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City of Highland Park                      2020 HIGHLAND PARK
Income Tax Department                      INDIVIDUAL INCOME TAX
P.O. Box 239
Eaton Rapids, MI 48827-0239           FORMS AND INSTRUCTIONS
                                           For use by individual residents,
Form HP-1040                          part-year residents and nonresidents

                                           – IF LABEL APPEARS BELOW

IMPORTANT

PLEASE PEEL OFF LABEL AND
AFFIX TO AREA DESIGNATED
ON INCOME TAX RETURN.

CITY OF HIGHLAND PARK INCOME TAX                                                                                   2020

ALL PERSONS HAVING HIGHLAND PARK TAXABLE INCOME IN 2020 MUST FILE A RETURN
                                      TAX RETURNS ARE DUE APRIL 30, 2021

                                           MAILING ADDRESS
            BALANCE DUE RETURNS                                            ALL OTHER RETURNS
            City of Highland Park 1040 Payments                            City of Highland Park
            P.O. Box 239                                                   P.O. Box 239
            Eaton Rapids, MI   48827                                       Eaton Rapids, MI   48827

TAX RATES             Resident: 2%
                      Nonresident: 1%
EXEMPTIONS            Exemption value: $600

                      Tax must be paid at the time you file your return if you owe $1.00 or more.
PAYMENT
OF TAX DUE            NOTE: If you are paying $100.00 or more with your 2020 return, you may need to make estimated income tax
                      payments for 2021. See page 2 for instructions.
                      Make check or money order payable to: CITY OF HIGHLAND PARK

YOUR RETURN           Tax returns are due April 30, 2021
                      Forms are available online at www.highlandparkmi.gov.

                      For assistance contact the Highland Park Income Tax Department at 3401 Evaline Ave, Hamtramck, Michigan or call
CONTACT US            (313) 603-3118.

                      Failure to attach documentation or attaching incorrect or incomplete documentation will delay
                      processing of the return or result in corrections being made to the return.



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                                                                        Page 2 of 6 
                                                                                         Indicate your residency status by marking (X) the proper box.
                                                                                                                             RESIDENCY STATUS 
                                                Schedule TC to the return.                                      Mark the box to indicate your filing status. 
Schedule TC to compute your tax, mark (X) line 23a and attach                                         an attachment that states your actual residence.
 is  %.) If you were a resident for only part of  the  year  and  used 1       PO Box, or an address that is not your legal residence, you must add 
 enter it on line 23b. (The resident tax rate is 2%. The nonresident rate       address under Present home address. If using a current       Enter your  
Multiply line 22 by the appropriate tax rate to compute tax liability, and                                                             line of return. 
                                                              ine 23 – Tax L   signature area; and enter the date of death in the box on the signature 
       Subtract line 21b from line 20. If line 21b is greater, enter zero.     1310 or a copy of the death certificate; write deceased  in  the 
                              ine 22 – Total Income Subject to Tax L             If the taxpayer or spouse is deceased: attach a copy of federal Form  
                                                       product on line 21b.                Enter your name and, if a joint return, your spouse’s name. 
line  1h)  on  line  21a and multiply line 21a by $600.00 and enter the                                                      attached to your return.
Enter  the  total  number  of  exemptions (page 2, Exemptions schedule,        social security number must agree with the SSN on the Form(s) W-2 
                                                     ine 21 – Exemptions L      Your Always write your social security number(s) on the return.   
                                                 18. from lineSubtract line 19                       NAME, ADDRESS, SOCIAL SECURITY NUMBER 
                              Line 20 Total Income after Deductions –                                         COMPLETING YOUR RETURN 
 Enter the total deductions from line 7 of Deductions schedule, page 2.                                                        and the Ordinance. 
                                                ine 19 – Total DeductionsL     Ordinance will prevail in any disagreement between these instructions 
                                                     Add lines 1 through 17.   Ordinance, MCLA 141.601 et seq.  The  Highland  Park  Income  Tax 
                                                  Line 18 – Total Income       These instructions are interpretations of the Uniform City Income Tax 
                                                     Add lines 2 through 16.                                                           DISCLAIMER 
                                                ine 17 – Total Additions L                 minimum combined charge for interest and penalty is $2.00.
                                         Support figures with schedules.       interest at the rate of 1% above the prime rate on an annual basis. The 
Subtract  column B from column A and enter difference in column C.             penalty of 1% per month, not to exceed a total penalty of 25%, and bear 
                   ines 1 - 16, Column C – Figure Taxable Income L             All tax payments remaining unpaid after they are due are liable  to  a 
                             adjustments or deductions being disallowed.                                         CHARGES FOR LATE PAYMENTS 
delay  processing  of  your  return or  result in tax withheld, exclusions,                 ., MI  48827-0239Income Tax, P.O.,Box 239  Eaton Rapids
Failure  to attach or attaching incomplete supporting information will         change must be explained. Mail amended  returns  to:  Highland  Park 
tax withheld, exclusions, adjustments or deductions must be provided.          schedules supporting the changes should accompany the filing. Every 
NOTE: Schedules, attachments and other  documentation  that  support           original return when totaling amended return payments and credits. All 
       ines 1 – 16, Columns A & B – Federal Data and Exclusions L              schedule, line 4; Include the tax paid  and  subtract  refunds  from  the 
                                      Round all figures to the nearest dollar. refunds received to the left of the box on page 2, Payments and Credits 
                       TOTAL INCOME AND TAX COMPUTATION                        paid or refunds received from the original return. Write in the tax paid or 
                                                                               the change and pay the tax due. An adjustment must be made for tax 
                FORM HP-1040, PAGE 1, INSTRUCTIONS                             Park taxable income, you must file an amended return within 90 days of 
       self employment tax, and penalty for early withdrawal of savings.       the top of the return. If a change on your federal return affects Highland 
MSA deduction, self-employed health insurance deduction, one-half or            at AMENDED File amended returns using the HP-1040 Clearly mark 
deductible  on  the  Highland  Park  return: student loan interest, Archer                                                   AMENDED RETURNS 
losses, etc. In addition, the following federal adjustments  are  not                          the failure to pay on time was due to reasonable cause. 
interest, medical expenses, charitable contributions, casualty and theft       understated by more than 5% of tax or the corporation can show that 
  allow  deductions for items such as taxes, not Highland Park does            Income Tax Administrator if the tax paid by the original due date is not 
 ITEMS NOT DEDUCTIBLE ON THE HIGHLAND PARK TAX RETURN                          extension  of  time  to  file  is granted. Penalty may be waived by the 
                                        7.  City, state and federal refunds.   notified. Interest and penalty is charged on taxes paid late even if an 
 (Michigan lottery prizes won after December 30, 1988 are taxable.)            assumed that the extension is automatically granted  unless  otherwise 
6.  Michigan Lottery prizes won on or before December 30,  1988.               When an extension form is filed and the balance due is paid, it may be 
                       including Reserve and National Guard       pay.                                                                            due. 
5.  Military pay of members of the armed forces of the  United  States,         An extension does not extend the time for paying the tax payments.
                       the sales of obligations of the United States.          extension with payment is not a substitute for making  estimated  tax 
subordinate units of government of the states and gains or losses on           made and the tentative tax due must be paid (MCL 141.664). Filing an 
4.  Interest  from  obligations of the United States, the states or            filing a Highland Park extension. Application for an extension must be 
                                                unemployment benefits.         Applying  for  a  federal  extension  does not satisfy the requirement for 
3.  Welfare  relief, unemployment compensation and supplemental                Automatic Extension of Time to File an Individual Income Tax Return. 
         are taxed the same as under the Internal Revenue Code).               months. To apply for an extension, file Form HP-4868, Application for 
(Payments from a health and accident policy  paid  by  an  employer            income tax return may be extended for a period not to  exceed  six 
2.  Proceeds  of  insurance  where  the taxpayer paid policy premiums.         Returns are due on or before April 30, 2021. The due date of the annual 
                                                after reaching age 59½.                                               DUE DATE AND EXTENSIONS 
pensions), Individual Retirement Account (IRA) distributions received 
1  Social security, pensions and  annuities  (including  disability                                           the year, you still must file a tax return. 
             Highland Park does not tax the following types of income:         If you have made estimated tax payments and do not owe more tax for 
          INCOME EXEMPT FROM HIGHLAND PARK INCOME TAX                               of estimated tax will result in assessment of penalty and interest. 
             box and enter the spouse’s full name in the filing status box.    Failure to make required estimated tax payments or underpayment 
separately, enter spouse’s Social Security number in the spouse’s SSN                payments if your income increases or decreases during the year. 
Indicate  filing  status  by  marking  (X) the proper box. If married filing   and  January  31  of the following year. Adjust the remaining quarterly 
                                                       FILING STATUS           in three equal payments on June 30 and September 30 of the tax year 
                                                                               one-fourth (¼) of the estimated tax. The remaining estimated tax is due 
                                                        compute the tax.       the Highland Park website) by April 30 of the tax year and pay at least 
separate  returns  or file a resident return using Form HP-1040TC to           quarterly estimated tax payments. File Form HP-1040ES (available on 
and had a different residency status from  that  of  your  spouse,  file       plus  other  credits by $100 or more, you may be required to make 
If you were married in 2020 Married with Different Residency Status.           When your total income tax is greater than the amount of tax withheld 
 use form HP-1040TC to calculate the tax and attach it to the HP-1040.                                                ESTIMATED TAX PAYMENTS 
Highland Park or vice versa. If you were a resident for only part of 2020,                      withholding Highland Park tax from your 2021 wages. 
residence) during the year from one inside Highland Park to one outside        to make estimated income tax payments if you work for an employer not 
a  person  who changed their domicile (primary       Part-Year  Resident  –     You will be required withhold Highland Park tax from your paycheck.
                                        were a nonresident the entire year.    to  file  a  tax  return  and pay tax even if your employer did not 
outside the City of Highland Park all year. File as a nonresident if you       You are required more information on your allowable exemption total. 
a person whose domicile (principle residence) was       Nonresident  –         even if you did not file a federal tax return. See Exemptions schedule for 
                                                              the entire year. personal  and  dependency  exemptions,  you  must  file  a  tax  return  — 
City of Highland Park all year. File as a resident if you were a resident      If you had Highland Park taxable income greater than the total of your 
a person whose domicile (principle residence) was in the        Resident  –                                           WHO MUST FILE A RETURN 
 2020 HIGHLAND PARK FORM HP-1040 INSTRUCTIONS FOR RESIDENTS, NONRESIDENTS AND PART-YEAR RESIDENTS                                                            



