Form S1040ez - City Of Saginaw Income Tax - 2001
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1S A G I N A W 2 0 0 1 S1040EZ
DUE: APRIL 30, 2002
MUST TYPE OR PRINT IN INK - INCOMPLETE FORMS WILL BE RETURNED
REFER TO INSTRUCTIONS ON BACK TO SEE WHO CAN USE THIS FORM.
Your First Name and Middle Initial
Last Name
Your Social Security Number
P
City of Saginaw Use ONLY
R
If Joint, Spouse’s First Name and Middle Initial
Last Name
Spouse’s Social Security Number
IP____________________
I
N
UP___________________
Mailing Address
T
Auditor_______________
O
City/Town
State
Zip Code
IF MARRIED FILING SEPARATELY PLEASE GIVE SPOUSE’S:
R
Name ____________________ Social Security #_____________________
Your Employer during 2001 and
Spouse’s Employer during 2001
Please Give Actual Address Where You
address of your actual job location
and address of actual job location
Resided in 2001
RESIDENCY STATUS
T
Y
RESIDENT
Enter name and address used on your 2000 return. If none filed please give reason.
P
NON-RESIDENT
E
1. Total wages, salaries and tips. RESIDENTS report the total of
D o l l a r s
Cents
the amounts shown in Box 1 of all your W-2 forms.
NON-RESIDENTS report the total of the amounts shown in Box
INCOME
,
.
0
0
1 of theW-2 forms for work performed in the City of Saginaw.
ATTACH
2. Interest/Dividend RESIDENTS report all taxable interest &
COPIES
dividend income. NON-RESIDENTS leave this line blank.
,
.
0
0
OF
W-2(S)
3. Add Lines 1 and 2. This is your total Saginaw Income.
HERE
,
.
0
0
EXEMPTION
4. Enter the amount of the Exemptions. If SINGLE enter
AMOUNT
$1,000.00; or if MARRIED filing jointly enter $2,000.00.
,
.
0
0
TAXABLE
0
0
INCOME
5. Subtract Line 4 from Line 3. This is your taxable income.
,
.
6. RESIDENTS multiply amount on Line 5 by 1.5% (.015).
,
.
0
0
NONRESIDENTS multiply amount on Line 5 by .75% (.0075).
TAX
7. Enter the total of the Saginaw tax withheld from Box 21
TAX
WITHHELD
of the W-2 forms attached to this return.
,
.
0
0
8. FIREWORKS CONTRIBUTION: PLEASE DONATE
FIREWORKS
0
0
$1.00 OR MORE.
,
.
TOTAL
9. TOTAL. Subtract Line 8 from Line 7.
,
.
0
0
10. If Line 6 is larger than Line 9, subtract Line 9 from Line 6.
PAYMENT
This is the amount you OWE. Attach your payment.
,
.
0
0
AMOUNT
11. If Line 9 is larger than Line 6, subtract Line 6 from Line 9
.
OVERPAID
This is the amount you OVERPAID.
,
.
0
0
12. Amount of refund you would like applied to
APPLY TO
2002 Estimated Tax.
NEXT YEAR
0
0
,
.
13. Subtract Line 12 from Line 11. Enter amount to be
0
0
REFUNDED TO YOU (Allow until June 15, 2002).
REFUND
,
.
Under penalties of perjury, I declare that I have examined this return and to the best of my knowledge and belief it is true, correct and complete.
Your Signature
_________________________________________ Date __________ Preparer’s Signature
__________________________________________
Spouse’s Signature _________________________________________ Date __________ Preparer’s Phone Number__________________________________________
(IF FILING JOINTLY, BOTH MUST SIGN EVEN IF ONLY ONE HAD INCOME)
I AUTHORIZE CITY OF SAGINAW TO DISCUSS
DO NOT DISCUSS MY RETURN WITH MY PREPARER
MY RETURN WITH MY PREPARER
MAKE CHECKS PAYABLE TO: TREASURER, CITY OF SAGINAW AND MAIL TO:
INCOME TAX OFFICE, 1315 S. WASHINGTON AVE., SAGINAW, MI 48601
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