Form Br 1040ez - Attach To 1040 Form - Individual Return

REFER TO INSTRUCTIONS ON BACK TO SEE WHO CAN USE THIS FORM

ATTACH A COPY OF THE FRONT OF FEDERAL 1040 FORM

BR 1040EZ

2002

INDIVIDUAL RETURN

Due Date: April 30, 2003

A. First Name and Initial

Last Name

Your Social Security Number

B. RESIDENCY

RESIDENT

Inside City Limits

Spouse’s Social Security Number

If Joint First Name of Spouse

NON-RESIDENT

Township of

Present Home Address

Big Rapids

________

Green

________

Colfax

________

City, State and Zip Code

Other __________________

(Please Specify)

D. EXEMPTIONS

C. FILING STATUS

Number______________________x $600.00 = $______________

A. _____ Single

If you are claimed as a dependent on someone else’s Big Rapids return, check

B. _____ Married, Filing Jointly

this box and do not take the exemption.

C. _____ Married, Filing Separately

Spouse’s Name__________________________________________________

If you are a FSU student with permanent home other than Big Rapids, check

Social Security Number __________________________________________

this box and claim yourself.

1. Total Wages, Salaries, and Tips ......................................................................................................................

2. Interest and/or Dividends Income ..................................................................................................................

3. Exemptions

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

(From D above)

(if you are a student and your parents do not file a City of Big Rapids return, check this box

and claim yourself)

4. Taxable Income (Line 1 + Line 2 - Line 3) ......................................................................................................

5. Tax (multiply amount on Line 4 by one of the following) ..................................................................................

A: RESIDENT ONLY -1% (.01)

B: NON-RESIDENT ONLY - 1/2% (.005)

6. Voluntary Contribution to Big Rapids Community Pool ..................................................................................

7. Total of Lines 5 and 6 ....................................................................................................................................

OFFICE USE ONLY

Payment received

with Return

8. Tax Withheld

______________________

2001 Estimated Payments

______________________

Credit from previous year over payment

Total Payments

9. Tax Due (Line 7 minus Line 8) ........................................................................................................................

10. Penalty and Interest......................................................................................................................................

10.

11. Balance Due ................................................................................................................................................

11.

12. Overpayment /Amount of Refund (Line 8 minus Line 7)................................................................................

12.

I declare, under penalty of perjury, that the information on this return and attachments is true and complete.

I authorize the City to discuss my

DO NOT discuss my

I declare, under penalty of perjury, that this return

claim and attachments with my

claim with my preparer.

is based on all information of which I have knowledge.

preparer

Filer’s Signature ______________________________________________ Date __________________