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 2020 HIGHLAND PARK FORM HP-1040 INSTRUCTIONS FOR RESIDENTS, NONRESIDENTS AND PART-YEAR RESIDENTS
 
Line 24 – Total Payments and Credits                                         Line 3 – Employee Business Expenses 
Enter the line 4 total from the Payments and Credits schedule on page        Employee business expenses are deductible only when incurred in the 
2. You must file the return even if there is no tax due or overpayment.      performance of service for an employer and only to  the  extent  not 
Line 25 – Estimated Tax or Late Payment Interest and Penalty                 reimbursed  by  the employer. Meal  expenses are not subject to the 
Nonpayment or underpayment of estimated income tax and  late                 reductions and limitations of the  Internal Revenue  Code.  Under  the 
payment of tax is subject to penalty and interest. You may calculate the     Highland Park Income Tax Ordinance meals must be incurred  while 
amounts and enter penalty on line 25a, interest on 25b, and the total        away from home overnight on business. 
interest and penalty on line 25c or the city may calculate and assess it.    BUSINESS EXPENSES ARE LIMITED TO THE FOLLOWING: 
Calculate estimated tax interest and penalty using Form 1040ES.                     A. Expenses of transportation, but not to and from work. 
TAX DUE OR REFUND                                                                   B. Expenses  of  travel, meals  and lodging while away from home 
                                                                                     overnight on business for an employer. 
Line 26 – Tax Due and Payment of Tax                                                C. Expenses  incurred  as  an  “outside  salesperson”  away  from  the 
If the tax on line 23b plus the interest and penalty on line 25c exceeds             employer's place of business. This does not  include  driver-
the total Payments and Credits on line 24, enter the difference, the tax             salesperson whose primary duty is service and delivery. 
due, on line 26. The tax due must be paid with the return when filed.               D. Expenses  reimbursed  by  employer from an expense  account  or 
The due date for the return is April 30, 2021.                                       other arrangement if included in gross earnings. 
Pay  by  Check  or  Money  Order.     Make the check or money order          NOTE: Business expenses claimed on line 4 of fed. Form 2106 are 
payable to the CITY OF HIGHLAND PARK, place the check or money               not allowed unless taxpayer qualifies as an outside salesperson. 
order in front of page 1 of the tax form and  mail  the  return  with  the   Attach a copy of Form HP-2106, federal Form 2106 or a list of your 
payment  to:  Highland  Park  Income  Tax,  P.O. Box 239, Eaton Rapids,      employee business expenses. 
MI 48827-0239. Do not send cash for your tax payment. The tax is due 
at the time of filing the return.                                            Line 4 – Moving Expenses 
Line 27 – Overpayment                                                        Moving expenses for moving into the Highland Park area are deductible 
If the total payments and credits on line 24 exceed the tax on line 23       to the same extent deductible under the Internal Revenue Code. Moving 
plus  the  interest  and  penalty on  line 25c, enter the difference, the    must  be related to starting work in a new location. Attach  a  copy  of 
overpayment, on line 27. Use lines 28 through 31 to indicate what you        federal Form 3903 or a list of moving expenses, with the distance 
want done with the refund. You must file the return even if there is no      in miles from where you moved. 
tax due, no overpayment or only a slight overpayment.                        Line 5 – Alimony Paid 
                                                                             Separate maintenance payments, alimony, and principal sums payable 
Line 29 – Credit Forward                                                     in  installments  (to  the  extent  includable in the spouse's or former 
Enter on line 29 the amount of overpayment to credit to the next year.       spouse’s  adjusted  gross  income  under  the  federal  Internal  Revenue 
Line 30 – Refund                                                             Code) and deducted on the federal return are deductible. Child support 
Enter on Line 30 the amount of the overpayment to be refunded. Your          is not deductible. Attach first 2 pages of federal return. 
refund will be issued as a paper check.                                      NOTE: The above deductions are limited to the amount claimed on 
Please allow 45 DAYS before calling about a refund.                          your  federal  return,  except  meals.  The  deductions  are  limited  by 
FORM HP-1040, PAGE 2 INSTRUCTIONS                                            the  extent  they  apply  to  income  taxable  under  the  Highland  Park 
                                                                             Income  Tax  Ordinance.  Part-year  residents  must  allocate 
EXEMPTIONS SCHEDULE                                                          deductions the same way they allocate income. 
Complete the Exceptions schedule to report and claim the  total              Line 6 – Renaissance Zone 
exemptions amount allowed. Everyone who files a Highland Park return         The Renaissance Zone deduction may be claimed by: a qualified 
gets  a  personal  exemption of $600 for 2020.  You  may  claim  an          resident  domiciled  in  a  Renaissance  Zone; an individual with income 
exemption  even  if  someone  else  claims  you  as  a  dependent  on        from rental real estate located in a Renaissance Zone; and an individual 
their return.                                                                proprietor or a partner in a partnership that has business activity within a 
Lines 1a - 1c – You and Spouse.        Enter your date of birth and mark (X) Renaissance  Zone.  Individuals  who qualify for the deduction       must 
the exemption boxes that apply to you. If filing jointly, complete line 1b   attach Schedule RZ of HP-1040 to their return to claim the deduction. 
for spouse. If you are age sixty-five or older or you are blind, you get an  Residents are not qualified to claim the deduction until they have been 
additional exemption. Mark (X) the boxes that apply, and enter on line       domiciled in a Renaissance Zone for 183 consecutive days. Individuals 
1e the total number of exemption boxes marked.                               are  not qualified to claim the Renaissance Zone deduction if they are 
Lines 1d – Dependents. Determine dependents using the same rules             delinquent  for any Michigan or Highland Park taxes. A Highland Park 
as on the federal return. If you cannot claim a dependent on the federal     income tax return must be filed to qualify and claim this deduction. 
return, you cannot claim them on a Highland Park return.  Enter  the         Line 7 – Total Deductions 
names of your dependent children that live with you, then the names of       Add lines 1 through 6. Enter the total on line 7 and on page 1, line 19. 
other  dependents  and  their  relationship  to  you.  Provide  dependents’ 
Social Security numbers and dates of birth. Enter totals on 1f and 1g.       PAYMENTS AND CREDITS SCHEDULE 
Lines 1e - 1h – Total Exemptions.      Add the amounts on 1e, 1f and 1g,     Line 1 – Highland Park Tax Withheld by Employers 
and enter the total exemptions on line 1h and on page 1, line 21a.           The  city  tax  withheld  by  each of your employers is to be reported on 
                                                                             Lines  7 through 10 of the Wages,  Excludible Wages and City Tax 
EXCLUDED WAGES SCHEDULE                                                      Withheld schedule. Total Highland Park  tax withheld,  line  17  of  this 
If any wages reported on page 1, line 1, column A, are not taxable, the      schedule, is reported on Form HP-1040, page 2. Payments and Credit 
Excluded  Wages  schedule  must be completed. The data to complete           schedule,  line 1. The Form W-2 (Wages and Tax Statement) you 
this schedule comes from the Wages, Excludible Wages and City Tax            received from each of your employers shows the tax withheld in box 19 
Withheld schedule.                                                           and the locality name in box 20. 
DEDUCTIONS SCHEDULE                                                          You must attach a copy of W-2 form(s) showing the entire amount 
You may deduct amounts that directly relate to income that is taxable by     of  HIGHLAND  PARK  tax  withheld  and  Highland  Park  (or  an 
Highland  Park, prorating where  necessary.  Allowable  deductions           abbreviated form of Highland Park) as the locality name. We will not 
include the following line number items:                                     allow the credit for Highland Park tax withheld without W-2 Forms. 
Line 1 – Individual Retirement Account (IRA) Contributions                   Line 2 – Tax Payments Other Than Tax Withheld 
Contributions  to  an IRA are deductible to the same extent deductible       On line 2, enter the total of the following: estimated tax paid, tax paid 
under the Internal Revenue Code. Attach first 2 pages of federal return      with an extension, tax paid paid by a partnership and credit forward from 
and evidence of contribution,  which includes, but is not limited to, one    past tax year. 
of the following: a copy of receipt for IRA contribution, a copy of federal  Line 3 – Tax Credit for Tax Paid (Residents only) 
Form 5498, a copy of a cancelled check that clearly indicates it is for an   Enter on line 3 the credit for income taxes paid to the other city. If you 
IRA contribution. ROTH IRA contributions are not deductible.                 had income subject to tax in another city while you were a      resident of 
Line 2 – Self-Employed SEP, SIMPLE and Qualified Plans                       Highland  Park,  you  may  credit  this credit. The  credit is  1% 
Self-employed SEP, SIMPLE and qualified retirement plan deductions           of the taxable  income.  This credit  must  be  based  on  income
may be entered on page 2, Deductions schedule, line 2.                       taxable by both cities, and the credit may not exceed the tax that  a
                                                                             nonresident of Highland Park would  pay on  the same  income  earned
                                                                             in Highland Park.  You must attach a copy of the income tax return
                                                                             filed with the other city  to receive this credit.
                                                                              
