Form L-1040 - Individual Income Tax Return - City Of Lapeer - 2004
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1
22004 L-1040
CITY OF LAPEER INDIVIDUAL INCOME TAX RETURN
DUE MAY 2, 2005
TAXPAYER'S FIRST NAME , MIDDLE INITIAL, AND LAST NAME
YOUR SOCIAL SECURITY NUMBER
YOUR OCCUPATION
IF JOINT RETURN, SPOUSE'S FIRST NAME, MIDDLE INITIAL, AND LAST NAME
SPOUSE'S SOCIAL SECURITY NUMBER
SPOUSE'S OCCUPATION
CURRENT HOME ADDRESS (NUMBER AND STREET INCLUDING APARTMENT NUMBER)
IF MARRIED, IS SPOUSE FILING A SEPARATE RETURN?
YES
NO
CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE
ENTER NAME AND ADDRESS USED ON 2003 RETURN IF DIFFERENT
FROM
TO
RESIDENCY STATUS
RESIDENT
NONRESIDENT
PART-YEAR RESIDENT
EXEMPTIONS
1a.
YOURSELF
65 OR OVER
BLIND
DISABLED
1b.
SPOUSE
65 OR OVER
BLIND
DISABLED
NAME OF DEPENDENT
SOCIAL SECURITY NUMBER
RELATIONSHIP
TOTAL LINE 1a. &1b.
1c.
DEPENDENTS
(ENTER TOTAL NUMBER 1c. - 1f.).
1d.
1e.
TOTAL EXEMPTIONS (1a.-1f.)
1f.
(ENTER ON LINE 17)
INCOME
ENTER WAGES, TIPS AND OTHER COMPENSATION (DEFERRED COMPENSATION DISTRIBUTIONS, SICK PAY, ETC.)
RESIDENT- ALL INCOME
LAPEER INCOME TAX
WAGES ETC
REGARDLESS OF WHERE EARNED. NON-RESIDENT- INCOME EARNED IN CITY
EMPLOYER'S NAME
ADDRESS OF ACTUAL WORK STATION
WITHHELD
W-2 FORM, BOX 1
ATTACH
2a.
2a.
.00
.00
2b.
2b.
.00
.00
COPY OF
2c.
2c.
.00
.00
PAGE 1 OF
FEDERAL
2d.
2d.
.00
.00
2e.
Total for additional employers from attached sheet.
2e.
.00
.00
RETURN
3.
TOTAL COMPENSATION AND LAPEER TAX WITHHELD (Attach W-2's)
3a.
.00
3b.
.00
4.
Taxable interest. (Attach copy of Page 1 of Federal 1040)
4.
.00
5.
Ordinary dividends. (Attach copy of Page 1 of Federal 1040)
5.
.00
6.
Business Income. (Attach copy of Federal Schedule C.)
6.
.00
ATTACH
7.
Capital gains or losses. (Attach copy of Federal Schedule D.)
7.
.00
W-2
8.
Rental real estate, royalties, partnerships, trusts, etc. (Attach copy of Federal Schedule E.)
8.
.00
FORMS
9.
Other income. Total from Page 2, line 31
(UNEMPLOYMENT IS NOT TAXABLE INCOME TO THE CITY)
9.
.00
HERE
10.
TOTAL INCOME. ADD LINES 3b. THROUGH 9
10.
.00
DEDUCTIONS
11.
Individual Retirement Account. (Attach copy of Page 1 of Federal 1040)
.00
11.
12.
Employee business expenses. (See instructions and attach Federal 2106 or list)
.00
12.
13.
Moving expenses. (Into City of Lapeer only) (Attach Federal 3903 or list)
.00
13.
14.
Alimony paid. DO NOT INCLUDE CHILD SUPPORT (Attach copy of Page 1 of Federal 1040)
.00
14.
15.
TOTAL DEDUCTIONS. ADD LINES 11 THROUGH 14
15.
.00
16.
TOTAL INCOME AFTER DEDUCTIONS. SUBTRACT LINE 15 FROM LINE 10
16.
.00
17.
Amount for exemptions. (Number of exemptions, _____ times exemption amount of $600.00)
17.
.00
ATTACH
18.
TOTAL INCOME SUBJECT TO TAX. SUBTRACT LINE 17 FROM LINE 16
18.
.00
CHECK
19.
City of Lapeer Tax: Multiply Line 18 by .01 for Residents, .005 for Non-residents or amount from Part-year Resident Schedule P
19.
.00
PAYMENTS AND CREDITS
OR
20.
20.
.00
MONEY
Tax withheld by your employer from line 3a above. (Attach LW-2 or W-2 forms)
ORDER
21.
21.
.00
Payments on 2004 Declaration of Estimated Income Tax, payments with an extension, and credits forward from 2003.
HERE
22.
22.
.00
Credit for tax paid to another city and for tax paid by a partnership. (Attach copy of other city's return)
23.
TOTAL PAYMENTS AND CREDITS. ADD LINE 20 THROUGH 22
23.
.00
TAX DUE
24.
PAY WITH RETURN>>>
24
.00
COMPLETE
If tax (line 19) is larger than payments (line 23) you owe tax. ENTER TAX DUE
OVERPAYMENT
25.
REFUND>>>
25
.00
26 a,b,c
If payments (line 23) are larger than tax (line 19) ENTER OVERPAYMENT
DIRECT DEPOSIT
FOR DIRECT
26.
a.
ROUTING NUMBER (MUST BE 9 DIGITS) ____ ____ ____ ____ ____ ____ ____ ____ ____
b. SAVINGS
____
OF REFUND
DEPOSIT
c.
ACCT # ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____
CHECKING
____
CREDIT TO 2005
see instructions
27.
Overpayment to be HELD and APPLIED TO YOUR 2005 ESTIMATED TAX
26
.00
I declare that I have examined this return (including accompanying schedules and statements) and to the best of my knowledge and belief it is true, correct and
complete. If prepared by a person other than taxpayer, the preparer's declaration is based on all information of which he has any knowledge.
/ /
/
/
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SIGN
DATE
DATE
TAXPAYER'S SIGNATURE-If joint return, both husband and wife must sign.
SIGNATURE OF PREPARER OTHER THAN TAXPAYER
HERE
PHONE (
)
-
====>
SPOUSE'S SIGNATURE
PREPARER'S ADDRESS
MAKE CHECK OR MONEY ORDER PAYABLE TO: CITY OF LAPEER.
PREPARER'S PHONE NUMBER
MAIL TO: LAPEER CITY INCOME TAX DEPARTMENT, 576 LIBERTY PARK, LAPEER, MI 48446
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