Form Bc-1040 - Individual Return - Battle Creek - 2012
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12BC-1040
BATTLE CREEK
INDIVIDUAL RETURN DUE APRIL 30, 2013
2012
12MI-BCKI
Taxpayer's SSN
Spouse's SSN
Taxpayer's first name
!I joint return spouse's first name
Initial
last
name
Initial
Last name
RESIDENCE STATUS
[ ] Residen1
[--~'INonresident
....---]
~~7~~~~r
Part-X~8!_~~~i~,~~!,~ __ ,~!J:tf:}~():!,~f:},~i,C!~r1c:y..('!!~C!~Y,m'!
From
00
Column C
Taxable Income
.00
00
00
NOT TAXABLE
.00
.00
.00
.00
.00
00
.00
.00
.00
NOT TAXABLE
NOT TAXABLE
.00
.00
.00
.00
.00
.00
.00
.00
.00
00
2tb
'0
19
.00
Spouse's full name if married filing separately
FILING STATUS
[' ']single
[~]Married
filing jointly
[
,__jMarried filing separateiy. Enter spouse's SSN
in Spouse's SSN box and Spouse's full name
---- here.
To
2ta
Total
interest
&
_00
penalty
'50
PAY WITH
RETURN
»»>
Column
B
Exclusions/Adjustments
Amount of credit to 2013» 29
Foreign postal code
Zip code
Column A
Federal Return Data
2
3
4
8
9
10
11
12
NOT APPLICABLE
13
14
15
16
17
.00
18
.00
-
Jstat.
rocei90
pmv,",.loo"",y
-,"',---
",',----'
..
'"",---"--_
..
,,
Foreign country name
(Enter the total exemptions, from Form BC-1040, page 2, box th, in line 21a and multiply
this number by $750 and enter on line 21b)
ROUND ALL FIGURES TO NEAREST DOLLAR
($0.50
next dollar)
Total deductions (Subtractions) (Total from page 2, Deductions schedule, line 7)
T01al income after deductions (Subtract line 19 from line 18)
Total income (Add lines 1 through 16)
Total additions (Add lines 2 through 16)
'8a
t8
29. Amount of overpayment credited forward to 2013
12. Subchapter S corporation distributions (Allach federal Sch. K-1)
13. Farm income or (loss) (Attach federal Schedule F)
14. Unemployment compensatlon
15. Social security benefits
16. Other income (Attach statement listing type and amount)
11. Rental real estate, royalties, partnerships, S corporations, trusts,
etc. (Allach federal Schedule E)
(MUltiply line 22 by Battle Creek resident tax rate of 1% (0.01) or nonresident1ax ra1e of 0.5%
23. Tax
(0.005) and enter tax on line 23b, or if using Schedule TC to compute tax, check box 23a and
enter tax from Schedule TC, line 23d)
23a
23b
Amount you owe (Add lines 23b and 25c, and subtract line 24) MAKE CHECK OR
TAX DUE
26. MONEY ORDER PAYABLE TO: CITY OF BATTLE CREEK OR TO PAY WITH A DIRECT
WITHDRAWAL mark (X) pay tax due, line 31b, and complete lines 31c, d
&
e)
19.
'0.
21. Exemptions
22.
Total income subject to 1ax (Subtract line 21b from line 20)
22
OVERPAYMENT
27. Tax overpayment (SUbtract lines 23b and 25c from line 24; choose overpayment options on lines 28 - 30)
24.
Total payments and credits (Total from page 2, Payments and Credits schedule, line 4)
24
-----.-.------------------------------------------------------------·--------'-+"'787',7777-'0'7-"720"7:71
Interest and penalty for: failure to make
Interest
Penalty
25. estlmated tax payments; underpayment
of estimated tax; or late payment of tax
25a
28. Reserved
INCOME
ATTACH
w·'
FORMS
HERE
8.
Other gains or (losses) (Allach copy of federal Form 4797)
9.
Taxable IRA distributions
10. Taxable pensions and annuities (Attach copy of Form(s) 1099-R)
ATTACH
1.
Wages, salaries, tips, etc. ( W-2 forms must be attached)
COPY OF 2.
Taxable interest
PAGE 1
3.
Ordinary dividends
OF
FEDERAL 4.
Taxable refunds, credlts or offsets
RETURN
Alimony received
5.
6.
Business income or (loss) (Attach federal Schedule C)
Capital gain or (loss)
(Attach copy of fed. S:'h". :O"I
77 • aC ·
L
J""'U).~~t.!eg~;""'._
__ ~
.
..
..
___,ULli
_ _ .
..c'J\)L. . _ _._____
_____________._.LI~
I
ENCLOSE
CHECK
OR
MONEY
ORDER
Make sure the SSN(s) above and on Present home address (Number and street)
page 2, line 1d are correct.
Check box if you need a tax
form mailed to you next year.
r.F"O::C::';;ity=::",~.~O=O~'':y ""='-"='-'--'--jCiiy:iown-orp'os'i~oii'ice~ ~.
30. Amount of overpayment refunded {Line 27 less lines 28d and 29} (For refund to be directly deposited
10 your bank account, mark refund box, line 31a, and complete Ilne 31 c, d
&
e)
Refund amount»
30
Direct deposit refund or
31a
Refund
31,
Routing
direct withdrawal payment
(direct deposit)
number
31.
(Mark (X) appropriate box
31b
Pay tax due
31d
Account
31a or31bandcomplete
(direct Withdrawal)
number
Jines 31c, 31d and 31e)
31.
Account Type:
MAIL TO: See mailing instructions
Savings
Revised: 11/07/2012
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