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                                                                           Page 4 of 6 
                                                                                                                                                                  
                                                                                   ode regarding capital gains. All capital gains realized while a resident  C
                                                                                   The Uniform City Income Tax Ordinance follows the Internal Revenue 
  esident  (Form  1099-R,  box  7,  Distribution  Code,  G)  unless  the r                                                 Line 7 – Capital Gain or (Loss) 
 The  conversion  of  a  traditional  IRA  to  a  ROTH  IRA  is  taxable  to  a                                       educted on a Highland Park return. d
                                      document excluded IRA distributions.         Federal rules concerning passive losses are applicable to  losses          C. 
  xclusions  and  Adjustments  to  IRA  Distributions  schedule  is  used  to E    Attach a complete copy of federal Schedule       from the federal return. 
 (2)(A)(iv)  of  the  IRC  and  all  other  excludible  IRA  distributions.  The   s located. Report on line 6, columns A and C, the total business income i
 IRA distributions received after age 59½ or described by Section 72(t)            ll self-employment income is taxable regardless of where the business A
 Exclude in column B, IRA distributions qualifying as retirement benefits:                                                          Line 6 – Business Income 
                                            taxable.distribution code 4) are                  mount of alimony received as reported on the federal return. a
  eneficiary  other  than  the  decedent’s  spouse  (Form  1099-R,  box  7, b      Alimony  received  is  taxable.  Report  on  line  5,  columns  A  and  C,  the 
 istribution  code  1)  and  IRA  distributions  made  to  a  decedent’s d                                                        Line 5 – Alimony Received
  or  Form  1040A.  Premature  IRA  distributions  (Form  1099-R,  box  7,                              NOT TAXABLE. Exclude all. No explanation needed. 
 In column A enter the IRA distributions reported on federal Form 1040                                      Line 4 – Taxable Refunds, Credits or Offsets
                                                Line 9 – IRA Distributions               excluded dividends on the Excludible Dividend Income schedule.  
                       losses reported on your federal income tax return.          nd  tax  option  corporations  (S  corporations,  etc.).  Document  the a
 schedule  to  compute  exclusions  and  adjustments  to  other  gains  and        excludible  dividends  from  U.S.  Bonds,  Treasury  Bills,  Treasury  notes 
 se  the  Exclusions  and  Adjustments  to  Other  Gains  or  (Losses) U           dividend  income  from  the  federal  return.  Report  on  line  3,  column  B, 
                                                     federal Form 4797.            Dividends are taxable. Report on line 3, column A, the total amount of 
 must  attach  a  copy  of    Residents  reporting  other  gains  and  losses                                                              ine 3 – Dividends L
                                                                                                                  on the Excludible Interest Income schedule.
                                             Form 6252 and/or Form 8824.           Excludible  Interest  Income  schedule.  Document  the  excluded  interest 
 must  be  supported  by              attaching  a  copy Deferred of  federalgains Treasury  Bills  and  notes;  document  this  excluded  interest  on  the 
  taxable  in  the  year  recognized  on  the  federal  income  tax  return.       2, column A. Report on line 2, column B, interest from U.S. Bonds and 
 Deferred other gains from installment sales and like-kind exchanges are           Report the amount of taxable interest income from federal 1040, on line 
                                      Highland Park Income Tax Ordinance. 
 the  gain  or  loss  on  property  purchased  prior  to  the  inception  of  the                                                                        Etc.). . 
 axable regardless of where the property is located, except the portion of t       through  interest  income  from  a  tax  option  corporation  (S  corporation, 
 the federal 1040. Other gains and losses realized while a resident are            interest  from  U.S.  Bonds,  Treasury  Bills,  Treasury  notes  and  flow 
 Other gains or losses are taxable to the extent that they are taxable on          Interest is taxable to the same extent on the federal return except for 
                                      Line 8 – Other Gains or (Losses)                                                                          ine 2 – Interest L
                                                                                                                                                   military pay. 
  the Exclusions and Adjustments to Capital Gains or (Losses) schedule.            excludible.  An  example  of  excludible  (nontaxable)  resident  wages  is 
 Excluded capital gains must be explained by completing and attaching              schedule on Form 1040, page 2. A resident’s wages are generally not 
                                                    federal Schedule D.             listed by employer on the Excluded Wages andTax Withheld schedule 
 must  attach  a  copy  of    Residents  reporting  capital  gains  or  losses     wages must be documented on the Wages, Excludible Wages, and City 
                       Attach copies of federal Sch. K-1 (Form 1120S).             All nontaxable    Report  on  line  1,  column  B,  the  total  excluded  wages.
                              S-Corp  cannot  be  transferred  to  HP-1040.              .you employer does not withhold Highland Park tax for you in 2021
  is  income.  Losses  on  an D  or  form  4797 Sch reported  on  federal          You  will  also  be  required to make estimated tax payments if      tax rate. 
  corporation)Flow  through  income  from  a  tax  option  corporation  (S         you are still required to file and pay tax on those wages at the resident 
                                                federal income tax return.         If your employer did not withhold Highland Park tax from your paycheck, 
 exchanges  are  taxable  in  the  same  year  reported  on  the  taxpayer’s                             York City: 100% of this compensation is taxable. 
 Deferred  capital  gain  income  from  installment  sales  and  like-kind         Highland  Park  and  receives  a  paycheck  from the  home office  in  New 
                                                federal income tax purposes.       Example:  Taxpayer  lives  in  the  City  of  Highland  Park  but  works  in 
 carryover  for  Highland  Park  may  be  different  than  the  carryover  for      no  matter  where  earned.compensation  for  services  rendered—
 capital losses may be carried over to future tax years. The capital loss          separation,  and  incentive  payments,  tips, commissions and other 
  the Internal Revenue Code and limited to $3,000 per year. Unused net              earnings, including salary,  bonus, ALL         A resident is taxed on 
  Capital losses are allowed to the same extent they are allowed under                                                                                  1040EZ. 
                       a resident of Highland Park are not deductible.             reported  on  your  federal  tax  return,  Form  1040,  Form  1040A  or Form 
 3.  Capital loss carryovers that originated prior to the taxpayer becoming        reported on Form HP-1040, page 1, line 1, column A, and the wages 
                       attributed to the time before inception ordinance.          total  wages  from  line  15  of  this  schedule  should  equal  the  wages 
 the  inception  of  the  Highland  Park  income  tax  ordinance  that  is         schedule  to  report  all  wages,  excludible  wages  and  tax  withheld.  The 
 2.  The portion of the capital gain or loss on property purchased prior to        Complete  the  Wages,  Excludible  Wages  and  City  Tax  Withheld 
                                      subordinate units of government.                       Park tax withheld must be attached to page 1 of the return. 
 1.  Capital  gains  on  sales  of  obligations  of  the  United  States  and      resident  tax  returns.  All  W-2  forms  showing  wages  and Highland 
                                                     following exceptions:           of  the  federal  tax  return  must  be  attached  to  all The  first  2  pages
 are  taxable  regardless  of  where  the  property  is  located,  with  the                                          Line 1 – Wages, Salaries, Tips, Etc.
                                                                               
                                                              RESIDENT            INSTRUCTIONS
                                                                                                                                                                  
                       of move in/move out to support adjusted income.             income.  Adjustments  and  deductions  must  be  allocated  in  the  same  
      . You must attach copies of proof mailed to you call (313) 603-3118          Income is allocated according to the residency status for each item of 
  To have a form Highland Park website: www.highlandparkmi.gov.                               Complete the form using the instructions on the Schedule TC. 
  Schedule TC and other Highland Park tax forms are available on the               the amount of their tax on Schedule TC, which has multiple tax rates. 
                                      residents as a guide to allocate income.     year, you must file as a part-year resident. Part-year residents compute 
 way  income  is  allocated.  Use  the  instructions  for  residents  and  non-     as a nonresident during the If you had income taxable as a resident and
                                                      PART-YEAR RESIDENT            INSTRUCTIONS                                                                  
                                                                                                                                                                  
