Schedule F)
______________
Line
21
N/A
N/A
N/A
Other income (list type and amount)
THE UNDERSIGNED DECLARES THAT THIS FORM (AS COMPLETED AND IN LIEU OF FORM 1040, 1040A, 1040EZ
OR 1040TEL), IS A TRUE, CORRECT AND COMPLETE FORM FOR THE TAXABLE PERIOD STATED AND THAT
THE FIGURES USED HEREIN ARE THE SAME AS USED FOR FEDERAL INCOME TAX PURPOSES.
____________________________________________________
__________________________________
Signature of person preparing if other than taxpayer
Date
Signature of taxpayer/agent
Date
_____________________________________
Title
____________________________________________________
__________________________________
Address or name and address of firm employer
Spouse’s signature (if joint return)
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