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2004 MUSKEGON M-1040EZ
INDIVIDUAL INCOME TAX RETURN DUE DATE MAY 2, 2005
REFER TO INSTRUCTIONS ON BACK TO SEE WHO CAN USE THIS FORM
YOUR FIRST NAME AND MIDDLE INITIAL LAST NAME YOUR SOCIAL SECURITY NUMBER
USE THE
MUSKEGON IF JOINT, SPOUSE'S FIRST NAME AND MIDDLE INITIAL LAST NAME YOUR SPOUSE'S SOCIAL SECURITY NUMBER
MAILING
LABEL
OTHERWISE HOME ADDRESS (NUMBER AND STREET OR RURAL ROUTE) YOUR PHONE NUMBER
PLEASE
PRINT CITY, TOWN, OR POST OFFICE STATE ZIP CODE
SEE Check box if this is RESIDENCY STATUS MARRIED FILING SEPARATELY
Check box if your Check box if you
INSTRUCTIONS the first time you address has do not need a RESIDENT SPOUSE'S NAME
ON BACK filed a Muskegon changed since filing return form mailed
return. your 2003 return. to you next year. NON-RESIDENT SSN
1. Total wages, salaries, and tips. (See instructions on back.)
RESIDENTS: Total from Box 1 of all your W-2 forms.
NON-RESIDENTS: Total from Box 1 of the W-2 forms for work done in the City of Muskegon. Attach 1. , . 0 0
INCOME your W-2 form(s).
2. Interest income. (See instructions on back.)
RESIDENTS: Report all taxable interest income. 2.
ATTACH 0 0
NON-RESIDENTS: Leave blank. , .
COPY 2
OF YOUR 3. Dividend income. (See instructions on back.)
RESIDENTS: Report all dividend income. 3.
W-2 FORM(S) 0 0
NON-RESIDENTS: Leave blank. , .
HERE 4. Add lines 1, 2 and 3. This is your total Muskegon income. 4. , . 0 0
EXEMPTION 5. Enter amount from Exemptions Worksheet on back; or if SINGLE enter $600.00; or if
MARRIED filing jointly enter $1,200.00. 5.
AMOUNT , . 0 0 PLEAS
TAXABLE 6. Subtract line 5 from line 4. This is your taxable income. 6.
INCOME , . 0 0 E
7. ROU
TAX RESIDENTS: Multiply line 6 by one percent (.01).
NON-RESIDENTS: Multiply line 6 by one-half of one percent (.005). 7. , . 0 0 ND TO THE NEARES
8. Total Muskegon tax withheld by employers (attach W-2 forms showing Muskegon withheld) 8. , . 0 0
PAYMENTS 9.
AND Payments on 2004 Declaration of Muskegon Estimated Income Tax. 9. 0 0
CREDITS , .
10. Credit for income tax paid to another Michigan city (RESIDENTS ONLY).
(Attach copy of other city's return.) USE CITY CREDIT WORKSHEET. 10. , . 0 0 T
11. DOL
TOTAL Add lines 8. 9 and 10 and enter here. 11. , . 0 0 LAR
12. If line 7 is larger than line 11, subtract line 11 from line 7. This is the amount you owe. Please attach your
TAX DUE payment. Make check payable to: City of Muskegon. If payment due is greater than $100.00, you may be 12. 0 0
assessed additional penalties and interest if you were required to pay estimated taxes. , .
13. a. If line 11 is larger than line 7, subtract line 7 from line 11. This is your refund. Allow at least 45 days.
b. Routing number:
c. Type: Checking Savings
REFUNDS 13. 0 0
AND d. Account number: , .
CREDITS 14. Check this box to DONATE your refund to the BIG RED ED CLUB. 14. , . 0 0
15.
Check this box to credit this refund to the 2005 estimated tax liability. 15. , . 0 0
I have read this return. Under the penalties of perjury, I declare that to the best of my knowledge and belief the return For City of Muskegon use.
is true, correct and accurately lists all amounts and sources of Muskegon income I received during the tax year. Please do not write in box.
Mail return to: Income Tax Department, P.O. Box 29, Muskegon, MI 49443-0029.
PLEASE SIGN HERE YOUR SIGNATURE DATE SPOUSE'S SIGNATURE (IF JOINT RETURN) DATE
KEEP A COPY OF THIS
FOR YOUR RECORDS. Machine Certification
Filename: h:\approved\groleau\63832tax.f3f, Date: 11-18-104 8:11:17
Sheet: 4, Copy: Front, Scale: 100%, Type: Artwork
2004 INSTRUCTIONS FOR FORM M-1040EZ
WHO CAN USE THIS FORM IF:
You were a resident of Muskegon for all of 2004 with income from wages, interest or dividends with none of the income being excludable from
USE THIS Muskegon income tax and the tax payments are Muskegon tax withheld, estimated tax payments and credit for income tax paid to another
FORM Michigan city; or
You were a non-resident of Muskegon for all of 2004 with wages earned in Muskegon and none of the earnings from Muskegon employers is
excludable from Muskegon income tax.