                                                                                            and enter the beginning and ending dates of residence at each. 
          must sign it and provide their address and telephone number.             whether  the  address  was  for  the  taxpayer (T), spouse (S) or both (B) 
  must sign and date the return. If someone else prepared the return, they         other  principal  residences  (domiciles)  occupied  during  2020.  Mark 
 You must sign and date the return. If filing a joint return, both spouses         none was filed. Complete the schedule by listing the addresses of the 
                                                    SIGN THE RETURN                on  page  1,  write  “Same.”  If  no  2019  return  was  filed  provide  reason 
          number (PIN). To designate the tax preparer, enter “Preparer.”           address used on last year’s return. If this address is the same as listed 
 name, phone number and any five digits as their personal identification           Every taxpayer must complete the Address schedule. Start by listing the 
  Income Tax Department, mark (X) the “Yes” box and enter the person’s                                                               ADDRESS SCHEDULE
 To allow another person to discuss the tax return information with the                Add lines 1 through 3. Enter the total on line 4 and on page 1, line 24. 
                                                THIRD-PARTY DESIGNEE                                                 Line 4 – Total Payments and Credits
  2020 HIGHLAND PARK FORM HP-1040 INSTRUCTIONS FOR RESIDENTS, NONRESIDENTS AND PART-YEAR RESIDENTS                                                                



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    2020 20  HIGHLANDHIGHLANDPARKPARKFORMFORMHP-1040HP-1040INSTRUCTIONSINSTRUCTIONSFORFORRESIDENTS,RESIDENTS,NONRESIDENTSNONRESIDENTSANDANDPART-YEARPART-YEARRESIDENTSRESIDENTS20
individualindividualmakingmakingthetheconversionconversionisis5959½½yearsyearsoldoldororolderolderatatthethetimetime                                                (SLLcorporation,ine ine 11 11 etc.)– – flowRental Rental through incomeReal Real or lossEstate, Estate, reportedRoyalties, Royalties, on Schedule E.                        S S Corporations, Corporations, Partner-Partner-
ofofthetheconversionconversiondistribution.distribution.                                                                                                            Lineships,ships,12 Royalties,Royalties,DistributionsEstates,Estates,from SubchapterTrust,Trust,Etc.Etc.S corporations.
Line 10 – Taxable Pension Distributions Line 10 – Taxable Pension Distributions                                                                                     AAll income reported on Schedule E is taxable except for tax option ll income reported on Schedule E is taxable except for tax option 
EnterEnterononlineline10,10,columncolumnA,A,pensionpensionandandannuitiesannuitiesreportedreportedononfederalfederal                                                Entercorporation corporation on line 12((cashSScorporationcorporationor property,,etc. etc. distributions))flowflowfromthroughthroughS  corporations incomeincomefromororlosslossreportedreported 
FormForm10401040ororFormForm1040A.1040A.ExcludedExcludedpensionpensionandandretirementretirementbenefitsbenefits                                                    lineononScheduleSchedule16, code D ofE.E.Federal Schedule K-1. The Hamtramck City Income Tax 
are reported on line 10, column B and explained on the Exclusions and are reported on line 10, column B and explained on the Exclusions and                         Ordinance does not recognize Subchapter S status. Distributions from an S 
AdjustmentsAdjustmentstotoPensionPensionDistributionsDistributionsschedule.schedule.                                                                                corporationLLineine1212––areTaxTaxtaxableOptionOptionas if paidCorporationCorporationby a regular corporationDistributionsDistributionsas dividends.(S(SIfcorporation)corporation)you 
PensionPensionandandretirementretirementbenefitsbenefitsfromfromthethefollowingfollowingarearenotnot taxable: taxable:                                              areDistributions Distributions a shareholderreceived received in a corporationby by thata a hasresident resident elected to filefrom from undera a Subchaptertax tax Soption option corporation’scorporation’s 
1.  Pension plans that define eligibility for retirement and set contribution 1.  Pension plans that define eligibility for retirement and set contribution         of the Internal Revenue Code, you are not required to report any distributed Accumulated Adjustments Account, Other Adjustments Account and/or Accumulated Adjustments Account, Other Adjustments Account and/or 
    andandbenefitbenefitamountsamountsininadvance;advance;                                                                                                          incomethe the Shareholder’s Shareholder’s from Federal ScheduleUndistributed Undistributed K-1 lines 1 through 11,Taxable Taxable nor mayIncome Income deduct yourPreviously Previously TaxedTaxed 
2.  Qualified retirement plans for the self-employed;  2.  Qualified retirement plans for the self-employed;                                                        share of any loss or other deductions distributed by the corporation.Account (federal Form 1120S, Schedule M-2, line 7) are income on a Account (federal Form 1120S, Schedule M-2, line 7) are income on a 
    Benefits from any of the previous plans received on account of  Benefits from any of the previous plans received on account of                                  Line 13 – Farm Income or (Loss)Highland Park return and are to be  reported  on  this  line.  These Highland Park return and are to be  reported  on  this  line.  These 
    disability disability or or as as a a surviving surviving spousespouseififthethedecedentdecedentqualifiedqualifiedforforthethe                                  Profitdistributionsdistributionsor loss fromarearethefoundfoundoperationononfederalfederalof aScheduleSchedulefarm is taxableK-1K-1(1120),(1120),as reportedlinelineon20.20.theReportReportfederal 
    exclusionexclusionatatthethetimetimeofofdeath;death;                                                                                                            returnthesetheseregardlessdistributionsdistributionsis whereononthethethefarmAdjustments Adjustments is located. Therefor for Subchapter Subchapter are no exclusions.S S CorporationCorporation 
3. 3. Distributions Distributions from from a a 401(k) 401(k) or or 403(b)403(b)planplanattributableattributabletotoemployeremployer                                AttachDistributionsDistributionsa completeschedule.schedule.copyAlsoAlsoof federalattach attach Schedulecopies copies F.                 of of federal federal Schedule Schedule K-1K-1 
    contributionscontributionsororattributableattributabletotoemployeeemployeecontributionscontributionstotothetheextentextent                                      Line(Form(Form141120S).1120S).Unemployment Compensation
    they result in matching contributions by the employer; they result in matching contributions by the employer;                                                   LLine 13 – Farm Income or (Loss) ine 13 – Farm Income or (Loss) 
4.  Benefits  paid  to  an  individual  from a retirement annuity policy that 4.  Benefits  paid  to  an  individual  from a retirement annuity policy that         NOT TAXABLE. Exclude all. No explanation needed.Profit or loss from the operation of a farm is taxable as reported on the Profit or loss from the operation of a farm is taxable as reported on the 
    has been annuitized and paid over the life of the individual. has been annuitized and paid over the life of the individual.                                     Line 15 – Social Security Benefitsfederal return regardless of where the farm  is  located.  There  are  no federal return regardless of where the farm  is  located.  There  are  no 
PensionPensionandandretirementretirementbenefitsbenefitsfromfromthethefollowingfollowingareare taxable:  taxable:                                                   NOTexclusions.exclusions.TAXABLE. ExcludeAttachAttachall. No explanationaacompletecompleteneeded.copycopyofoffederalfederalScheduleScheduleF.F. 
1. 1. PrematurePrematurepensionpensionplanplandistributionsdistributions(those(thosereceivedreceivedpriorpriortoto                                                  LineLLineine161414Other––UnemploymentUnemploymentIncome                         CompensationCompensation 
    qualifyingqualifyingforforretirement);retirement);                                                                                                              Other income reported on the resident’s federal return is taxable except for NOTNOTTAXABLE.TAXABLE.ExcludeExcludeall.all.NoNoexplanationexplanationneeded.needed. 
2.  Amounts received from deferred compensation plans that let the 
2.  Amountsemployeereceivedset the amountfrom deferredto be putcompensationaside and doplansnot setthatretirementlet the                                            incomeLLineine1515from––recoveriesSocialSocialrelatedSecuritySecurityto federalBenefitsBenefitsitemized deductions from prior tax 
    employeeage or requirementsset the amountfor yearsto beofputservice. aside andThese do notplans setinclude, retirementbut                                       years.NOTNOTTAXABLE.IncludeTAXABLE.incomeExcludeExcludenot previouslyall.all.NoNodiscussed.explanationexplanationThis includesneeded.needed.partnerships, 
    age or requirements for years of service.  These  plans  include,  but                                                                                          estates,Linetrusts,16alimony– Otherreceived,Incomedistributions from profit sharing plans, 
    are not limited to, plans under IRC Sections 401(k), 457 and 403(b): are not limited to, plans under IRC Sections 401(k), 457 and 403(b):                       Line 16 – Other Income 
          AmountsAmountsreceivedreceivedbeforebeforethetherecipientrecipientcouldcouldretireretireunderunderthetheplanplan                                          premature distributions from IRA’s capital gains, winnings from State Lottery, OtherOtherincomeincomereportedreportedononthetheresident’sresident’sfederalfederalreturnreturnisistaxabletaxableexceptexcept 
      provisions, provisions, including including amounts amounts paid paid ononseparation,separation,withdrawalwithdrawaloror                                      gamblingforforincomeincomewinningsfromfromfromrecoveriesrecoveriescasinos, racetracks,relatedrelatedtotoorfederalfederalnon-charitableitemizeditemizedlotteriesdeductionsdeductionsor fromfrom 
      discontinuancediscontinuanceofofthetheplan;plan;                                                                                                              bingopriorpriorhalls,taxtaxyears.oryears.fromReportReportany otherononthisthissource.”linelineReportaanetnetonoperatingoperatingthis line a netlosslossoperatingcarryovercarryoverlossfromfrom 
          Amounts Amounts receivedreceivedasasearlyearlyretirementretirementincentives,incentives,unlessunlessthethe                                                carryoverthethepreviouspreviousfromtaxtaxtheyear.year.previousReportReporttax year.exclusionsexclusionsReport exclusionsandandadjustmentsadjustmentsand adjustmentsononp.p.2,2,usingusing 
      incentivesincentiveswerewerepaidpaidfromfromaapensionpensiontrust;trust;                                                                                      onthethep.ExclusionsExclusions2, using the ExclusionsandandAdjustmentsAdjustmentsand AdjustmentstototoOtherOtherOtherIncomeIncomeIncomeschedule.schedule.”schedule. 
3.  Benefits paid from a retirement annuity policy other than annuitized 3.  Benefits paid from a retirement annuity policy other than annuitized                   Line 17 – Total AdditionsLine 17 — Total Additions Line 17 — Total Additions 
    benefitsbenefitspaidpaidoveroverthethelifelifeofofthetheindividualindividualarearetaxabletaxabletotothethesamesame                                              AddAddAddlineslineslines2 through22throughthrough16 of each16.16.  ofofcolumneacheachandcolumncolumnenterandandamountsenterenteronamountsamountsline 17.            ononlineline17.17.  
    extent taxable under the Internal Revenue Code.                                                                                                                 Line 18 – Total IncomeLine 18 – Total Income 
Report taxable pension and retirement income on line 10, column C.                                                                                                  Add lines 1 through 16 of each column and enter amounts on line 18. 
ReportLineextent11 taxabletaxableRentalpensionunderRealtheandEstate,InternalretirementRoyalties,RevenueincomeSCode.Corporations,on line 10, columnPartnerships,C. AddLineAddlineslines181 through1–throughTotal16 of each16Incomecolumnof eachandcolumnenterandamountsenteronamountsline 18.                                          on line 18. 
  Royalties, Estates, Trust, etc.                                                                                                                                   Line 19 – DeductionsLine 19 – Deductions Line 19 – Deductions 
  All Income reported on Schedule E is taxable except for tax option corporation                                                                                    Enter amount from Deductions schedule, page 2, line 7.Enter amount from Deductions schedule, page 2, line 7. Enter amount from Deductions schedule, page 2, line 7. 
                                                                                                                                                                      
