Form P-1040 - City Of Portland Individual Return - 2012
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CITY OF PORTLAND
2012
P-1040
For year January 1-December 31, 2012
Your Social Security Number
Spouse's Social Security Number
RESIDENCY STATUS
RESIDENT
NON-RESIDENT
PART-YEAR RESIDENT
FROM____________TO_________
First Name and Initial
Last Name
FILING STATUS
SINGLE
MARRIED FILING JOINTLY
* MARRIED FILING SEPARATELY
If Joint, Spouse's First Name and Initial
Last Name
EXEMPTIONS
65 OR OVER BLIND
DEAF
DISABLED
A
YOURSELF
Mailing Address ( If using a PO Box you must also list your physical home address )
B
SPOUSE
D. NUMBER OF OTHER DEPENDENTS (EXPLAIN)
C. NAMES OF DEPENDENT CHILDREN WHO LIVED WITH YOU
City / Town
State
Zip Code
TOTAL NUMBER OF EXEMPTIONS CLAIMED ON BOXES A,B,C, & D
INCOME
ATTACH
Wages, salaries, tips, etc.
1.
1.
Taxable interest.
2.
COPY OF
2.
Ordinary dividends.
3.
PAGE 1 OF
3.
Taxable refunds, credits or offsets.
4.
NOT TAXABLE
FEDERAL
4.
Alimony received.
5.
RETURN
5.
Business income. (Attach Federal Schedule C, page 1 & 2.)
6.
6.
Capital gains or losses. (Attach Federal Schedule D.)
7.
7.
Other gains or losses. (Attach Federal Form 4797.)
Check if Schedule is not required
8.
8.
Taxable IRA distributions.
9.
9.
Taxable pension distributions. (Attach copy of Form 1099-R.)
10.
10.
Rental real estate, royalties, partnerships, trusts, etc. (Attach Federal Schedule E(s).)
11.
11.
Subchapter S corporation distributions. (Attach Federal Schedule K-1.)
12.
12.
Farm income or (loss). (Attach Federal Schedule F.)
13.
ATTACH
13.
Unemployment compensation.
14.
NOT TAXABLE
W-2 & 1099-R
14.
Social security benefits.
15.
NOT TAXABLE
FORMS
15.
Other income. Attach statement listing type and amount.
16.
HERE
16.
Total income. Add lines 1 through 16.
17.
0.00
17.
See instructions. Deductions must be allocated on the same basis as related income.
DEDUCTIONS
Individual Retirement Account deduction. (ATTACH PG. 1 OF FEDERAL RETURN & EVIDENCE OF PAYMENT.)
18.
18.
Self-employed SEP, SIMPLE and qualified plans. (ATTACH PAGE 1 OF FEDERAL RETURN.)
19.
19.
Employee business expenses. (SEE INSTRUCTIONS.)
20.
20.
Moving expenses. (Into Portland only) (ATTACH FEDERAL 3903.)
21.
21.
Alimony paid.
22.
22.
DO NOT INCLUDE CHILD SUPPORT (ATTACH PAGE 1 OF FEDERAL RETURN.)
Non-Resident Income (For part-year residents that did not work in Portland)
23.
23.
Other Deductions
24.
24
Total deductions. Add lines 18 through 24
25.
25.
0.00
Total income after deductions. Subtract line 25 from line 17
26.
26.
0.00
0
Amount from exemptions ( Number of Exemptions, __________ times $1,000.00 )
27.
27.
0.00
Total income subject to tax. Subtract line 27 from line 26
28.
ATTACH
0.00
28.
TAX -MULTIPLY LINE 28 BY YOUR TAX RATE
29.
CHECK
29.
RES. = 1% (.01), NON-RES. = 1/2% (.005), PART YEAR RES.-
0.00
ATTACH P 'SCH PY' ( PG 8 )
PAYMENTS AND CREDITS
OR
Portland tax withheld by your employer
30.
MONEY
(ATTACH W-2 FORMS showing tax withheld)
30.
Payments on 2012 Declaration of Estimated Income Tax, payments with an extension and carry forward credits.
31.
ORDER
31.
.
32.
HERE
Credit for tax paid to another city and for tax paid by a partnership
32.
Copy of other cities tax return must be attached for credit. (Worksheet on page 10)
Total payments and credits. Add lines 30 through 32
33.
0.00
33.
TAX DUE
34.
If tax (line 29) is larger than payments (line 33) you owe tax.
PAY WITH RETURN >>>
34.
0.00
(If over $100.00 see page 5)
CREDIT TO 2013
35.
If payments (line 33) are larger than tax (line 29) enter overpayment to be credited forward to 2013
35.
36.
If payments (line 33) are larger than tax (line 29) enter overpayment to be refunded via a refund check
36.
REFUND CHECK
0.00
DIRECT DEPOSIT
#
If payments (line 33) are larger than tax (line 29) enter overpayment to be refunded via direct deposit
37.
0.00
Check box for direct deposit of refund. List bank account information below.
37 A.
37 B. Routing number
* 37 C. Type of Account:
CHECKING
SAVINGS
* If type of account is not checked a
check will be mailed
37 D. Account number
PLEASE SIGN YOUR RETURN BELOW
If joint return, both husband and wife must sign.
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, the preparer's declaration is based on all information of which he/she has any knowledge.
====>
SIGNATURE OF PREPARER OTHER THAN TAXPAYER
SIGN
X X
HERE
DATE
TAXPAYER'S SIGNATURE
====>
X
PREPARER'S ADDRESS
SPOUSE'S SIGNATURE
PHONE #
PREPARER'S PHONE NUMBER:
MAKE CHECK OR MONEY ORDER PAYABLE TO: CITY TREASURER
MAIL TO: CITY INCOME TAX DEPARTMENT, 259 KENT ST. PORTLAND, MI 48875
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