Form Hp 1040 - Individual Income Tax Return - City Of Highland Park - 2004 Page 3

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ALLOCATION OF HIGHLAND PARK WAGES
SUPPLEMENT TO HP 1040 TAX RETURN
SCHEDULE 1NR
Use this supplement to aid in proper computation of wages earned in Highland Park (Schedule 1NR). This must be completed in order to allo-
cate wages, no other form is allowed.
NAME: ________________________________________________________________________ SS # ______________________________
PRESENT EMPLOYER: __________________________________________ OCCUPATION: ____________________ TAX YEAR 20 ______
JANUARY
FEBRUARY
MARCH
S
M
T
W
T
F
S
S
M
T
W
T
F
S
S
M
T
W
T
F
S
1
2
3
4
5
1
2
1
2
6
7
8
9
10
11
12
3
4
5
6
7
8
9
3
4
5
6
7
8
9
13
14
15
16
17
18
19
10
11
12
13
14
15
16
10
11
12
13
14
15
16
20
21
22
23
24
25
26
17
18
19
20
21
22
23
17
18
19
20
21
22
23
27
28
29
30
31
24
25
26
27
28
24
25
26
27
28
29
30
31
APRIL
MAY
JUNE
S
M
T
W
T
F
S
S
M
T
W
T
F
S
S
M
T
W
T
F
S
1
2
3
4
5
6
1
2
3
4
1
7
8
9
10
11
12
13
5
6
7
8
9
10
11
2
3
4
5
6
7
8
14
15
16
17
18
19
20
12
13
14
15
16
17
18
9
10
11
12
13
14
15
21
22
23
24
25
26
27
19
20
21
22
23
24
25
16
17
18
19
20
21
22
28
29
30
26
27
28
29
30
31
23
24
25
26
27
28
29
30
JULY
AUGUST
SEPTEMBER
S
M
T
W
T
F
S
S
M
T
W
T
F
S
S
M
T
W
T
F
S
1
2
3
4
5
6
1
2
3
1
2
3
4
5
6
7
7
8
9
10
11
12
13
4
5
6
7
8
9
10
8
9
10
11
12
13
14
14
15
16
17
18
19
20
11
12
13
14
15
16
17
15
16
17
18
19
20
21
21
22
23
24
25
26
27
18
19
20
21
22
23
24
22
23
24
25
26
27
28
28
29
30
31
25
26
27
28
29
30
31
29
30
OCTOBER
NOVEMBER
DECEMBER
S
M
T
W
T
F
S
S
M
T
W
T
F
S
S
M
T
W
T
F
S
1
2
3
4
5
1
2
1
2
3
4
5
6
7
6
7
8
9
10
11
12
3
4
5
6
7
8
9
8
9
10
11
12
13
14
13
14
15
16
17
18
19
10
11
12
13
14
15
16
15
16
17
18
19
20
21
20
21
22
23
24
25
26
17
18
19
20
21
22
23
22
23
24
25
26
27
28
27
28
29
30
31
24
25
26
27
28
29
30
29
30
31
PLEASE CIRCLE THOSE DATES WORKED OUTSIDE HIGHLAND PARK.
TOTAL DAYS CIRCLED
PLEASE NOTE: ANY DEDUCTIONS MUST BE TAKEN IN PROPORTION TO PERCENT OF INCOME REPORTED

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