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F-1040                          INDIVIDUALFLINTRETURN DUE APRIL 30,2023                          2022                                                                22MI-FLT1
Taxpayer's SSN                       Taxpayer's first name                          Initial Last name                                     RESIDENCE STATUS
                                                                                                                                                                                           Part-year
                                                                                                                                                  [D] Resident E   Nonresident [O resident
Spouse's SSN                         If joint return spouse's first name            Initial Last name                                             Part-year resident - dates of residency (mm/dd/yyyy)
                                                                                                                                          From        I 
Mark (X) box if deceased             Present home address (Number and street)                                           Apt. no.          To          I 
Taxpayer                Spouse                                                                                       I                    FILING STATUS
n                                    Address line 2 (P.O. Box address for mailing use only)                                                       [[i_] Single [[i_] Married filing jointly
Enter date of death on page 2, right 
side of signature area.                                                                                                                               Married filing separately. Enter spouse's  
                                     City, town or post office                                        State Zip code                              [J SSN in Spouse's SSN box and Spouse's full  
Mark (X) below if form attached                                                                                                                       name here.
Federal Form 1310                    Foreign country name                  Foreign province/county          Foreign postal code
□ Supporting Notes and                                                                                                                            Spouse's full name if married filing separately
n Statements (attachment 22)                                              I 
                                 ROUND ALL FIGURES TO NEAREST DOLLAR                                     Column A                         Column B                   Column C
            INCOME                      (Drop amounts under $0.50 and increase                   Federal Return Data                    Exclusions/Adjustments       Taxable Income
                                        amounts from $.50 to $0.99 to next dollar)
           1.  Wages, salaries, tips, etc. ( W-2 forms must be attached)                    1                        .00                                       .00                               .00
ATTACH
COPY OF    2.  Taxable interest                                                             2                        .00                                       .00                               .00
PAGE 1 OF  3.  Ordinary dividends                                                           3                        .00                                       .00                               .00
FEDERAL
RETURN     4.  Taxable refunds, credits or offsets of state and local income taxes          4                        .00                                       .00   NOT TAXABLE
           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                                             .00                                       .00                               .00
                                                      fli 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
ATTACH     13. Farm income or (loss)  (Attach copy of federal Schedule F)                   13                       .00                                       .00                               .00
W-2        14. Unemployment compensation                                                    14                       .00                                       .00   NOT TAXABLE
FORMS      15. Social security benefits                                                     15                       .00                                       .00   NOT TAXABLE
HERE
           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 F-1040, page 2, box 1h, in line 21a and multiply this 
                                     number by $600 and enter on line 21b)                                                                21a                  21b                               .00
                                                                                                                                                  17 
           22.          Total income subject to tax (Subtract line 21b from line 20)                                                                           22                                .00
                                     (Multiply line 22 by Flint resident tax rate of 1.% (0.01) or nonresident tax rate of 0.5% (0.005) 
           23. Tax at {tax rate}     and enter tax on line 23b, or if using Schedule TC to compute tax, check box 23a and enter tax 
                                     from Schedule TC, line 23d)                                                                          23a                  23b                               .00
               Payments              Flint tax withheld            Other tax payments (est, extension,            Credit for tax paid             rnTotal  
           24. and                                                 cr fwd, partnership & tax option corp)         to another city                   payments 
               Credits     24a I                         .00 I 24b I                             .00 I      24c I                         .00 I     & credits  24d                               .00
               Interest and penalty for: failure to make                              Interest                           Penalty                    Total
           25. estimated tax payments; underpayment of                                                                                              interest & 
               estimated tax; or late payment of tax               25a I                         .00  I     25b I                         .00     I penalty    25c                               .00
ENCLOSE                         Amount you owe (Add lines 23b and 25c, and subtract line 24)                                                      PAY WITH
CHECK OR   TAX DUE       26. MAKE CHECK OR MONEY ORDER PAYABLE TO: CITY OF FLINT                                                                  RETURN       26                                .00
MONEY                           IF PAID ON LINE CREDITCARD/ELECTRONIC CHECK ENTER CONFIRMATION #                     I                    I 
ORDER      OVERPAYMENT                  27. Tax overpayment (Subtract lines 23b and 25c from line 24d; choose overpayment options on lines 28 - 30)            27                                .00
               Amount of                Flint Indigent Water Fund
           28. overpayment                                                                                                                          Total
               donated     28a I                         .00     I 28b I                              I     28c I                                 I donations 28d                                .00
           29. Amount of overpayment credited forward to 2022                                                                     Amount of credit to 2022 >>  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
               Direct deposit refund                     (direct deposit)           31c Routing
                                                                                        number
           31. (Mark (X) box 31a and            31b      Not available              31d Account
               complete lines 31c, 31d                                                  number
               and 31e)                                                             31e Account Type:    II I  Checking      II         I  Savings
                                                                                                                                                                      Revised: 1/1/2022
           MAIL ALL RETURNS TO: FLINT--INCOME TAX DEPARTMENT, PO BOX529 EATON RAPIDS,                                , MI  48827 0529   -

                                          Taxpayer's name                                                                          Taxpayer's SSN
F-1040, PAGE 2                                                                                                                                                                    22MI-FLT2
                                          I                                                                                        I 
EXEMPTIONS                                     Date of birth (mm/dd/yyyy)                              Regular  65 or over         Blind      Deaf      Disabled
SCHEDULE               1a. You                                                                                                                                   1e. Enterboxesthecheckednumberonof
                       1b. Spouse         I                                           I               B        B B                            B           B               lines 1a and 1b
1d. List Dependents    1c.        rr  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       FLINT 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
                                                                                                                                       PROCESSING OF 
 3.                                                                                                                  .00               RETURN. WAGE                           .00
 4.                                                                                                                  .00               INFORMATION                            .00
 5.                                                                                                                  .00                 STATEMENTS                           .00
                                                                                                                                       PRINTED FROM 
 6.                                                                                                                  .00                      TAX                             .00
 7.                                                                                                                  .00               PREPARATION                            .00
 8.                                                                                                                  .00               SOFTWARE ARE                           .00
                                                                                                                                              NOT 
 9.                                                                                                                  .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  (See instructions and attach copy of federal Form 2106)                                                                                   3                              .00
 4. Moving expenses  (Into Flint area 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                  ADDRESS (INCLUDE CITY, STATE & ZIP CODE) Start with address used on last year's return. If the address is the same as                                  FROM                  TO
T, S, B                listed on page 1 of this return, print "Same." If no return filed, list reason. Continue listing residence addresses from this year.               MONTH   DAY              MONTH DAY

THIRD PARTY DESIGNEE
Do you want to allow another person to discuss this return with the Income Tax Office?                       r 1  Yes, complete the following     17 1  No
Designee's                                                                                                                         Phone                         Personal identification 
name                                                                                                                               No.                           number (PIN)
                                                                                                                                 I                          I                            I 
                       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 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                                               I                             NACTP
  PREPARER'S SIGNATURE                                                                                                                                           software                        FLT22
                                                                                                                                                            I number
                                                                                                                                                                                         Revised: 1/1/2022