BR-1040                              BIG RAPIDS                                                       202  2                                                 2 MI-BR-1040-12
                                 INDIVIDUAL RETURN DUE APRIL 30, 2023
Taxpayer's SSN                        Taxpayer's first name                     Initial Last name                                               RESIDENCE STATUS
                                                                                                                                                    Resident     Nonresident           Part-year
                                                                                                                                                                                       resident
Spouse's SSN                          If joint return spouse's first name       Initial Last name                                             Part-year resident - dates of residency (mm/dd/yyyy)
                                                                                                                                              From
Mark (X) box if  deceased             Present home address (Number and street)                                       Apt. no.                 To
Taxpayer                  Spouse                                                                                                                FILING STATUS
Enter date of death on page 2, right  Address line 2 (P.O. Box address for mailing use only)                                                        Single       Married filing jointly
side of the signature area
                                      City, town or post office                                 State      Zip code                                 Married filing separately. Enter spouse's 
Mark box (X) below if;                                                                                                                              SSN in Spouse's SSN box and Spouse's full 
Federal Form 1310 attached                                                                                                                          name here.   
                                      Foreign country name                 Foreign province/county         Foreign postal code
Itemized deductions on your                                                                                                                     Spouse's full name if married filing separately
Federal tax return for 2022
                             ROUND ALL FIGURES TO NEAREST DOLLAR
          INCOME                     (Drop amounts under $0.50 and increase                      Column A                                  Column B               Column C  
                                     amounts from $.50 to $0.99 to next dollar)           Federal Return Data                 Exclusions/Adjustments             Taxable Income
          1.   Wages, salaries, tips, etc. ( W-2 forms must be attached)        1                              .00                                          .00                                .00
SEND 
COPY OF   2.   Taxable interest                                                 2                              .00                                          .00                                .00
PAGE 1 OF 3.   Ordinary dividends                                               3                              .00                                          .00                                .00
FEDERAL   4.   Taxable refunds, credits or offsets of state and local income taxes 4                           .00                                          .00  NOT TAXABLE
RETURN
          5.   Alimony received                                                 5                              .00                                          .00                                .00
          6.   Business income or (loss) (Attach copy of federal Schedule C)    6                              .00                                          .00                                .00
          7.   Capital gain or (loss) 
               (Attach copy of fed. Sch. D) 7a.           Mark if federal       7                              .00                                          .00                                .00
                                                          Sch. D not required
          8.   Other gains or (losses) (Attach copy of federal Form 4797)       8                              .00                                          .00                                .00
          9.   Taxable IRA distributions (Attach copy of Form(s) 1099-R)        9                              .00                                          .00                                .00
          10. Taxable pensions and annuities (Attach copy of Form(s) 1099-R) 10                                .00                                          .00                                .00
          11. Rental real estate, royalties, partnerships, S corporations,
               trusts, etc. (Attach copy of federal Schedule E)                 11                             .00                                          .00                                .00
          12. Subchapter S corporation distributions (Att. copy of fed. Sch. K-1) 12            NOT APPLICABLE                                              .00                                .00
          13. Farm income or (loss) ( Attach copy of federal Schedule F)        13                             .00                                          .00                                .00
SEND  W-2    14. Unemployment compensation                                      14                             .00                                          .00  NOT TAXABLE
FORMS     15. Social security benefits                                          15                             .00                                          .00  NOT TAXABLE
          16. Other income (Attach statement listing type and amount)           16                             .00                                          .00                                .00
          17.             Total additions (Add lines 2 through 16)              17                             .00                                          .00                                .00
          18.             Total income (Add lines 1 through 16)                 18                             .00                                          .00                                .00
          19.             Total deductions (Subtractions) (Total from page 2, Deductions schedule, line 7)                                                  19                                 .00
          20.             Total income after deductions (Subtract line 19 from line 18)                                                                     20                                 .00
