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REFER TO INSTRUCTIONS ON BACK TO SEE WHO CAN USE THIS FORM
ATTACH A COPY OF THE FRONT OF FEDERAL 1040 FORM
BR 1040EZ
INDIVIDUAL RETURN 2017 DUE DATE: April 30, 2018
A. First Name and Initial Last Name Your Social Security Number B. RESIDENCY
RESIDENT
(Inside City Limits)
If Joint First Name of Spouse Spouse’s Social Security Number NON-RESIDENT
TOWNSHIP OF
BIG RAPIDS
Present Home Address COLFAX GREEN
BARTON GRANT
City, State, Zip HOME NORWICH
OTHER (Please specify)
C. FILING STATUS D. EXEMPTIONS
A. Single D. Name of Deceased: Number x $600.00 = $
B. Married, Filing Jointly If you are claimed as a dependent on someone else’s Big Rapids return, check this box and do not
C. Married, Filing Separately take the exemption.
Spouse’s Name If you are a FSU student with permanent home other than Big Rapids, check
Social Security Number this box and claim yourself.
1. Total Wages, Salaries, and Tips 1. 00
2. Interest and/or Dividends Income 2. 00
PLACE ADDITIONAL FORMS BEHIND AND STAPLE
3. Exemptions (from D above)
(If you are a student and your parents do not file a City of Big Rapids return, check this box and claim yourself) 3. 00
4. Taxable Income (Line 1 + Line 2 –Line 3) 4. 00
2’s & 1099’s HERE 5. Tax (Multiply amount on Line 4 by one of the following)
A: RESIDENT 1% (.01)
B: NON-RESIDENT ½% (.005) 5. 00
6. Voluntary Contribution to BIG RAPIDS COMMUNITY POOL and/or COMMUNITY LIBRARY (Please circle) 6. 00
7. Total of Lines 5 and 6 7. 00
STAPLE COPY OF W-
8. Tax Withheld 00 OFFICE USE ONLY
2017 Estimated Payments 00
Credit from previous year over payment 00
Total Payments and Credits 00
9. Tax Due (Line 7 minus Line 8) 9. 00
DO NOT STAPLE
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10. Penalty and Interest 10. 00
11. Balance Due 11. 00
12. Overpayment / Amount of Refund (Line 8 minus Line 7) 12. 00
I declare, under penalty of perjury, that the information on this return and attachments is true and complete.
ENCLOSE CHECK I authorize the City to discuss my claim and attachments with my DO NOT discuss my claim I declare, under penalty of perjury, that this return is based on
preparer with my preparer all information of which I have knowledge.
PREPARER’S SIGNATURE & ADDRESS
Filer’s Signature Date
Birthday
SIGN HERE Spouse’s Signature Date
Birthday PHONE ( ) -
Mail Your Return to: City of Big Rapids, Income Tax Processing Center, PO Box 536, Eaton Rapids, MI 48827-0536
Make Your Check or Money Order Payable to: CITY OF BIG RAPIDS
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