Form P1040 (Nr) - City Of Pontiac Income Tax, Individual Return - Non Resident - 2005

P P 1 1 0 0 4 4 0 0 ( ( N N R R ) )

FOR CALENDAR YEAR TAXPAYERS,

CITY OF PONTIAC INCOME TAX

THIS RETURN IS DUE ON OR

2 2 0 0 0 0 5 5

I I N N D D I I V V I I D D U U A A L L R R E E T T U U R R N N – – N N O O N N R R E E S S I I D D E E N N T T

BEFORE MAY 1, 2006

Y Y O O U U R R S S O O C C I I A A L L S S E E C C U U R R I I T T Y Y N N U U M M B B E E R R

S S P P O O U U S S E E ' ' S S S S O O C C I I A A L L S S E E C C U U R R I I T T Y Y N N U U M M B B E E R R

VALIDATION AREA

First Name(s) and Initial(s)

Last Name

Your Occupation

Spouse's Name

Spouse’s Occupation

(Street or Rural Route Address)

P.O. Box

I I M M P P O O R R T T A A N N T T

TRANSACTION NO.

City, Town or Post Office

State

Postal Zip Code

Complete the following:

DID YOU FILE A 2004

ASSESS NO.

Spouse filing a separate return Y N

social security number __________________________

PONTIAC RETURN?

Yes □ No □ If No, Explain

Enter the name and address used on your return for 2004 _____________________________

IF YES, IS THE NAME(S), FILING

If none filed, give reason. _______________________________________________________

VERIFIED

STATUS AND ADDRESS IDENTICAL

___________________________________________________________________________

TO PREVIOUS YEAR RETURN?

If No, State Prior

□

□

Yes

No

Information And

Date of Change

□ YOURSELF

□ Blind

□ 65 & Over

(Your Birth Date)______________

□ SPOUSE

□ Blind

□ 65 & Over

(Spouse’s Birth Date)______________

No. of boxes

®

Exemptions

checked

R R E E F F U U N N D D S S W W I I L L L L B B E E H H E E L L D D U U P P F F O O R R M M I I S S S S I I N N G G I I N N F F O O R R M M A A T T I I O O N N

(See

No. of children

Check

No. of

®

Dependents

If age 1 or over dependent's

who lived

Instructions)

if under

Relationship

months

Name (first, initial, and last name)

social security number

with you

age 1

in your home

No. of children who didn't

®

live with you due to a

If more than four

divorce or separation

dependents, use

No. of other

attachment.

®

dependents

Add numbers

a a . . If your child didn't live with you but is claimed as your dependent under a pre-1985 agreement check here ....................................................® □

®

entered in

b b . . Total number of exemptions claimed – Enter on line 10 ............................................................................................................................................

boxes above

I I N N C C O O M M E E

1 1 . .

– D D O O N N O O T T I I N N C C L L U U D D E E S S . . U U . . B B . . P P A A Y Y If joint return, include all income earned in Pontiac of both

TOTAL WAGES REPORTED

P P o o n n t t i i a a c c I I n n c c o o m m e e T T a a x x

husband and wife. Enter GROSS income from employers for wages, salaries, commissions, tips, sick pay,

IN BOX 1 ON PW-2 OR W-2

etc. earned in Pontiac, indicate (W) for wife. (Box 1 W2 form)

w w i i t t h h h h e e l l d d

DOLLARS

Employer's Name

Actual Work Location (Number, Street, City and State)

.00

.00

$ $

1 1

.00

00

.00

00

.00

00

2 2 . . If more space is needed please attach separate listing sheet.

2 2

TOTALS ®

( (

) )

3 3 . . L L E E S S S S E E X X C C L L U U D D A A B B L L E E P P O O R R T T I I O O N N O O F F W W A A G G E E S S I I N N L L I I N N E E 1 1 E E A A R R N N E E D D O O U U T T S S I I D D E E P P O O N N T T I I A A C C ( ( F F R R O O M M P P A A G G E E 2 2 L L I I N N E E E E ) )

Excludable Wages 3 3

00

00

4 4 . . Income (loss) FROM BUSINESS - from page 2 line 27 - ...............................................................................................................Business 4 4

A A T T T T A A C C H H F F E E D D E E R R A A L L S S C C H H E E D D U U L L E E C C

00

5 5 . . Income (loss) FROM PARTNERSHIP(S) AND OTHER SOURCES - from page 2 line 31 ............................................Partnerships/Others 5 5

6 6 . . Income (loss) FROM RENTALS, SALES OR EXCHANGES of tangible property located in Pontiac

00

D, E, 4797, ETC.......................................................................Property Sales/Rentals 6 6

A A T T T T A A C C H H C C O O P P I I E E S S O O F F F F E E D D E E R R A A L L S S C C H H E E D D U U L L E E S S

00

7 7 . . TOTAL - Add lines 2 through 6 ...................................................................................................................................................... Sub Total 7 7

00

8 8 . . TOTAL DEDUCTIONS - From page 2 line 32 ............................................................................................................................ Deductions 8 8

00

9 9 . . TOTAL - SUBTRACT line 8 from line 7 .......................................................................................................................................................... 9 9

00

1 1 0 0 . . LESS: Amount of exemptions - Enter number of exemptions from b b (

) X 600.00 ................................................................ Exemptions 1 1 0 0

00

1 1 1 1 . . TOTAL - Income subject to tax - SUBTRACT line 10 from line 9 ................................................................................................... Taxable 1 1 1 1

00

1 1 2 2 . . City of Pontiac Tax 1/2% (MULTIPLY LINE 11 BY .005) ...................................................................................................................... Tax 1 1 2 2

P P A A Y Y M M E E N N T T S S A A N N D D C C R R E E D D I I T T S S

00

1 1 3 3 . . a. Pontiac income tax withheld by your employer from line 2 above - Attach PW-2 or W-2 ..................... 1 1 3 3 a a

00

b. Payments and credits on 2005 Declaration of Estimated Pontiac Tax ..................................................... b b

00

c. Other credits - EXPLAIN IN ATTACHED STATEMENT............................................................................ c c

TOTAL - Add lines 13 a, b, and c..................................................................................................................................................................1 1 3 3

00

1 1 4 4 . . If your payment (line 13) is larger than your tax (line 12), enter the amount you OVERPAID

Applied to your 2006 Estimated Tax

The overpayment amount on line 14 is to be:

Refunded To You

00

Donation to the City of Pontiac

1 1 4 4

T T A A X X D D U U E E

1 1 5 5 . .

Amounts due must be paid by May 1, 2006 or it will be subject to interest and penalty

If your tax (line 12) is larger than your payment (line 13), enter AMOUNT YOU OWE

P P a a y y i i n n f f u u l l l l w w i i t t h h t t h h i i s s r r e e t t u u r r n n

00

1 1 5 5

( ( W W r r i i t t e e s s o o c c i i a a l l s s e e c c u u r r i i t t y y n n u u m m b b e e r r o o n n c c h h e e c c k k o o r r m m o o n n e e y y o o r r d d e e r r a a n n d d e e n n c c l l o o s s e e w w i i t t h h

r r e e t t u u r r n n . . M M a a k k e e r r e e m m i i t t t t a a n n c c e e p p a a y y a a b b l l e e t t o o : : “ “ T T R R E E A A S S U U R R E E R R , , C C I I T T Y Y O O F F P P O O N N T T I I A A C C ” ” t t o o a a d d d d r r e e s s s s o o n n b b a a c c k k ) )