Form Ph-1040x - Amended Individual Income Tax Return - City Of Port Huron
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2PH-1040X
TAX YEAR being amended:
CITY OF PORT HURON
AMENDED INDIVIDUAL INCOME TAX RETURN
'
Revised 12/16
Your first name and initial
Last name
Your social security number
If a joint return, spouse's first name and initial
Last name
Spouse's social security number
Home address (number and street or PO Box)
Apartment number
Is this the same name and address
as your original return?
City, town or post office, state and ZIP code
Yes
No
RESIDENCY STATUS
If a PARTIAL RESIDENT, enter the dates you lived in the city:
Resident
Nonresident
Partial Resident
On original return
FROM: ______________________ TO: ______________________
FROM: ______________________ TO: ______________________
On this return
FILING STATUS
Single
Married filing joint return
Married filing separate return
Note: you cannot change from joint to separate
On original return
returns after the due date for filing has passed
On this return
A.
B.
C.
On Original Return
Net Change
Correct Amount
Increase or
AMOUNT OF TAX
(Decrease)
1. Total income . . . . . . . . . . . . . . . . . . . . . . . .
1
2. Exemption credit. If changing, fill out part I on the back . . . . . . .
2
3. Taxable income. Subtract line 2 from line 1. If less than zero, enter -0-
3
4. Tax. Residents 1% (.01), nonresidents ½ of 1% (.005), or Schedule L
4
PAYMENTS
5. Total Port Huron tax withheld . . . . . . . . . . . . . . . . .
5
6. Estimated tax payments and amounts carried forward from last year
6
7. Other credits . . . . . . . . . . . . . . . . . . . . . . . .
7
8. Amount paid with your original return plus any additional tax paid after it was filed
. . . . . . . . . . . . . .
8
9. Total payments and credits. Add lines 5 through 8 in column C . . . . . . . . . . . . . . . . . . . . . .
9
REFUND OR BALANCE DUE
10. Refund, if any, shown on your original return . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
11. Subtract line 10 from line 9, this is the net tax you paid to the city . . . . . . . . . . . . . . . . . . . . .
11
12. If line 4 is more than line 11, subtract line 11 from line 4. This is your tax due . . . . . . .
PAY BALANCE DUE
12
13. If line 11 is more than line 4, subtract line 4 from line 11. This is the amount you overpaid . . . .
OVERPAYMENT
13
Be sure to complete the back of the return
I declare, under penalty of perjury, that the information in this return and attachments is true and
I declare under penalty of perjury, that this return is based on all
complete to the best of my knowledge.
information of which I have knowledge.
Your signature
Date
Preparer's name, address and ID number
X
Spouse's signature - if a joint return BOTH MUST SIGN
Date
X
Date
Preparer's signature
Mail to: Income Tax Division
City of Port Huron
Make checks payable to:
100 McMorran Blvd.
X
Port Huron, MI 48060
If paying in person, pay at the City Treasurer's Office
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