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CITY OF PORT HURON - INDIVIDUAL INCOME TAX RETURN
PH-1040 This return is due May 1, 2023 2022
Your first name and initial Last name Your social security number
Residency Status
SEE INSTRUCTIONS
If a joint return, spouses first name and initial Last name Spouse's social security number
RESIDENT
NONRESIDENT Home address (number and street) if a P.O. Box or if this is not your actual residence, see instructions Did you file a 202 1Port Huron return?
PARTIAL RESIDENT Yes No
City, town or post office, state and ZIP code
Partial residents must complete If yes, is the name(s), filing status and
Schedule L - see instructions address the same as last year?
If you were a resident for only part of the year, indicate when you were a resident: Yes No If no, explain and
give date of change
From: to: former address:
PRESENT EMPLOYER(S) '
Regular 65 or Older Blind Deaf Disabled
EXEMPTIONS Additional Number of boxes checked
(see instructions) You: exemptions Note: claim an exemption even if you
if you or your are a dependent on another return
Dependents Spouse: spouse are:
First name Last name Social security number Relationship to you
Number of dependents you
claim on your federal return
(list to the left)
Total number of exemptions
(add the numbers entered
in the boxes above)
Column I Column II Column III
Amounts from your Column I minus Column II
Federal Return Exclusions Income subject to tax
1. Wages, salaries, tips, etc. 00 00 00
2. Interest income RESIDENTS ONLY (partial residents see Schedule L) 00 00 00
3. Dividend income
A RESIDENTS ONLY (partial residents see Schedule L) 00 00 00
4. Business income or (loss) Attach Federal Schedule C 00 00 00
T
5. Capital gain or (loss) 00 00 00
T
6. Supplemental income or (loss) Attach Federal Schedule E 00 00 00
A 7. Other income 00 00 00
C
8. Adjustments Attach explanation and support 00 00 00
H
9. Total income - add lines 1 through 8 00
10. Exemption Credit. Number of exemptions x $600.00 (from exemptions above) 00
W -
11. TAXABLE INCOME. Subtract line 10 from line 9. If line 10 is greater than line 9, enter -0- 00
2 's
12. TAX multiply line 11 by 1% (.01) if a resident or by ½ of 1% (.005) if a nonresident. Partial residents see Schedule L 00
13. Port Huron tax withheld. You MUST attach W-2's showing the full amount of tax withheld . . 13 00
E 2 14
14. 202 estimated tax payments, extension payments and carried forward from last year . . . . . .
H 00
15. Credit for tax paid by a partnership . . . . . . . . . . . . . . . . . . . . . . . . . . 15
R 00
16. Credit for tax paid to another city. Residents only, SEE INSTRUCTIONS . . . . . . . 16
E 00
17. Total payments and credits. Add lines 13, 14, 15 and 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 00
18. If line 12 is more than line 17, subtract line 17 from line 12. This is your tax due ................................................. BALANCE DUE 18 00
19. If line 17 is more than line 12, subtract line 12 from line 17. This is the amount you overpaid ...................................... Overpayment 19 00
20a
20. Amount of line 19 to be: applied to your 202 3estimated taxes ' 00 or REFUNDED'20b 00
I declare, under penalty of perjury, that the information in this return and attachments is true and I declare under penalty of perjury, that this return is based on all
complete to the best of my knowledge. information of which I have knowledge.
Your signature Date
Preparer's name, address and ID number
X
Spouse's signature - if a joint return BOTH MUST SIGN Date
X
Make checks payable to: City of Port Huron Mail to: Income Tax Division Preparer's signature Date
100 McMorran Blvd.
IfTopayingpay online,in person,go topaywww.porthuron.org.at the City Treasurer's Office. Port Huron, MI 48060 X