          21. Exemptions             (Enter the total exemptions, from Form BR-1040, page 2, box 1h, on line 21a and multiply 
                                     this number by the value of an exemption and enter on line 21b)                                      21a               21b                                .00
          22.             Total income subject to tax (Subtract line 21b from line 20)                                                                      22                                 .00
          23.          Tax at       (Multiply line 22 by resident or nonresident tax rate for city and enter tax on line 23b, or if using 
                1% or 1/2%           Schedule TC to compute tax, check box 23a and enter tax from Schedule TC, line 23d)                  23a               23b                                .00
               Payments               Big Rapids tax withheld      Other tax payments (est, extension,         Credit for tax paid                Total 
          24. and                                                  cr fwd, partnership & tax option corp)      to another city                    payment
               credits        24a                         .00      24b                          .00   24c                                 .00     s    &    24d                                .00
          25. Interest and penalty for: failure to make                          Interest                             Penalty                     Total  
               estimated tax payments; underpayment of                                                                                            interest 
               estimated tax; or late payment of tax               25a                          .00   25b                                 .00     & penalty 25c                                .00
ENCLOSE                          Amount you owe (Add lines 23b and 25c, and subtract line 24d) MAKE CHECK OR MONEY ORDER                      PAY WITH
CHECK OR  TAX DUE            26. PAYABLE TO: CITY OF BIG RAPIDS
MONEY                                                                                                                                         RETURN        26                                 .00
ORDER     OVERPAYMENT                   27. Tax overpayment (Subtract lines 23b and 25c from line 24d; choose overpayment options on lines 28 - 30)         27                                 .00
               Amount of                Community Pool                     Community Library                                                      Total  
          28. overpayment                                                                                                                         donation
               donated        28a                         .00      28b                          .00                                               s         28d                                .00
          29. Amount of overpayment     to credit forward                                                                     Amount of credit to 2023>>  29                                   .00
          30. Amount of overpayment refunded (Line 27 less lines 28d and 29) (For refund to be directly deposited to 
               your bank account, mark refund box, line 31a, and complete line 31 c, d & e)                                               Refund amount >>  30                                 .00
                                             31a          Refund                 31c    Routing 
               Direct deposit refund                      (direct deposit)              number
          31. (Mark (X) appropriate box                                         31d     Account
               31a and complete lines                                                   number
               31c, 31d and 31e)
                                                                                31e     Account Type:        31e1. Checking                     31e2.  Savings
          MAIL TO:  CITY OF BIG RAPIDS, INCOME TAX DEPARTMENT, 226 NORTH MICHIGAN AVE, BIG RAPIDS, MI, 49307                                                     Revised 1/01/2023

                                                        Taxpayer's name                                                         Taxpayer's SSN
BR-1040, PAGE 2                                                                                                                                                                             22MI-BR-1040-2
CF 1040  PAGE 2                                                                                                                                                                                     c
EXEMPTIONS                                                 Date of birth (mm/dd/yyyy)                                    Regular
                                             1a. You                                                                                                                                        1e. Enter the number of  
SCHEDULE                                                                                                                                                                                             boxes checked on  
                                             1b. Spouse                                                                                                                                              lines 1a and 1b
1d.                     List Dependents      1c.         Check box if you can be claimed as a dependent on another person's tax return
#                                 First Name             Last Name                               Social Security Number         Relationship                      Date of Birth             1f.      Enter number of 
                                                                                                                                                                                                     dependent children 
1.                                                                                                                                                                                                   listed on line 1d 
2.                                                       `
3.                                                                                                                                                                                          1g. Enter number of other 
                                                                                                                                                                                                     dependents listed on  
4.                                                                                                                                                                                                   line 1d 
5.
