Form Sf-1040 - Income Tax Individual Return - 2002
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1
22002
A.
RESIDENCY STATUS:
INCOME TAX
CHECK
RESIDENT
INDIVIDUAL RETURN
ONE
NONRESIDENT
FORM SF-1040
BOX
PART-YEAR RESIDENT
B.
Your Social Security #
First Name & Initial
Spouse's First Name & Initial
Last Name
Spouse's Social Security #
Address (If you have a P.O. Box, list actual home address also.)
City
State
Zip
Your Occupation
Spouse's Occupation
C.
FILING STATUS
Single
Married filing joint return
Married filing separately*
*(Spouse's name and SS# if married filing separately:)
)
D.
EXEMPTIONS
Regular
65 & Over / Disabled
Blind
Deaf
Number of boxes
a. Yourself
checked in a and b
b. Spouse
Please do not write in this box, for City use only.
Number of children from
See instructions for disabled exemption, attach doctor's statement if claiming any disabilities.
c who lived with you
c. Dependents
Dependent's
Number of months
Relationship
Name (first, initial and last name)
social security number
lived in your home
Number of children from
c who didn't live
–
–
with you due to
divorce or separation
–
–
–
–
Number of other
dependents listed
–
–
in c
Total number of
d. If your child didn't live with you but is claimed as your dependent under a pre-1985 agreement, check here >
exemptions claimed
E.
E.
INCOME
TOTAL WAGES
1. TOTAL W-2 INCOME: Wages, salaries, tips and other compensation, etc.
Attach ALL W-2's. Must show gross wages in box 1.
REPORTED ON W-2(s)
A. NONRESIDENT - If applicable, complete SCHEDULE 1 or 2 on the back of this form.
B. PART-YEAR RESIDENT - Complete SCHEDULE 3 on back of this form, enter amount on line 8.
Street address of where you physically reported to work for each W-2.
If additional space is needed, attach a separate sheet
1.
. 00
. 00
. 00
2. TOTAL W-2 INCOME
TOTAL
2.
. 00
3. ADDITIONS TO INCOME: All other income; interest, dividends, business income, capital gains, rents,
. 00
royalties, partnerships, estates, trusts, etc.
Attach ALL schedules and
explanations...........................
3.
. 00
4. DEDUCTIONS FROM INCOME: All allowed losses and deductions per instructions.
Attach ALL schedules and explanations
.
4.
5. ADJUSTED INCOME: Add lines 2 and 3, less line 4....................................................................................................................
5.
. 00
. 00
6. EXEMPTIONS: (number of exemptions claimed in Section D above _____________ x
$1500.00)
............................................
6.
. 00
7. TAXABLE INCOME: (line 5 less line 6) ..........................................................................................................................................
7.
8. TAX: multiply amount on line 7 by one of the following:
. 00
I
CHECK ONE BOX
A. RESIDENT ONLY - 1% (.01)
B. NONRESIDENT ONLY - 1/2% (.005)
C. PART-YEAR RESIDENT - from Schedule 3, line
.........
8.
F.
F.
PAYMENTS AND CREDITS
. 00
9. A. Springfield tax withheld from W-2(s).........................................................................................................................................
9a.
. 00
B. Total 2002 City of Springfield estimated payments ..................................................................................................................
9b.
C. Credit for income tax liability paid to another Michigan municipality or by a partnership. (See page 4, line 9c, for limitations.)
. 00
Name of Michigan municipality and/or partnership. _______________________(Attach copy of nonresident return.
NO CREDIT IF NOT
ATTACHED.)
9c.
. 00
10. Total payments and credits - add lines 9a, 9b, and 9c ...................................................................................................................
10.
G.
G.
REFUND OR AMOUNT YOU OWE
Return due April 30, 2003. Amounts not paid by due date are subject to interest and penalty.
. 00
11. If line 8 is larger than line 10 enter AMOUNT YOU OWE. If $1.00 or more
PAY IN FULL WITH
RETURN..................................
11.
. 00
12. If line 10 is larger than line 8, enter amount OVERPAID................................................................................................................
12.
13. OVERPAID AMOUNT ON LINE 12 IS TO BE:
. 00
. 00
. 00
13a. Springfield Community Foundation: $________ 13b. Credited to 2003 Estimated Tax: $________ 13c. Refunded to you: $________
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements,
I declare under penalty of perjury that this return is based on all
and to the best of my knowledge, believe they are true, correct and complete.
information of which I have knowledge.
Your Signature
Date
Your birthdate
Preparer's Signature
Date
Spouse's Signature
Date
Spouse's birthdate
Daytime Phone:
Evening Phone:
Phone:
Identification No.
Make payable to: CITY TREASURER,
Mail to: CITY OF SPRINGFIELD, INCOME TAX DEPARTMENT, 601 AVENUE A, SPRINGFIELD, MI 49015-1499
Visa, MasterCard and Check Direct Card accepted
For additional forms visit our Web Site at
page 5
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