                                                                                                                                 NONRESIDENTNONRESIDENTINSTRUCTIONSINSTRUCTIONS  
                                                                                                                                                                      
NONRESIDENT INCOME SUBJECT TO TAX:NONRESIDENT INCOME SUBJECT TO TAX:                                                                                                for  each employer. Wages are normally allocated using the actual for  each employer. Wages are normally allocated using the actual 
1.1.CompensationCompensation        for for  workworkdone  done  ororservicesservicesperformedperformedininHighlandHighlandPark,Park,                               numbernumberofofdaysdaysororhourshoursworkedworkedininandandoutsideoutsideofofHighlandHighlandParkParkduringduring 
    which includes, but is not limited to, the following: salaries, wages, which includes, but is not limited to, the following: salaries, wages,                   the tax year for an employer. Vacation time, sick time and holidays are the tax year for an employer. Vacation time, sick time and holidays are 
    bonuses, commissions, fees, tips,  incentive  payments,  severance bonuses, commissions, fees, tips,  incentive  payments,  severance                           not  included  in  total  days worked in arriving at the wage allocation not  included  in  total  days worked in arriving at the wage allocation 
    pay, vacation pay and sick pay. pay, vacation pay and sick pay.                                                                                                 percentage. Vacation pay, holiday pay, sick pay, bonuses, severance percentage. Vacation pay, holiday pay, sick pay, bonuses, severance 
2.  Net profits from the operation of  an  unincorporated  business, 2.  Net profits from the operation of  an  unincorporated  business,                           pay, etc. are taxable to same extent as normal earnings. pay, etc. are taxable to same extent as normal earnings. 
    profession or other activity attributable to business activity conducted profession or other activity attributable to business activity conducted               100%  Earned  in  Highland  Park. 100%  Earned  in  Highland  Park.                                   All  wages,  salaries, tips, sick pay, All  wages,  salaries, tips, sick pay, 
    in  Highland  Park, whether or not such business is located in in  Highland  Park, whether or not such business is located in                                   bonuses,  deferred compensation, severance pay, and other bonuses,  deferred compensation, severance pay, and other 
    Highland Park. This includes business interest income from business Highland Park. This includes business interest income from business                         compensation (Form W-2, boxes 1 and  8)  is  taxable  to  nonresidents compensation (Form W-2, boxes 1 and  8)  is  taxable  to  nonresidents 
    activity in Highland Park. activity in Highland Park.                                                                                                           who worked 100% of the time in Highland Park. who worked 100% of the time in Highland Park. 
3.  Gains  or losses from the sale or exchange of real or tangible 
3.  Gains personalorpropertylosses fromlocatedthe salein Highlandor exchangePark.of real or tangible                                                                Wage Wage Allocation.Allocation.    NonresidentsNonresidentswhowhoperformedperformedonlyonlypartpartofoftheirtheir 
4  personalNet profitspropertyfrom thelocatedrentalinof Highlandreal  or  tangible Park.                        personal  property                                  services services for for an an employer employer in in the the HighlandHighlandParkParkmustmustallocateallocatetheirtheir 
4   Netlocatedprofitsin Highlandfrom the rentalPark.of  real  or  tangible  personal  property                                                                      wages. wages. UseUsethetheNonresidentNonresidentandandPart-YearPart-YearResidentResidentWageWageAllocationAllocation 
5. locatedPrematurein HighlanddistributionsPark.from an Individual Retirement Account (IRA)                                                                         section section of of the the Wages,Wages,ExcludibleExcludibleWagesWagesandandCityCityTaxTaxWithheldWithheld 
5.  Premature distributions from an Individual Retirement Account (IRA) where  a  deduction  was  claimed  on  a  current  or  previous  year’s                     schedule. schedule. 
    where  a  deduction  was  claimed  on  a  current  or  previous  year’s                                                                                         Wage Allocations on Commissions, Etc.                                                                                         A nonresident salesperson 
    Highland Park income tax return. Highland Park income tax return.                                                                                               Wage Allocations on Commissions, Etc.                                                                                     A nonresident salesperson 
6.  Premature  distributions  from  a pension plan attributable to work 6.  Premature  distributions  from  a pension plan attributable to work                     paid on a commission basis or other  results achieved should allocate paid on a commission basis or other  results achieved should allocate 
    performed in Highland Park. performed in Highland Park.                                                                                                         wages based on commissions received or  other  results  achieved wages based on commissions received or  other  results  achieved 
7.  Deferred compensation earned in Highland Park.7.  Deferred compensation earned in Highland Park.                                                                attributable  to  efforts expended  in Highland Park. A nonresident attributable  to  efforts expended  in Highland Park. A nonresident 
Line 1 – Wages, Salaries, Tips, Etc. Line 1 – Wages, Salaries, Tips, Etc.                                                                                           insurance salesperson paid sales commissions  and  renewal insurance salesperson paid sales commissions  and  renewal 
All wages of a nonresident are to be reported on the Wages, Excludible All wages of a nonresident are to be reported on the Wages, Excludible                       commissions  should  allocate  compensation on the following basis: commissions  should  allocate  compensation on the following basis: 
Wages and City Tax Withheld schedule. The total wages from line 15 of Wages and City Tax Withheld schedule. The total wages from line 15 of                         Allocate  commissions from life,  health, accident and vehicle (auto) Allocate  commissions from life,  health, accident and vehicle (auto) 
this schedule is the amount reported on Form HP-1040, page 1, line 1, this schedule is the amount reported on Form HP-1040, page 1, line 1,                         insurance based on the location (residence) of the purchaser. Allocate insurance based on the location (residence) of the purchaser. Allocate 
column A. The total wages should be the same as the wages reported column A. The total wages should be the same as the wages reported                               commissions from group insurance based on the location of the group. commissions from group insurance based on the location of the group. 
on your federal tax return (Form 1040, Form 1040A or Form 1040EZ).  on your federal tax return (Form 1040, Form 1040A or Form 1040EZ).                              Allocate  commissions  from fire  and casualty insurance based on the Allocate  commissions  from fire  and casualty insurance based on the 
                                                                                                                                                                    location of the risk insured. location of the risk insured. 
All W-2 forms showing income earned in Highland Park and/or tax All W-2 forms showing income earned in Highland Park and/or tax                                     Line 2 – Interest Line 2 – Interest 
withheld for Highland Park must be attached to the return. withheld for Highland Park must be attached to the return.                                               Non-business interest income of a nonresident is not taxable. Exclude Non-business interest income of a nonresident is not taxable. Exclude 
Report on page 1, line 1, column B, the total excluded wages from Line Report on page 1, line 1, column B, the total excluded wages from Line                       all non-business interest income. No explanation needed. all non-business interest income. No explanation needed. 
16 of the Wages, Excludible Wages and City Tax Withheld schedule. All 16 of the Wages, Excludible Wages and City Tax Withheld schedule. All                         Interest  income  that  is  business  income from business activity in Interest  income  that  is  business  income from business activity in 
excluded wages must be documented on the Wages, Excludible Wages excluded wages must be documented on the Wages, Excludible Wages                                   Highland Park is taxable and must  be reported.  Attach  a  schedule Highland Park is taxable and must  be reported.  Attach  a  schedule 
and City Tax Withheld schedule and  listed, by employer, on the and City Tax Withheld schedule and  listed, by employer, on the                                     showing source and computation of taxable and  nontaxable  interest showing source and computation of taxable and  nontaxable  interest 
Excluded Wages schedule on Form HP-1040, page 2. On the Wages, Excluded Wages schedule on Form HP-1040, page 2. On the Wages,                                       income. income. 
Excludible Wages and City Tax Withheld schedule,  lines  13  and  14, 
Excludible Wages and City Tax Withheld schedule,  lines  13  and  14, enter the reason the wages are excludible and the address of the work                         Line 3 – Dividends Line 3 – Dividends 
enterstationthewherereasonyoutheperformedwages aretheexcludiblework for theandemployer.the address of the work                                                      NOTNOTTAXABLE.TAXABLE.ExcludeExcludeallalldividenddividendincome.income.NoNoexplanationexplanationneeded.needed. 
station where you performed the work for the employer.                                                                                                              Line 4 – Taxable Refunds, Credits or Offsets 
Do  not  use  box  18  of  W-2  form  to  report  taxable  wages  or  to Do  not  use  box  18  of  W-2  form  to  report  taxable  wages  or  to                   Line 4 – Taxable Refunds, Credits or Offsets NOT TAXABLE. Exclude all. No explanation needed. 
allocate  wages,  use  all  wages  reported  on  your  federal  return  as allocate  wages,  use  all  wages  reported  on  your  federal  return  as               NOT TAXABLE. Exclude all. No explanation needed. 
the  allocation  basis. the  allocation  basis. A separate wage allocation must be completed  A separate wage allocation must be completed                          Line 5 – Alimony Received Line 5 – Alimony Received 
                                                                                                                                                                    NOT TAXABLE. Exclude all. No explanation needed. NOT TAXABLE. Exclude all. No explanation needed. 
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                                                                                                                                                                                       Page 6 of 6 
                                                                                                                                                                                                                                                                pension and retirement benefits. 
                                                                                                                                                                                               ine  10  under  “Residents”  for  additional  information  on  nontaxable pension and retirement benefits. L
