Form 481.0 - Individual Income Tax Return - Department Of Treasury Of Puerto Rico - 2010
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4Ovals must be filled completely. Example
Form 481.0
Rev. 12.10
RETURN WITH CHECK (PLEASE ATTACH CHECK HERE)
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S
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SHORT FORM
Serial Number
2010
2010
GOVERNMENT OF PUERTO RICO
DEPARTMENT OF THE TREASURY
Liquidator
R
G V1 V2 P1 P2
INDIVIDUAL INCOME TAX RETURN
Reviewer
FOR CALENDAR YEAR 2010 OR TAXABLE YEAR BEGINNING ON
N
D1
D2
E
A
M
AMENDED RETURN
DECEASED DURING THE YEAR: _____/_____/_____
__________________ , ___________ AND ENDING ON__________________ , ___________
Day Month Year
Spouse's Social Security Number
Taxpayer's Social Security Number
Payment Stamp
Sex:
M
F
Taxpayer's Date of Birth
Taxpayer's Name
Initial
Last Name
Second Last Name
Day
Month
Year
Spouse's Date of Birth
Postal Address
Day
Month
Year
Zip Code
Disabled:
Taxpayer
Spouse
"Place Label here".
Spouse's First Name and Initial
Last Name
Second Last Name
Change of Address:
Yes
No
2011 Return:
Spanish
English
Home Address (Town or Urbanization, Number, Street)
Telephone
Receipt Number:
Amount:
Telephone
E-Mail Address
Zip Code
Part 1
YES
NO
HIGHEST SOURCE OF INCOME:
OCCUPATION (Enter the Code):
Taxpayer
a.
United States Citizen?
Government, Municipalities or
e.
b.
Resident of Puerto Rico at the end of the year?
Public Corporations Employee
Spouse
c.
Obligation to make payments to ASUME?
f.
Federal Government Employee
d.
Other exempt income? (Submit Schedule)
Private Business Employee
g.
Receipt Stamp
Indicate total amount $ _______________
h.
Retired/Pensioner
FILING STATUS AT THE END OF THE TAXABLE YEAR:
3.
Head of household (Not married)
Married living with spouse and filing jointly
1.
Married not living with spouse (Not head of household)
2.
4.
Single
(Submit spouse's name and social security number above)
Fill in here if you choose the optional computation of tax for married individuals living together, filing a joint return and
both working. Do not complete Parts 2 and 3, and go to Schedule CO Individual.
Part 2
A-Income Tax Withheld
B-Wages, Commissions, Allowances and Tips
Wages, Commissions, Allowances and Tips
1.
ATTACH ALL YOUR WITHHOLDING STATEMENTS
.
.
0
0
,
,
0
0
(Forms 499R-2/W-2PR, 499R-2c/W-2cPR or W-2,
as applicable).
.
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0
0
0
0
,
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00
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,
0
0
0
0
,
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0
0
,
,
0
0
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0
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0
,
01
Total of withholding statements with this return ...........................
A-Income Tax Withheld
B-Federal Wages
.
.
2. Federal Government Wages (See instructions) ...................................
0
0
0
0
,
,
(01)
(02)
.
0
0
3. Income from Annuities and Pensions (Schedule H Individual, Part II, line 12) ..................................................
,
(03)
.
0
0
4. Adjusted Gross Income (Add lines 1B, 2B and 3) ...............................................................................................
,
(10)
Retention Period: Ten (10) years
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