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

ATTACH A COPY OF THE FRONT OF FEDERAL 1040 FORM

2011

BR 1040

ciTy Of BiG RAPiDs incOMe TAX

INDIVIDUAL RETURN

Due Date: April 30, 2012

B. ResiDency

A. first name and initial

last name

your social security number

ResiDenT

inside city limits

nOn-ResiDenT

if Joint first name of spouse

spouse’s social security number

Township of

Big Rapids

Green

Present home Address

colfax

Grant

Barton

norwich

home

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

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

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)

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

Office Use Only

11. B

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

Payment received

APiDs

iThhelD

with Return

12. 2011 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 2012

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