6.                                                                                                                                                                                          1h. Total exemptions (Add 
                                                                                                                                                                                                     lines 1e, 1f and 1g; 
7.                                                                                                                                                                                                   enter here and also on 
8.                                                                                                                                                                                                   page 1, line 21a)       
EXCLUDED WAGES AND TAX WITHHELD SCHEDULE (See instructions. Resident wages generally not excluded) 
W-2                     Col. A                COLUMN B                   COLUMN C                                 COLUMN D                                                                 COLUMN E               COLUMN F
#                       T or S    SOCIAL SECURITY NUMBER EMPLOYER'S ID NUMBER                                    EXCLUDED WAGES                   FAILURE TO         BR TAX WITHHELD                              LOCALITY NAME
                                  (Form W-2, box a)       (Form W-2, box b)                       (Attach Excluded Wages Sch)                     ATTACH W-2         (Form W-2, box 19)                      (Form W-2, box 20)
 1.                                                                                                                             .00           FORMS TO PAGE                                          .00
 2.                                                                                                                             .00               1 WILL DELAY                                       .00
 3.                                                                                                                                           PROCESSING OF 
                                                                                                                                .00           RETURN.  WAGE                                          .00
 4.                                                                                                                             .00               INFORMATION                                        .00
 5.                                                                                                                             .00               STATEMENTS                                         .00
 6.                                                                                                                                               PRINTED FROM 
                                                                                                                                .00                 TAX                                              .00
 7.                                                                                                                             .00               PREPARATION                                        .00
 8.                                                                                                                             .00               SOFTWARE ARE                                       .00
 9.                                                                                                                                                 NOT 
                                                                                                                                .00               ACCEPTABLE                                         .00
10.                                                                                                                             .00                                                                  .00
11.                     Totals (Enter here and on page 1; part-yr residents on Sch TC)                                          .00 << Enter on pg 1,ln 1, col B                                     .00 << Enter on pg 1, ln 24a
DEDUCTIONS SCHEDULE (See instructions; deductions allocated on the same basis as related income)                                                                                                       DEDUCTIONS
 1.                     IRA deduction  (Attach copy of Schedule 1 of federal return & evidence of payment)                                                                                1                                    .00
 2.                     Self-employed SEP, SIMPLE and qualified plans  (Attach copy of Schedule 1 of federal return)                                                                      2                                    .00
 3.                     Employee business expenses  (Attach copy of BR-2106 and detailed list)                                                                                            3                                    .00
 4.                     Moving expenses  (Into city area only, Military ONLY)  (Attach copy of federal Form 3903)                                                                         4                                    .00
 5.                     Alimony paid  (DO NOT INCLUDE CHILD SUPPORT.  Attach copy of Schedule 1 of federal return)                                                                        5                                    .00
 6.                     Renaissance Zone deduction  (Attach Schedule RZ OF 1040)                                                                                                          6                                    .00
 7.                               Total deductions (Add line 1 through line 6, enter total here and on page 1, line 19)                                                                   7                                    .00
ADDRESS SCHEDULE (Where taxpayer (T), spouse (S) or both (B) resided during year and dates of residency)
MARK                              List all residence (domicile) addresses (Include city, state & zip code). Start with address used on last year's return. If the address on page 1 of this           FROM                   TO
                                  return is the same as listed on last year's return, print "Same." If no return filed last year, list reason. Continue listing this tax year's residence 
T, S, B                           addresses. If address listed on page 1 of this return is in care of another person, enter current residence (domicile) address.                                MONTH       DAY  MONTH        DAY

THIRD PARTY DESIGNEE
Do you want to allow another person to discuss this return with the Income Tax Office?                                           Yes, complete the following       No
Designee's                                                                                                                                    Phone                                       Personal identification 
name                                                                                                                                          No.                                         number (PIN)
                                  Under the penalty of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief it is 
                                  true, correct and complete.  If I am a resident claiming a credit for taxes paid to another city, I acknowledge and consent to the City’s verification of unrefunded payment 
                                  to that city.     If prepared by a person other than taxpayer, the preparer's declaration is based on all information of which preparer has any knowledge.
SIGN                              TAXPAYER'S SIGNATURE - If joint return, both spouses must sign Date (MM/DD/YY)        Taxpayer's occupation                     Daytime phone number                       If deceased, date of death 
HERE 
===>
                                  SPOUSE'S SIGNATURE                                             Date (MM/DD/YY)        Spouse's occupation                                                                  If deceased, date of death 

                                  SIGNATURE OF PREPARER OTHER THAN TAXPAYER                                                                   Date (MM/DD/YY)     PTIN, EIN or SSN
                                                                                                                                                                  Preparer's phone no.
                                  FIRM'S NAME (or yours if self-employed), ADDRESS AND ZIP CODE                                                                                           NACTP  
            PREPARER'S  SIGNATURE                                                                                                                                                         software  
                                                                                                                                                                                          number 
                                                                                                                                                                                                                  Revised 1/01/2023

Taxpayer's name                                                Taxpayer's SSN
                                                                                                                     202 2BIG RAPIDS
WAGES AND EXCLUDIBLE WAGES SCHEDULE - BR-1040, PAGE 1, LINE 1, COLUMN B                                                                                                      Attachment 2-1
All W-2 forms must be attached to page 1 of the return                                                                                                                       Revised 1/01/2023
Use this form to provide details for all Forms W-2 and all other wage income reported on federal Forms 1040 (line 7),1040A (line 7), or 1040EZ (line 1) such as: wages received as a household 
employee for which you did not receive a W-2; tips reported on federal Form 4137; taxable dependent care benefits; employer-provided adoption benefits; scholarship and fellowship grants not 
reported on Form W-2; disability pensions shown on Form 1099-R if the taxpayer has not reached the minimum retirement age set by the employer; corrective distributions from a retirement plan
shown on Form 1099-R from excess salary deferrals and/or excess contributions (plus earnings); wages from Form 8919, line 6; and other wage items not included in a Form W-2.
