Form P1040 (Nr) - City Of Pontiac Income Tax, Individual Return - Non Resident - 2004
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282942-NUT01
12/16/04
4:47 PM
Page 3
FOR CALENDAR YEAR TAXPAYERS,
CITY OF PONTIAC INCOME TAX
P1040 (NR)
THIS RETURN IS DUE ON OR
2004
INDIVIDUAL RETURN – NON RESIDENT
BEFORE APRIL 30, 2005
YOUR SOCIAL SECURITY NUMBER
SPOUSE'S SOCIAL SECURITY NUMBER
VALIDATION AREA
First Name(s) and Initial(s)
Last Name
Your Occupation
Spouse's Name
Spouse’s Occupation
(Street or Rural Route Address)
P.O. Box
IMPORTANT
TRANSACTION NO.
City, Town or Post Office
State
Postal Zip Code
Complete the following:
DID YOU FILE A 2003
ASSESS NO.
PONTIAC RETURN?
Spouse filing a separate return Y N
social security number __________________________
Yes □ No □ If No, Explain
Enter the name and address used on your return for 2003 _____________________________
IF YES, IS THE NAME(S), FILING
If none filed, give reason. _______________________________________________________
VERIFIED
STATUS AND ADDRESS IDENTICAL
___________________________________________________________________________
TO PREVIOUS YEAR RETURN?
□
□
Yes
No
If No, State Prior
Information And
Date of Change
□ YOURSELF
□ Blind
□ 65 & Over
(Your Birth Date)______________
□ SPOUSE
□ Blind
□ 65 & Over
(Spouse’s Birth Date)______________
No. of boxes
➤
Exemptions
checked
REFUNDS WILL BE HELD UP FOR MISSING INFORMATION
(See
No. of children
➤
Check
No. of
If age 1 or over dependent's
who lived
Dependents
Instructions)
if under
Relationship
months
social security number
Name (first, initial, and last name)
with you
age 1
in your home
No. of children who didn't
➤
live with you due to a
If more than four
divorce or separation
dependents, use
No. of other
➤
attachment.
dependents
a. If your child didn't live with you but is claimed as your dependent under a pre-1985 agreement check here ....................................................➤ □
Add numbers
➤
entered in
b. Total number of exemptions claimed – Enter on line 10 ............................................................................................................................................
boxes above
INCOME
1.
– DO NOT INCLUDE S.U.B. PAY If joint return, include all income earned in Pontiac of both
TOTAL WAGES REPORTED
Pontiac Income Tax
husband and wife. Enter GROSS income from employers for wages, salaries, commissions, tips, sick pay,
IN BOX 1 ON PW-2 OR W-2
etc. earned in Pontiac, indicate (W) for wife. (Box 1 W2 form)
withheld
DOLLARS
Employer's Name
Actual Work Location (Number, Street, City and State)
.00
.00
$
1
.00
00
.00
00
.00
00
TOTALS ➤
2. If more space is needed please attach separate listing sheet.
2
(
)
3. LESS EXCLUDABLE PORTION OF WAGES IN LINE 1 EARNED OUTSIDE PONTIAC (FROM PAGE 2 LINE E)
Excludable Wages 3
00
00
4. Income (loss) FROM BUSINESS - from page 2 line 27 - ...............................................................................................................Business 4
ATTACH FEDERAL SCHEDULE C
00
5. Income (loss) FROM PARTNERSHIP(S) AND OTHER SOURCES - from page 2 line 31 ............................................Partnerships/Others 5
6. Income (loss) FROM RENTALS, SALES OR EXCHANGES of tangible property located in Pontiac
00
ATTACH COPIES OF FEDERAL SCHEDULES
D, E, 4797, ETC.......................................................................Property Sales/Rentals 6
00
7. TOTAL - Add lines 2 through 6 ...................................................................................................................................................... Sub Total 7
00
8. TOTAL DEDUCTIONS - From page 2 line 32 ............................................................................................................................ Deductions 8
00
9. TOTAL - SUBTRACT line 8 from line 7 .......................................................................................................................................................... 9
00
10. LESS: Amount of exemptions - Enter number of exemptions from b (
) X 600.00 ................................................................ Exemptions 10
00
11. TOTAL - Income subject to tax - SUBTRACT line 10 from line 9 ................................................................................................... Taxable 11
00
12. City of Pontiac Tax 1/2% (MULTIPLY LINE 11 BY .005) ...................................................................................................................... Tax 12
PAYMENTS AND CREDITS
00
13. a. Pontiac income tax withheld by your employer from line 2 above - Attach PW-2 or W-2 ..................... 13a
00
b. Payments and credits on 2004 Declaration of Estimated Pontiac Tax ..................................................... b
00
c. Other credits - EXPLAIN IN ATTACHED STATEMENT............................................................................ c
00
TOTAL - Add lines 13 a, b, and c..................................................................................................................................................................13
14. If your payment (line 13) is larger than your tax (line 12), enter the amount you OVERPAID
Applied to your 2005 Estimated Tax
The overpayment amount on line 14 is to be:
Refunded To You
00
Donation to the City of Pontiac
14
15.
TAX DUE
Amounts due must be paid by April 30, 2005 or it will be subject to interest and penalty
Pay in full with this return
If your tax (line 12) is larger than your payment (line 13), enter AMOUNT YOU OWE
00
15
(Write social security number on check or money order and enclose with
return. Make remittance payable to: “TREASURER, CITY OF PONTIAC” to address on back)
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