Form 481.0 - Short Form - Individual Income Tax Return - 2002
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RETURN WITH CHECK (PLEASE ATTACH CHECK HERE)
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SHORT FORM
Serial Number
2002
2002
Liquidator
Reviewer
INDIVIDUAL INCOME TAX RETURN
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RETURN
ORIGINAL
AMENDED
q
R M V1 V2 P1 P2 N D E A G
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q
DECEASED DURING THE YEAR
DECEASED DURING THE YEAR
Payment Stamp
Social Security Number
Spouse's Social Security Number
CHANGE OF ADDRESS
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Yes
No
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M
F
First Name
Initial
Last Name
Second Last Name
Taxpayer's Date of Birth
Day
Month
Year
Postal Address
Spouse's Date of Birth
Zip Code
Day
Month
Year
"Place Label here".
E-Mail Address
Spouse's First Name
Initial
Last Name
Second Last Name
Receipt Number:
Home Telephone
Home Address (Town or Urbanization, Number, Street)
Amount:
Office Telephone
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SPANISH
ENGLISH
Zip Code
Part 1
YES
NO
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Receipt Stamp
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Your occupation
Spouse's occupation
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1)
3)
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2)
4)
Part 2
0
0
0
0
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C
C
0
0
0
0
,
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,
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0
0
0
0
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.
0
0
0
0
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,
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0
0
0
0
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,
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Income Tax Withheld
Federal Wages
0
0
(02)
0
0
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0
0
(03)
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0
0
(10)
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