                                                                                                                                                                                              ine incentives, 10  under unless  the “Residents” incentives for were additional paid from ainformation pension trust.on SeeLnontaxable 
                                                                                                                                                                                              incentives,  unless  the  incentives  were  paid from a pension trust. See discontinuance of the plan. Amounts  received  as  early  retirement 
                                                                                                                                                                                              discontinuance of the plan. Amounts  received  as  early  retirement provisions,  including  amounts  paid  on separation, withdrawal or 
                                                                                                                                                                                              provisions,  including  amounts  paid  on separation, withdrawal or Amounts  received  before  the  recipient could retire under the plan 
                                                                                                                                                                                              Amounts  received  before  the  recipient could retire under the plan Sections  401(k), 457 and 403(b) of the Internal Revenue Code (IRC): 
                                                                                                                                                                                              Sections  401(k), 457 and 403(b) of the Internal Revenue Code (IRC): service. These plans include, but  are not  limited  to,  plans  under 
                                                                                                                                                                                              service. These plans include, but  are not  limited  to,  plans  under aside and do not set retirement age or requirements for years of 
                                                                                                                                                                                              aside and do not set retirement age or requirements for years of compensation plans that let the employee set the amount to be  put 
                                                                                                                                                                                              compensation plans that let the employee set the amount to be  put Highland Park may not exclude amounts received  from  deferred 
                                                                                                                                                                                              Highland Park may not exclude amounts received  from  deferred A nonresident remaining employed by the  particular employer in 
                                                                                                                                                                                              A nonresident remaining employed by the  particular employer in normal wages from the employer are taxable. 
                                                                                                                                                                                               prior to qualifying for retirement)normalarewagestaxablefromto thethe employersame  extent are taxable.the 
                                                                                                                                                                                              prior to qualifying for retirement) are taxable to  the  same  extent  the Premature pension plan distributions (those received by a nonresident 
                                                                                                                                                                                              Premature pension plan distributions (those received by a nonresident Line 10 – Taxable Pension Distributions 
                                                                                                                                                                                                                                      SectionLine72(t)(2)(A)(iv)10 – TaxableofPensionthe IRCDistributionsare not taxable. 
                                                                                                                                                                                              nonresident. IRA distributionsSectionreceived72(t)(2)(A)(iv)after ageof the59IRC½ oraredescribednot taxable.by 
                                                                                                                                                                                              nonresident. IRA distributions received after age 59 ½ or described by (reported on Form 1099-R, box 7, distribution code 1) are taxable to a 
                                                                                              the Ordinance, the Ordinance prevails.                                                          (reportedighland onPark’s Form 1099-R,taxable box 7,income distributionin codethe 1) arecurrent taxableor to aa H                                      prior  tax  year 
Tax Ordinance. If any discrepancy exists between the instructions and                                                                                                                         ighland That portionPark’s of a prematuretaxable IRAincome distributionin that the was current deducted or froma H                                     prior  tax  year 
These instructions are an interpretation of the Highland Park Income                                                                                                                          That portion of a premature IRA distribution that  was  deducted  from Line 9 – IRA Distributions 
                                                                                                                                                                          Notice                                                      also enter this total onLinepage9 – IRA1,Distributionsline 8, column B. 
             schedule (page 2 instructions) for a list of allowable deductions.                                                                                                               line 4 of the schedule enteralsotheentertotalthisexcludedtotal onotherpagegains1, lineor8,lossescolumnandB. 
                                                                                                                                                                                               other gains and losses reported on the federal  income  tax  return.  On 
deductionsschedulethe same(pageway2relatedinstructions)incomeforisaallocated.list of allowableSee Deductionsdeductions.                                                                       lineGains4 ofandtheLossesschedulescheduleenter thetototalcomputeexcludedexclusionsother gainsand adjustmentsor losses andto 
deductionsthe HighlandtheParksameIncomeway relatedTax Ordinance.income isNonresidentsallocated. SeemustDeductionsallocate                                                                     otherUse thegainsExclusionsand lossesandreportedAdjustments on theto federal Otherincome federal tax Form return. 4797.On 
thedeductionsHighlandareParklimitedIncomeby theTaxextentOrdinance.they relateNonresidentsto incomemusttaxableallocateunder                                                                    Gainsmust attachand Lossesa copy of scheduleNonresidentsto computereportingexclusionsotherandgainsadjustmentsand lossesto 
deductionsnter amountarefromlimitedDeductionsby the extentschedule,they relatepageto income2, linetaxable7. A nonresident’sunder E                                                            Use the Exclusions and Adjustments  to  Other                                         federal  Form  4797. 
nter amount from Deductions schedule, page Line2,19 – Totalline 7.DeductionsA nonresident’sE                                                                                                  must attach a copy ofAttach copiesNonresidentsof federal SchedulereportingK-1other(Formgains1120S).and losses 
                                                                                                                      Line 19 – Total Deductions                                               Exclusions  and AttachAdjustments copies of federalto OtherScheduleGainsK-1and(Form(Losses)1120S).schedule. 
    Add lines 1 through 16 of each column and enter amounts on line 18.                                                                                                                       Exclusions is  excluded and on theAdjustments reportedtoonOtherfederal GainsForm and4797(Losses)or Schedule schedule.B 
    Add lines 1 through 16 of each column and enterLineamounts18 – TotalonIncomeline 18.                                                                                                      is Flow excluded through onincomethe   reportedfrom a ontaxfederal option corporation Form  4797 or(S Schedule corporation)B 
    Add lines 2 through 16 of each column and enterLineamounts18 – TotalonIncomeline 17.                                                                                                       Flow  through  income from a  tax option corporation  (S and/orcorporation)Form 8824. 
    Add lines 2 through 16 of each column andLineenter17amounts– Total Additionson line 17.                                                                                                   other gains must be supported by attaching a copy ofand/orfederalFormForm8824.6252 
                                                                                                                              fromLinethe17 – TotalpreviousAdditionstax year.                 otheryear recognizedgains mustonbethesupportedtaxpayer’sby attachingfederala copyincomeoftaxfederalreturn.FormDeferred6252 
Report on this line a Highland Park-related netfromoperatingthe previousloss carryovertax year.                                                                                               yearkindrecognizedexchangesonofthepropertytaxpayer’slocatedfederalin HighlandincomeParktaxare taxablereturn.inDeferredthe 
Report on this line a Highland Park-related net operating loss carryover Other  Income  schedule  to document exclusions and adjustments.                                                     kind exchanges of property located in Highland Park are taxable in the Park. Deferred other gains and losses from installment sales and like-
Other  Income  schedule  to document exclusions and adjustments. conducted  in Highland Park. Use the  Exclusions  and  Adjustments  to                                                        Park. Deferred other gains and losses from installment sales and like-to the extent the gains or losses are from property located in Highland 
conducted  in Highland Park. Use the  Exclusions  and  Adjustments  to Other income is taxable if it is from work performed or other activities                                               to the extent the gains or losses are from property located in Highland A nonresident’s other gains and losses are included in taxable income 
Other income is taxable if it is from work performed or other activities Line 16 – Other Income                                                                                               A nonresident’s other gains and losses are included in taxable income Line 8 – Other Gains or (Losses) 
                                                 NOT TAXABLE. Exclude all.LineNo explanation16 – Other Incomeneeded.                                                                                           carryover reported on the taxpayer’sLine 8 – OtherfederalGains orincome(Losses)tax return. 
