Form Br 1040 - Individual Return - City Of Big Rapids Income Tax - 2003
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1
2ATTACH A COPY OF THE FRONT OF FEDERAL 1040 FORM
2003
BR 1040
CITY OF BIG RAPIDS INCOME TAX
INDIVIDUAL RETURN
Due Date: April 30, 2004
B. RESIDENCY
A. First Name and Initial
Last Name
Your Social Security Number
RESIDENT
Inside City Limits
NON-RESIDENT
Spouse’s Social Security Number
If Joint First Name of Spouse
Township of
Big Rapids
________
Green
________
Present Home Address
Colfax
________
Grant
________
Barton
________
Norwich
________
City, State and Zip Code
Home
________
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 COMMUNITY POOL and/or Community Library (please circle).........
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. 2003 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 2004
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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