Form Br 1040 - Individual Return - City Of Big Rapids Income Tax

ATTACH A COPY OF THE FRONT OF FEDERAL 1040 FORM

2010

BR 1040

CITY OF BIG RAPIDS INCOME TAX

INDIVIDUAL RETURN

Due Date: April 30, 2011

A. First Name and Initial

Last Name

Your Social Security Number

B. RESIDENCY

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RESIDENT

Inside City Limits

If Joint First Name of Spouse

NON-RESIDENT

Spouse’s Social Security Number

Township of

Big Rapids

Green

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Present Home Address

Colfax

Grant

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Barton

Norwich

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Home

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City, State and Zip Code

Other_______________________

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(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.

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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.

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Social Security Number __________________________________________

1. INCOME:

See Instructions

A: RESIDENT

......................................................................

Attach Copy of Federal Form

B: NON-RESIDENT

Attach Copy of any Federal Schedule(s) that are applicable to your City Return

2. ADDITIONS TO INCOME (attach Federal Schedule(s) and Explain) ..........................................................................

3. SUBTRACTIONS FROM INCOME (attach Federal Schedule(s) and Explain)..............................................................

4. IRA DEDUCTIONS ....................................................................................................................................................

5. ADJUSTED INCOME (Add Lines 1 & 2, Subtract 3 & 4)............................................................................................

6. EXEMPTIONS (From D above)

..............

(If you are a student and your parents do not file a City of Big Rapids return, check this box

and claim yourself)

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7. TAXABLE INCOME (Line 5 less Line 6)......................................................................................................................

8. TAX (Multiply amount on Line 7 by one of the following)

A: RESIDENT - 1% (.01)

B: NON-RESIDENT - 1/2% (.005) ................................................................................................................

9. VOLUNTARY CONTRIBUTIONS TO BIG RAPIDS COMMUNITY POOL and/or COMMUNITY LIBRARY ..

(Please circle)

10. TOTAL OF LINE 8 AND 9........................................................................................................................................

10.

PAYMENTS AND TAX CREDITS

O O F F F F I I C C E E U U S S E E O O N N L L Y Y

11. B

.............................................................................. 11.

P P a a y y m m e e n n t t r r e e c c e e i i v v e e d d

APIDS

ITHHELD

w w i i t t h h R R e e t t u u r r n n

12. 2010 E

............................................................................ 12.

STIMATED

AYMENTS

_____________________

13. C

...................................................... 13.

_____________________

REDIT FROM PREVIOUS YEAR OVER PAYMENT

14. C

) .... 14.

_____________________

REDITS FOR

NCOME

AX PAID TO ANOTHER

ICHIGAN

UNICIPALITY

ESIDENTS

NLY

15. T

(Add Lines 11, 12, 13 & 14)........................................................................................

15.

OTAL

AYMENTS AND

REDITS

16. TAX DUE (Line 10 larger than Line 15) ....................................................................................................................

16.

17. PENALTY AND INTEREST (Schedule 3)..................................................................................................................

17.

18. BALANCE DUE (Add Lines 16 and 17) ..................................................................................................................

18.

19. OVERPAYMENT (Line 15 is larger than Line 10 ......................................................................................................

19.

Amount on Line 19 is to be (CHECK ONE BOX ONLY)

Credited to 2011

Refunded to You

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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.