Form Bc1040 - City Of Battle Creek Income Tax Individual Return - 1999

CHECK

RESIDENT

FOR CALENDAR YEAR 1999

ONE

NONRESIDENT

CITY OF BATTLE CREEK INCOME TAX

OR FISCAL YEAR ENDING____________

BOX

P ART-YEAR RESIDENT

INDIVIDUAL RETURN

Taxpayer's Social Security No.

Spouse's Social Security No.

First Name(s) and Middle Initial(s)

Last Name

Present Home Street Address

(Post Office Box No.)

City, Town or Post Office

State

Postal Zip Code

Did you file a 1998 Battle Creek Return?

Yes

No

If yes, are the Name(s) and Address the same? If not, check this box

No

DO NOT WRITE IN THIS SPACE

Present employer's name_____________________________________

No. of boxes

__________________________

__________________________

checked

(Your Birth Date)

(Spouse's Birth Date)

MARRIED FILING JOINTLY

YOURSELF

65 & Over

SPOUSE

65& Over

No. of children

Blind

Deaf

Disabled

Blind

Deaf

Disabled

MARRIED FILING SEPARA TE

who lived

with you

(All Disabilities Require Doctor's Statement(s) be Attached.)

BC 1040 RETURNS, ENTER:

Check if

If age 1 or over dependents

Dependents

No. of months lived

Relationship

No. of children

Name (first, Initial, and last name)

under age 1

social security number

in your home

who didn't live

with you

_______________________________________

due to a divorce

SPOUSE'S NAME

No. of other

dependents

_______________________________________

SPOUSE'S SOCIAL SECURITY #

Add numbers

entered in

SINGLE

If your child didn't live with you but is claimed as your dependent under pre-1985 agreement check here ....................................................

boxes above

Total number of exemptions claimed ........................................................................................................................................................................................ .

1. TOTAL W-2 INCOME: Wages, salaries, tips, etc. (Attach all W-2’s on the back of this form)

00

A. NONRESIDENTS REFER TO NONRESIDENT INSTRUCTIONS ...................................................................... 1.

00

2. ADDITIONS TO INCOME: All other income; interest, dividends, business income, capital gains, .............................. 2.

rents, royalties, partnerships, estates, trusts, farm, etc. (ATTACH ALL SCHEDULES AND EXPLANATIONS)

00

3. SUBTRACTIONS FROM INCOME: All allowed losses and adjustments per instructions .......................................... 3.

(ATTACH ALL SCHEDULES AND EXPLANATIONS)

00

4. ADJUSTED INCOME: Add lines 1 and 2 less line 3: ................................................................................................. 4.

00

5. EXEMPTIONS: Multiply the number of exemptions claimed by $1500.00 ................................................................. 5.

00

6. TAXABLE INCOME: line 4 less line 5 ........................................................................................................................ 6.

7. TAX: Multiply amount on line 6 by one of the following:

A. RESIDENT ONLY - 1% (.01 ) .............................................................................................................................

00

B. NONRESIDENT ONLY - 1/2% (.005) ................................................................................................................ 7.

C. PART-YEAR RESIDENT - Tax from Schedule 3, line ..........(Check this box) ....................................................

Inv.

Date

PAYMENTS AND TAX CREDITS

Tax

00

8. Battle Creek tax withheld (Attach W-2 supplied by employer) ............................................. 8.

Fees

00

9. 1999 Estimate payments (including credit from 1998 overpayment) .................................. 9.

Total

10. Credit for income tax paid to another Michigan municipality

or by a partnership (Name __________________________) ATTACH COPIES .......... 10.

00

00

11. TOTAL PAYMENTS AND CREDITS: Add lines 8, 9 and 10. .................................................................................... 11.

00

12. BALANCE DUE line 7 larger than line 11 ................................................................................................................ 12.

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0

PAY WITH RETURN

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0

(Make checks payable to City Treasurer)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0

13. OVERPAYMENT: line 11 larger than line 7.

00

A. Amount to be Refunded .................................................................................................................................. 13A.

B. Amount to be Credited to 2000 Estimated tax ................................................................................................. 13B.

00

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my

knowledge and belief, they are true, correct and complete.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SIGN HERE

SIGN

(Taxpayer's signature and date)

(Signature of preparer other than taxpayer and date)

HERE

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SIGN HERE

(Spouse's signature and date)

(Address)

(Telephone #)

. . . . . . . . . . . . . . . . . . . . . . . . .

TELEPHONE #

Mail returns with payments to: BATTLE CREEK CITY TREASURER, P.O. BOX 1982, BATTLE CREEK, MI 49016-1982

Mail refunds and other returns to: CITY INCOME TAX DIVISION, P.O. BOX 1657, BATTLE CREEK, MI 49016-1657

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