                                          NOT TAXABLE. ExcludeLine 15 – Socialall. NoSecurityexplanationBenefitsneeded.                                                                        the  ExclusionscarryoverandreportedAdjustmentson thescheduletaxpayer’sto excludefederaltheincomecapitaltaxloss              return. 
                                                 NOT TAXABLE.LineExclude15 – Socialall. NoSecurityexplanationBenefitsneeded.                                                                  the  A commonExclusionserrorandonAdjustmentsa nonresidentschedulereturn istofailureexcludeto completethe capital lossNOTE:
                                          NOT TAXABLE.Line 14Exclude– Unemploymentall. No explanationCompensationneeded.                                                                       Aschedulecommontoerrorcomputeon aexclusions nonresidentandreturnadjustmentsis failure totocompletecapital  gains.NOTE:
                                                      subjectsLinethe14 – Unemploymentfarm to HighlandCompensationPark income tax.                                                            scheduleUse  the toExclusions compute exclusions and  Adjustments and adjustmentsto CapitaltoGainscapital or (Losses)gains. 
produce stand located insubjectsthe city istheHighlandfarm toParkHighlandbusinessParkactivityincomeandtax.                                                                                    Use  the  Exclusions  and  Adjustments  to Capital Gains or (Losses) 1120S).
produceSales ofstandcropslocatedat thein theproducecity ismarket,Highland Parkany ofbusinessthe farmer’sactivitymarketsand                                                                 or aAttach  copies  of  federal  Schedule  K-1  (Form                                           (Losses) schedule 1120S).
Sales of crops atExclusionsthe produceand Adjustmentsmarket, anytoofFarmtheIncomefarmer’sschedule.markets or aAttach excludedcopies onof  federal the ExclusionsSchedule  K-1 and(FormAdjustments to Capital (Losses)Gains scheduleor 
Highland  Park, Exclusionsthe  entire  farm and Adjustmentsprofit or losstoisFarmexcluded,Incomeusingschedule.the                                                                             excludedcorporation, on theetc.) Exclusionsreported and Adjustmentson  a  nonresident’s to Capital  Gains federal or          Schedule  D  is 
Highland  Park,  the  entire  farm  profit or loss is excluded, using the is done, services rendered or other  business activity  is  conducted  in                                           corporation,  etc.)  reported  on  a  nonresident’s  federal  Schedule  D  is Flow  through  income  or  loss from a tax option corporation (S 
isofdone,the threeservicesfactor renderedFarm Allocationor other Percentagebusiness activity formula.is Whereconducted no workin                                                              Flow  through  income recognizedor  lossonfromtheataxpayer’stax option corporationfederal income(S               tax return. 
ofthetheprofitthreeorfactorloss           reportedFarm Allocationon HighlandPercentagePark returnformula.is determinedWhere nobyworkuse                                                        exchange of propertyrecognizedlocatedonintheHighlandtaxpayer’sPark arefederaltaxableincomein thetaxyearreturn. 
the profit or loss reported on Highland Park return is determined by use rendered or other activities conducted in Highland Park. The portion of                                              exchange of property located in Highland Park are taxable in the year Deferred  capital  gain  income  from installment sales and like-kind 
rendered or other activities conducted in Highland Park. The portion of income to the extent the profit or loss results from work done, services                                              Deferred  capital  gain  income  from installment sales and like-kind carryover for federal income tax purposes. 
incomeA nonresident’sto the extentprofittheorprofitlossor lossfromresultsa farmfromareworkincludeddone,inservicesHighland Parkcapital  loss  carryover  for  Highland carryoverParkfor federalmay beincomedifferenttaxthanpurposes.the 
A nonresident’s profit or loss from a farm are included in Highland Park Line 13 – Farm Income or (Loss)                                                                                      capital  loss  carryover  for  Highland  Park may be different than the Unused capital losses may be carried over  to  future  tax  years.  The 
                                                                    other deductionsLinedistributed13 – Farmtransferredby theIncomecorporation.”or (Loss)to HP-1040.                          Unusedto the samecapitalextentlossestheymayarebeallowedcarriedunderover theto  future Internaltax Revenueyears. Code.The 
reportbusinessanyisdistributedlocatedincomein Highlandnor mayPark.you deductLossesyouronshareantransferredS-Corpof any losscannottoorHP-1040.be                                               toPark.the sameCapitalextentlossestheyfromarepropertyallowedlocatedunder thein HighlandInternal RevenuePark are allowedCode. 
businessunderCorporationSubchapteris locatedDistributions S of theinInternalHighlandareRevenuetaxablePark.Code,Lossesif youtheareonnotSanSubchapterrequiredS-Corpto cannotLine be12  –        Park.to theCapitalextentlossesthe gainsfromorpropertylosses arelocatedfrom propertyin HighlandlocatedParkinareHighlandallowed 
IfCorporationyouexclusionsare a shareholderDistributions and adjustments;in a corporationare taxableenterthatif alsothehasonelectedSpageSubchapter1,tolinefile11,Line columnLine12 12– C.   toCapitalthe extentgainstheorgainslossesoroflossesa nonresidentare fromarepropertyincludedlocatedin taxablein Highlandincome 
Trusts,exclusionsEtc. schedule.and adjustments;On line 6 enterof thisalsoscheduleon pageenter1, linethe 11,totalcolumn C.                                                                     Capital gains or losses of a nonresidentLineare7 –includedCapitalinGainstaxableor (Losses)income 
Trusts,from RentalEtc. schedule.Real Estate,OnRoyalties, line 6  of thisPartnerships, schedule enterS  Corporations,the  total                                                                     is reported on page 1, line 16, columnLine 7C.– CapitalSee instructionsGains or (Losses)for line 16. 
fromExplainRentalall exclusionsReal Estate,onRoyalties, the Exclusions Partnerships, and  Adjustments S  Corporations,to  Income                                                               A Highlandis reportedParkonnetpageoperating1, line 16,losscolumncarryoverC. Seefrominstructionsthe previousfortaxlineyear16. 
Explain all exclusions on the Exclusions  and  Adjustments  to  Income reported on Schedule E; and income from estates and trusts.                                                            A Highland Park net operating loss carryover from the previous tax year schedule to exclude profit or loss from the operation of a business. 
option corporationreported(Soncorporation, Schedule E;etc.)andflow incomethrough from estatesincome andor trusts.loss                                                                          Complete schedulethe toExclusions exclude profitand orAdjustmentsloss from thetooperationBusinessofIncomea business. 
option corporation (S corporation,  etc.) flow  through  income  or  loss income from business activity or  property  outside  Highland  Park;  tax                                           Complete  the  Exclusions  and  Adjustments to Business Income conducted  in  Highland Park, the profit or loss is entirely excluded. 
income from business activity or  property  outside  Highland  Park;  tax The  following  income  reported  on  federal Schedule E is excludable:                                             conducted  in  Highland Park, the profit or loss is entirely excluded. Where no work is done, services rendered or other business activity is 
The  following  income  reported  on  federal Schedule E is excludable: distributions to nonresidents and on undistributed taxable income.                                                    Where no work is done, services rendered or other business activity is formula. 
in HighlanddistributionsPark, theto nonresidentsestate or trustandmustonfileundistributeda return andtaxablepay taxincome.on                                                                   profit  or  loss  is  determined  using  the three factor Business Allocationformula. 
in Highland Park, the estate or trust must file a return and pay tax on is taxable to nonresidents. When an estate or trust has taxable income                                                profit  or  loss  is  determined  using  the three factor Business Allocation business operates both in and outside  of  Highland  Park,  the  taxable 
is taxable to nonresidents. When an estate or trust has taxable income business activity in Highland Park or property located in Highland Park                                                business operates both in and outside  of  Highland  Park,  the  taxable line 5 of this schedule is also entered on page 1, line 6, column B. If a 
business activity in Highland Park or property located in Highland Park All income reported on the federal Schedule E that comes from                                                         line 5 of this schedule is also entered on page 1, line 6, column B. If a to exclude business income. The total excluded business income from 
All income reported on the federal Schedule E that comes from Estates, Trusts, Etc.                                                                                                           to exclude business income. The total excluded business income from The Exclusions and Adjustments to Business Income schedule is used 
orporations,Royalties,,                               Partnerships, S C                                                stateLineEstates,11 – RentalTrusts, Etc.Real E                         The6,Exclusionscolumn A,andbusinessAdjustmentsincometoreportedBusinesstaxableIncomeonscheduleyour federalis usedreturn. 
orporations,Royalties,,                               Partnerships,amountS C                                         stateon pageLine1,11line– Rental10, columnReal E                  B.     business6, columnactivitiesA, businessconductedincomein Highlandreported taxablePark. Reporton youronfederalpage 1,return.line 
pension distributions on the last lineamountof theonschedulepage 1,andlinealso10,entercolumntheB.                                                                                             businessthe  extentactivitiesit resultsconductedfrom workindone,HighlandservicesPark.renderedReport onorpageother1, line 
pension distributions on the last line of the schedule and also enter the Adjustments to Pension Income schedule. Enter  the  total  excluded                                                 the  extent it results from work done, services rendered or other Profit or loss from the operation of a business or profession is taxable to 
Adjustments to Pension Income schedule. Enter  the  total  excluded Excludible  pension  distributions are listed  on the Exclusions and                                                      Profit or loss from the operation of a business or profession is taxable to Line 6 – Profit or (Loss) from a Business, Etc. 
Excludible  pension  distributions are listed  on the Exclusions and                                                                                                                                                                 Line 6 – Profit or (Loss) from a Business, Etc.  
    , NONRESIDENTS AND PART-YEAR RESIDENTSHIGHLAND PARK FORM HP-1040 INSTRUCTIONS FOR RESIDENTS                                                                                                                                                                                                               2018           
   , NONRESIDENTS AND PART-YEAR RESIDENTSHIGHLAND PARK FORM HP-1040 INSTRUCTIONS FOR RESIDENTS                                                                                                                                                                                                              2020



