Form Br 1040 - Individual Return - City Of Big Rapids Income Tax - 2001
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1
2ATTACH A COPY OF THE FRONT OF FEDERAL 1040 FORM
2001
BR 1040
CITY OF BIG RAPIDS INCOME TAX
INDIVIDUAL RETURN
Due Date: April 30, 2002
A. First Name and Initial
Last Name
Your Social Security Number
B. RESIDENCY
RESIDENT
Inside City Limits
Spouse’s Social Security Number
If Joint First Name of Spouse
NON-RESIDENT
Township of
Present Home Address
Big Rapids
________
Green
________
Colfax
________
City, State and Zip Code
Other __________________
(Please Specify)
D. EXEMPTIONS
C. FILING STATUS
Number______________________x $600.00 = $______________
A. _____ Single
If you are claimed as a dependent on someone else’s Big Rapids return, check
B. _____ Married, Filing Jointly
this box and do not take the exemption.
C. _____ Married, Filing Separately
If you are a FSU student with permanent home other than Big Rapids, check
Spouse’s Name__________________________________________________
this box and claim yourself.
Social Security Number __________________________________________
1. INCOME:
See Instructions
A: RESIDENT
00
......................................................................
1.
Attach Copy of Federal Form
B: NON-RESIDENT
Attach Copy of any Federal Schedule(s) that are applicable to your City Return
00
2. ADDITIONS TO INCOME (attach Federal Schedule(s) and Explain) ..........................................................................
2.
00
3. SUBTRACTIONS FROM INCOME (attach Federal Schedule(s) and Explain)..............................................................
3.
00
4. IRA DEDUCTIONS ....................................................................................................................................................
4.
00
5. ADJUSTED INCOME (Add Lines 1 & 2, Subtract 3 & 4)............................................................................................
5.
6. EXEMPTIONS (From D above)
00
..............
6.
(If you are a student and your parents do not file a City of Big Rapids return, check this box
and claim yourself)
00
7. TAXABLE INCOME (Line 5 less Line 6)......................................................................................................................
7.
8. TAX (Multiply amount on Line 7 by one of the following)
A: RESIDENT - 1% (.01)
00
B: NON-RESIDENT - 1/2% (.005) ................................................................................................................
8.
00
9. VOLUNTARY CONTRIBUTIONS TO BIG RAPIDS COMMUNITY POOL ..................................................
9.
00
10. TOTAL OF LINE 8 AND 9 ........................................................................................................................................
10.
PAYMENTS AND TAX CREDITS
OFFICE USE ONLY
00
Payment received
11. B
R
T
W
.............................................................................. 11.
IG
APIDS
AX
ITHHELD
with Return
00
12. 2001 E
P
............................................................................ 12.
STIMATED
AYMENTS
_____________________
00
_____________________
13. C
...................................................... 13.
REDIT FROM PREVIOUS YEAR OVER PAYMENT
00
_____________________
14. C
I
T
M
M
(R
O
) .... 14.
REDITS FOR
NCOME
AX PAID TO ANOTHER
ICHIGAN
UNICIPALITY
ESIDENTS
NLY
00
15. T
P
C
(Add Lines 11, 12, 13 & 14) ........................................................................................
15.
OTAL
AYMENTS AND
REDITS
00
16. TAX DUE (Line 10 larger than Line 15) ....................................................................................................................
16.
00
17. PENALTY AND INTEREST (Schedule 3) ..................................................................................................................
17.
00
18. BALANCE DUE (Add Lines 16 and 17) ..................................................................................................................
18.
00
19. OVERPAYMENT (Line 15 is larger than Line 10 ......................................................................................................
19.
Amount on Line 19 is to be (CHECK ONE BOX ONLY)
A.
Credited to 2002
B.
Refunded to You
I declare, under penalty of perjury, that the information on this return and attachments is true and complete.
I authorize the City to discuss my
DO NOT discuss my
I declare, under penalty of perjury, that this return
claim and attachments with my
claim with my preparer.
is based on all information of which I have knowledge.
preparer
Filer’s Signature ______________________________________________ Date __________________
PREPARER’S SIGNATURE & ADDRESS
Birthdate ______________________________
Spouse’s Signature ____________________________________________ Date __________________
Phone (
)_______________________________
Birthdate ______________________________
MAIL YOUR RETURN FOR REFUND TO: CITY OF BIG RAPIDS, INCOME TAX DIVISION, 226 NORTH MICHIGAN AVE., BIG RAPIDS, MI 49307
MAIL YOUR RETURN FOR PAYMENT TO: CITY OF BIG RAPIDS, TREASURER’S OFFICE, 226 NORTH MICHIGAN AVE., BIG RAPIDS, MI 49307
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