Form 5074 - Allocation Of Individual Income Tax To Guam Or The Commonwealth Of The Northern Mariana Islands (Cnmi) - 2014
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25074
Allocation of Individual Income Tax to Guam or the
OMB No. 1545-0074
Commonwealth of the Northern Mariana Islands (CNMI)
Form
2014
Information about Form 5074 and its instructions is at
Department of the Treasury
Attachment
▶
168
Sequence No.
Internal Revenue Service
Attach to Form 1040.
▶
Your social security number
Name(s) shown on Form 1040
Part I
Income From Guam or the CNMI Reported on Form 1040
Guam
CNMI
1 Wages, salaries, tips, etc. .
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2 Taxable interest
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3 Ordinary dividends
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4 Taxable refunds, credits, or offsets of local Guam or CNMI income taxes
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5 Alimony received .
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6 Business income or (loss) .
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7 Capital gain or (loss) .
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8 Other gains or (losses) .
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9 IRA distributions (taxable amount)
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10 Pensions and annuities (taxable amount) .
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11 Rental real estate, royalties, partnerships, S corporations, trusts, etc. .
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12 Farm income or (loss)
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13 Unemployment compensation
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14 Social security benefits (taxable amount) .
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15 Other income. List type and amount
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16 Total income. Add lines 1 through 15 .
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Part II
Adjusted Gross Income From Guam or the CNMI Reported on Form 1040
17 Educator expenses .
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18 Certain business expenses of reservists, performing artists, and fee-basis
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government officials .
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19 Health savings account deduction
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20 Moving expenses .
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21 Deductible part of self-employment tax .
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22 Self-employed SEP, SIMPLE, and qualified plans
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23 Self-employed health insurance deduction.
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24 Penalty on early withdrawal of savings .
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25 IRA deduction .
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26 Student loan interest deduction .
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27 Tuition and fees
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28 Add lines 17 through 27 .
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29 Adjusted gross income. Subtract line 28 from line 16 .
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▶
Part III
Payments of Income Tax to Guam or the CNMI
30 Payments on estimated tax return filed with Guam or the CNMI .
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31 Income tax withheld from your wages while employed by the U.S.
Government as a civilian in Guam or the CNMI .
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32 Income tax withheld from your wages while employed as a member of the
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U.S. Armed Forces in Guam or the CNMI .
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33 Income tax withheld from your wages earned in Guam or the CNMI other
than amounts on lines 30 through 32
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34 Total payments. Add lines 30 through 33.
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▶
5074
For Paperwork Reduction Act Notice, see the Instructions for Form 1040.
Form
(2014)
Cat. No. 42243X
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