Use this form to calculate excludible (nontaxable) wages included in total wages reported on your federal tax return (Forms 1040, line 7; 1040A; line 7; or 1040EZ, line 1). Excludible wages for each 
employer are also reported on Form BR-1040, page 2, Excluded Wages and Tax Withheld Schedule and the total amount of excludible wages is reported on Form BR-1040, page 1, line 1, col. B. 
WAGES, ETC.                                         Employer (or source) 1                Employer (or source) 2                                              Employer (or source) 3
1. Employer's ID number (W-2, box b) or 
source's ID Number if available
2. Employer's name (Form W-2, box c) or 
source's name
3. SSN from Form W-2, box a
4. Enter T for taxpayer or S for spouse 
5. Dates of employment during tax year         From         To                       From                            To         From                          To
6. Mark (X) box If you work at multiple 
locations in and out of BIG RAPIDS
7. Address  of  work  station  (Where  you 
actually work, not  address on  Form W-2 
unless  you  work  there:  include  street 
number and  street name, city, state  and 
ZIP code; if line  6  is checked  enter 
primary work location)
8. Wages, tips, other compensation           
(Form W-2, Box 1); report statutory 
employee wages as zero 
9. Wages not included in Form W-2, box 1 
(See instructions)
10. Code for wage type reported on line 9 
NONRESIDENT WAGE ALLOCATION                         Employer (or source) 1                Employer (or source) 2                                              Employer (or source) 3
For use by nonresidents or part-year residents who worked both in and outside of the city for the employer while a nonresident. Part-year residents working both in and outside
while a nonresident must use the wage allocation to determine wages earned in city while a nonresident (use only wages and days worked while a nonresident for computations.)
Nonresidents working all of their work time for an employer in the city should skip this Nonresident Wage Allocation section for that employer as all of their wages are taxable.
11. Enter actual number of days or hours on 
job for employer during period (Do not 
include weekends you did not work)
12. Vacation, holiday and sick days or hours 
included in line 11, only if work performed 
in and outside the city
13. Actual number of days or hours worked 
(Line 11 less line 12)
14. Enter actual number of days or hours 
worked in city
15. Percentage of days or hours 
worked in city (Line 14 divided by                                                 %                                          %                                                                        %
line 13; default is 100%)
16. Wages earned in city (Total of lines 8 and 
9 multiplied by line 15; part-year residents 
use only the portion of wages earned 
while a nonresident) 
EXCLUDIBLE WAGES                                    Employer (or source) 1                Employer (or source) 2                                              Employer (or source) 3
17. Enter nonresident excludible wages (Total 
of lines 8 & 9 less line 16) 
18. Enter resident excludible wages 
19. Enter reason excludible wages reported 
on lines 17 and/or 18 are not taxable by 
BIG RAPIDS
20. Total excludible wages (Line 17 plus line 
18; Enter here and  on  BR-1040, page 2, 
Excluded Wages schedule) 
21. Total taxable wages (Line 8 plus line 9  
less line 20)
22. Total wages (Add lines 8 and 9 for all employers and other sources; must equal 
amount reported on Form BR-1040, page 1, line 1, column A; Part-year residents 
must equal amount reported on Schedule TC, line 1, column A)
23. Total excludible wages from all employers and other sources (Add line 20 for all columns; enter here and also on 
Form BR-1040, page 1, line 1, column B; part-year residents enter here and on Schedule TC, line 1, column B)
24. Total taxable wages from all employers and other sources (Line 22 less line 23); enter here and also on Form BR-1040, page 1, line 1, column C; part-year 
residents enter here and allocate on Schedule TC, line 1, between columns C and D)
FAILURE TO ATTACH ALL FORMS W-2 OR PROPERLY COMPLETE AND ATTACH THIS SCHEDULE WILL DELAY PROCESSING OF RETURN.