YOU CANNOT USE THIS FORM IF:
You received alimony payments, had Muskegon business income (Sch C), sold or exchanged property (Sch D or 4797), had taxable IRA
distributions, taxable pension/annuity distributions, supplemental income (Sch E or F), miscellaneous income, exclusions or adjustments.
YOUR Because this form is designed to be read by a machine, please print your numbers inside the boxes like this:
RETURN
Do not type your numbers. Do not use dollar signs.
1 2 , 3 4 5 . 0 0
NAME AND SOCIAL SECURITY NUMBER
Fill in your first name, middle initial, last name and social security number. If a joint return, also fill in your spouse's first name, middle initial, last
name and social security number.
FIRST RETURN
Check the first return box if this is the first time you filed a Muskegon income tax return.
ADDRESS CHANGE
Check the address change box if your address had changed since filing your 2003 Muskegon income tax return.
RESIDENCY STATUS
Check the resident or non-resident box under Residency Status. A part year resident of Muskegon cannot use this form.
MARRIED FILING SEPARATELY
If married and filing separately, enter spouse's name and social security number in Married Filing Separately box.
INCOME If you have income on your federal income tax return that is not taxable by Muskegon, use Form M-1040.
LINE 1. TOTAL WAGES, SALARIES AND TIPS
Residents and non-residents enter the amount of wages reported on your Federal Return.
LINE 2. INTEREST INCOME
Residents enter the amount of taxable interest income reported on your Federal Return.
Non-residents enter zero. Interest income is not taxable to a non-resident.
LINE 3. DIVIDEND INCOME
Residents enter the amount of dividend income reported on your Federal Return.
Non-residents enter zero. Dividend income is not taxable to a non-resident.
LINE 4. TOTAL MUSKEGON INCOME
Enter the total of lines 1, 2 and 3.
PAYMENTS AND LINE 9.
CREDITS Residents and non-residents enter the total estimated income tax paid during 2004 including the amount paid with voucher 4 due January
31, 2005.
LINE 10.
Residents may take credit for income tax paid to another Michigan city. The credit is limited to the Muskegon non-resident rate of 0.5%
(.005) and the Muskegon exemption of $600.00 per person. (Refer to Worksheet on the back of M-1040TC)
TAX DUE LINE 12.
Tax due of one dollar ($1.00) or more must be paid in full when the return is filed. Make check or money order payable to: the City of
Muskegon. If your payment is over $100.00. You may be assessed additional penalties and interest, if you are required to file estimated tax
vouchers.
OVERPAYMENTS LINE 13, 14, and 15. OVERPAYMENTS
Overpayments of less than one dollar ($1.00) will not be refunded and cannot be donated. All other overpayments will be refunded or may
be donated to the BIG RED ED CLUB, or Credited to the 2005 estimated tax liability. To donate the overpayment, check the donation box on
line 14 and enter the overpayment. To claim a refund, enter the overpayment on line 13a. Complete lines 13b through 13d if you want us to
directly deposit the amount shown on line 11a into your checking or savings account at a bank or other financial institution (such as a mutual
fund, brokerage firm, or credit union) instead of sending you a check. NOTE: If you do not want your refund directly deposited into your
account, leave lines 13b through 13d balnk. Enter the overpayment on line 15 if you want it credited to your 2005 estimated tax liability.
EXEMPTION LINE 5. EXEMPTION AMOUNT
Complete worksheet below and enter the total from box 5a on page 1, line 5.
AMOUNT
EXEMPTIONS WORKSHEET
1. CHECK BOXES THAT APPLY 1A. NUMBER OF
REGULAR 65 AND OVER BLIND DEAF PARAPLEGIC, QUADRIPLEGIC, HEMIPLEGIC BOXES CHECKED
OR TOTALLY AND PERMANENTLY
YOURSELF DISABLED
SPOUSE
2. LIST FIRST NAMES OF DEPENDENT CHILDREN WHO LIVED WITH YOU 2A. NUMBER OF
CHILDREN LISTED
3. OTHER DEPENDENTS (LIST AND EXPLAIN) 3A. NUMBER OF OTHER
DEPENDENTS
4. TOTAL NUMBER OF DEPENDENCY EXEMPTIONS (ADD BOXES 1A, 2A AND 3A. AND ENTER THE TOTAL IN BOX 4A. 4A. TOTAL NUMBER
OF EXEMPTIONS
5. MULTIPLY TOTAL NUMBER OF EXEMPTIONS IN BOX 4A BY $600.00 AND ENTER THE TOTAL IN BOX 5A AND ON PAGE 1, LINE 5. 5A. EXEMPTION
AMOUNT
LINES 6 THROUGH 15
Follow the instructions on the front of this form for each separate line.
Thank You
Filename: h:\approved\groleau\63832tax.f3f, Date: 11-18-104 8:11:27
Sheet: 4, Copy: Back, Scale: 100%, Type: Artwork