Form L1040 - City Of Lapeer Income Tax Individual Return - 2001
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2L#44709-NUT01
1/7/02
4:47 PM
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□
L1040
CHECK
RESIDENT
CITY OF LAPEER INCOME TAX
□
2001
FOR CALENDAR
ONE
NONRESIDENT
□
INDIVIDUAL RETURN
OR FISCAL YEAR ENDING
BOX
PART-YEAR
FILING STATUS: □ Single
First Name and Initial
Your Social Security Number
□ Married filing jointly
(If Joint Return, First Name and Initial of Spouse)
Last Name
Spouse's Social Security Number
□ Married filing separate return, enter
Spouse's Name:
Home Address (Number and Street or Rural Route)
Your Occupation
& Soc. Sec. #:
City, Town or Post Office and State
Zip
Spouse's Occupation
No. of boxes
checked on a
and b
a. □ YOURSELF
□ 65 & Over
□ SPOUSE
□ 65 & Over
b. □ Blind
□ Deaf
□ Disabled
□ Blind
□ Deaf
□ Disabled
No. of children
on c who lived
(Permanent Disability Requires Doctor's Statement be Attached.)
with you
Did you file a 2000 City
c.
Check
No. of
No. of children
Dependents
If age 5 or over dependent's
if under
Relationship
months
Return? . . . . . . . . . . . .
on c who didn't
social security number
Name (first, initial, and last name)
age 5
in your home
live with you due
□
□
Yes
No
•
•
to a divorce or
separation
If yes, are the Name(s)
•
•
No. of parents
and Address the same?
•
•
listed on c
□
□
•
•
Yes
No
No. of other
dependents
•
•
listed on c + d
•
•
Add numbers
entered in boxes
d If your child didn't live with you but is claimed as your dependent under a pre-1985 agreement check here ....................... □
above
ATTACH FRONT PAGE OF FEDERAL 1040 FORM
1. TOTAL INCOME: (Wages, salaries, tips, etc. - Attach all W-2's) Employer's Name...................................................
.00
A. RESIDENTS: enter total W-2 income.
B. NONRESIDENTS: (See instructions) .............................................
1.
2. ADDITIONS TO INCOME: All other income: interest, dividends, business income, capital gains, rents,
.00
ADDITIONS TO INOCME:
royalties, partnerships, estates, trusts, farm, etc..............................................................
2.
(FAILURE TO ATTACH ALL SCHEDULES AND EXPLANATIONS WILL RESULT IN PROCESSING DELAYS)
.00
3. SUBTRACTIONS FROM INCOME (All allowed losses and adjustments.) .................................................................
3.
(FAILURE TO ATTACH ALL SCHEDULES AND EXPLANATIONS WILL RESULT IN PROCESSING DELAYS)
.00
4. ADJUSTED INCOME (Add lines 1 and 2 less line 3.).................................................................................................
4.
.00
5. EXEMPTIONS: Multiply the number of exemptions claimed by $600.00....................................................................
5.
.00
6. TAXABLE INCOME (line 4 less line 5)........................................................................................................................
6.
7. TAX - Multiply amount on line 6 by one of the following:
A. RESIDENT ONLY - 1% (.01) ..................................................................................................................................
.00
1
B. NONRESIDENT ONLY -
/
% (.005) ......................................................................................................................
2
7.
C. PART-YEAR RESIDENT - Tax from Schedule 3, line I ..........................................................................................
DO NOT WRITE
IN THIS SPACE
PAYMENTS AND TAX CREDITS:
8.
.00
8. Lapeer tax withheld (Attach W-2 supplied by employer) ....................................................
9.
.00
9. 2001 Estimate payments (including credit from 2000 overpayment) ..................................
10.
.00
10. Credits for income tax paid to another Michigan municipality or by a partnership..............
FAILURE TO ATTACH COPIES OF RETURNS AND EXPLANATIONS WILL RESULT IN PROCESSING DELAYS
.00
11. TOTAL PAYMENTS AND CREDITS (Add lines 8, 9 and 10.) ....................................................................................
11.
(Make checks payable to City of Lapeer.)
.00
PAY WITH RETURN
12. BALANCE DUE: (line 7 larger than line 11.) ...............................................................................................................
12.
13. OVERPAYMENT: (line 11 larger than line 7.)
.00
A. To be refunded .......................................................................................................................................................
13A.
.00
B. To be credited to 2002 Estimated tax .....................................................................................................................
13B.
(attach Declaration of Estimated Tax for 2002 - form 1040ES indicating amount to be credited with your payment)
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, his declaration is based on all information of which he has any knowledge.
SIGN HERE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SIGN
(Taxpayer's signature and date)
(Signature of preparer other than taxpayer and date)
HERE
SIGN HERE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Spouse's signature and date)
(Address)
(Telephone)
MAKE CHECKS PAYABLE TO: CITY OF LAPEER
MAIL RETURNS TO: CITY INCOME TAX DIVISION, 576 LIBERTY PARK, LAPEER, MI 48446-2189
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