Form 5074 - Allocation Of Individual Income Tax To Guam Or The Commonwealth Of The Northern Mariana Islands (Cnmi) - 2017

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5074
Allocation of Individual Income Tax to Guam or the
OMB No. 1545-0074
Commonwealth of the Northern Mariana Islands (CNMI)
Form
2017
Go to for the latest information.
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 Reserved for future use .
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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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34
Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Purpose of form. Form 5074 provides information to the United States
At the time this form and instructions went to print, the
so the IRS can figure the individual income tax that is due to Guam or
!
tuition and fees deduction formerly claimed on line 27 had
the CNMI.
expired. You can’t claim a deduction on line 27 for expenses
Who must file. If you were a U.S. citizen or resident alien (other than a
paid or incurred after 2016. Line 27 is now shown as
CAUTION
bona fide resident of Guam or the CNMI), you may need to file Form
“Reserved for future use” in case Congress extends the deduction for
5074. Complete this form if all of the following apply to you (and to your
2017. To find out if legislation extended the deduction so you can claim
spouse if filing a joint return).
it on your 2017 return, go to IRS.gov/Extenders.
5074
For Paperwork Reduction Act Notice, see the Instructions for Form 1040.
Form
(2017)
Cat. No. 42243X

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