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W94585-NUT01  1/13/15  1:43 PM  Page 7

 HP-1040                       INDIVIDUAL RETURN DUE APRIL 30, 2021HIGHLAND PARK                      2020                                                       12MI-HPK120MI-HPK1
 Taxpayer's SSN                        Taxpayer's first name                             Initial Last name                                 RESIDENCE STATUS
                                                                                                                                                                                       Part-year 
                                                                                                                                               Resident          Nonresident           resident
 Spouse's SSN                          If joint return spouse's first name               Initial Last name                                 Part-year resident - dates of residency (mm/dd/yyyy)
                                                                                                                                           From
 Make sure the SSN(s) above and on     Present home address (Number and street)                                               Apt. no.     To
 page 2, line 1d are correct.                                                                                                              FILING STATUS
                                       Address line 2 (P.O. Box address for mailing use only)                                                  Single            Married filing jointly
 Check box if you need a tax 
 form mailed to you next year.                                                                                                                 Married filing separately. Enter spouse's SSN 
 For city use only                     City, town or post office                                      State      Zip code                      in Spouse's SSN box and Spouse's full name 
                                                                                                                                               here.   
                                       Foreign country name                     Foreign province/county          Foreign postal code
                                                                                                                                           Spouse's full name if married filing separately
                             ROUND ALL FIGURES TO NEAREST DOLLAR                                           Column A                     Column B                 Column C                 
               INCOME                            ($0.50 next dollar)                                  Federal Return Data            Exclusions/Adjustments      Taxable Income
                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
 FIRST 2        3.  Ordinary dividends                                                           3                            .00                          .00                            .00
 PAGES OF 
 FEDERALFEDERAL  4. Taxable refunds, credits or offsets                                          4                            .00                          .00   NOT TAXABLE
 1040           5.  Alimony received                                                             5                            .00                          .00                            .00
 RETURN         6.  Business income or (loss) (Attach 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                                                    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 federal Schedule E)                                            11                           .00                          .00                            .00
                12. Subchapter S corporation distributions  (Attach federal Sch. K-1)            12   NOT APPLICABLE                                       .00                            .00
 ATTACH    13. Farm income or (loss)  (Attach 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 HP-1040, page 2, box 1h, in line 21a and multiply this 
                                     number by $600 and enter on line 21b)                                                              21a                21b                            .00
                22.       Total income subject to tax (Subtract line 21b from line 20)                                                                     22                             .00
                                     (Multiply line 22 by Highland Park resident tax rate of 2% (0.02) or nonresident tax rate of 1% 
                23. Tax              (0.01) 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
                24.       Total payments and credits  (Total from page 2, Payments and Credits schedule, line 4)                                           24                             .00
                    Interest and penalty for: failure to make                   Interest                                      Penalty      Total   
                25. estimated tax payments; underpayment                                                                                   interest & 
                    of estimated tax; or late payment of tax  25a                                .00       25b                         .00 penalty         25c                            .00
                                                                                                                                           PAY WITH
 ENCLOSE                          Amount you owe (Add lines 23b and 25c, and subtract line 24)                            
 CHECK OR        TAX DUE      26. MAKE CHECK OR MONEY ORDER PAYABLE TO: CITY OF HIGHLAND PARK                                              RETURN 
 MONEY                                                                                                                                     >>>>>           26                             .00
 ORDER
                 OVERPAYMENT                   27.  Tax overpayment (Subtract lines 23b and 25c from line 24; choose overpayment options on lines 28 - 30) 27                             .00
                28. Reserved                                                                                                               Total     
                                       28a                                      28b                                       28c              donations       28d
                29. Amount of overpayment credited forward to 2021                                                              Amount of credit to 2021 >>  29                           .00
                30. Amount of overpayment refunded (Line 27 less line 29) 
                                                                                                                                       Refund amount >>  30                               .00
                                                 31a          Not available              31c  Reserved
                31. Reserved                     31b          Not available              31d Reserved
                                                                                         31e Reserved
                 MAIL TO: Highland Park Income Tax Dept, P.O.Box239 ,                                                     Eaton Rapids, MI  48827-0239           Revised: 12/01/2019



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W94585-NUT01  1/13/15  1:43 PM  Page 8

Revised: 12/01/2019
                                    number 
                            software                                                                                                                                                     SIGNATURE              PREPARER'S   
                                    NACTP                                                                       FIRM'S NAME (or yours if self-employed), ADDRESS AND ZIP CODE
                                    Preparer's phone no.
                                      PTIN, EIN or SSN      Date (MM/DD/YY)                                            SIGNATURE OF PREPARER OTHER THAN TAXPAYER

If deceased, date of death                                                    Spouse's occupation      Date (MM/DD/YY)                                       SPOUSE'S SIGNATURE
                                                                                                                                                                                         ===>
                                                                                                                                                                                         HERE 
If deceased, date of death            Daytime phone number                   Taxpayer's occupation     Date (MM/DD/YY) TAXPAYER'S SIGNATURE - If joint return, both spouses must sign SIGN 
    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.
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 
                           number (PIN)                          No.                                                                                                                     name
                   Personal identification                       Phone                                                                                                            Designee's
                                                         No       Yes, complete the following          Do you want to allow another person to discuss this return with the Income Tax Office?
                                                                                                                                         THIRD PARTY DESIGNEE

DAY MONTH          DAY     MONTH             listed on page 1 of this return, print "Same." If no return filed, list reason. Continue listing residence addresses from this year.        T, S, B
    TO                 FROM             ADDRESS (INCLUDE CITY, STATE & ZIP CODE) Start with address used on last year's return. If the address is the same as                            MARK
                            (Where taxpayer (T), spouse (S) or both (B) resided during year and dates of residency)ADDRESS SCHEDULE
.00                                 4                                                     Total payments and credits  (Add lines 1 through 3, enter total here and on page 1, line 24)                                       4.
.00                                 3                                        Credit for tax paid to another city  (Residents attach a copy of other city's return; not allowed for nonresidents)                             3.
.00                                 2                       Tax payments other than tax withheld (Estimated income tax payments, extension payment, partnership payments and credit forward)                                 2.
.00                                 1                   Tax withheld by your employer for HIGHLAND PARK  (Attach W-2 Forms showing tax withheld for HIGHLAND PARK, Form W-2, box 19)                                         1.
                                                                                                                       PAYMENTS AND CREDITS SCHEDULE
.00                                 7                                                              Total deductions (Add line 1 through line 6, enter total here and on page 1, line 19)                                     7.
.00                                 6                                                                                  Renaissance Zone deduction  (Attach Schedule RZ OF 1040)                                              6.
.00                                 5                                                     Alimony paid  (DO NOT INCLUDE CHILD SUPPORT.  Attach copy of page 1 of federal return)                                             5.
.00                                 4                                                              Moving expenses  (Into Highland Park area only)  (Attach copy of federal Form 3903)                                       4.
.00                                 3                                                              Employee business expenses  (See instructions and attach copy of federal Form 2106)                                       3.
.00                                 2                                                         Self-employed SEP, SIMPLE and qualified plans  (Attach copy of page 1 of federal return)                                       2.
.00                                 1                                                                  IRA deduction  (Attach copy of page 1 of federal return & evidence of payment)                                        1.
    DEDUCTIONS                               (See instructions; deductions allocated on same basis as related income) DEDUCTIONS SCHEDULE 
.00                                 .00                                        10             .00                      .00                                                                                                   5
.00                                 .00                                        9              .00                      .00                                                                                                   4
.00                                 .00                                        8              .00                      .00                                                                                                   3
.00                                 .00                                        7              .00                      .00                                                                                                   2
.00                                 .00                                        6              .00                      .00                                                                                                   1
       WAGES                                 WAGES                                                     WAGES                     WAGES
RESIDENT EXCLUDED          NONRESIDENT EXCLUDED                  EMPLOYER'S ID #              NONRESIDENT EXCLUDED     RESIDENT EXCLUDED                     EMPLOYER'S ID                                                   #
COLUMN C                                COLUMN B                 COLUMN A      W-2                     COLUMN C            COLUMN B                          COLUMN A                              W-2 
                                                        (See instructions. Resident wages generally not excludible)  EXCLUDED WAGES SCHEDULE 
    line 21a)                                                                                                                                                                                                                 8
    here and also on page 1,                                                                                                                                                                                                  7
    lines 1e, 1f and 1g; enter 
    1h. Total exemptions (Add                                                                                                                                                                                                 6
                                                                                                                                                                                                                              5
                           line 1d                                                                                                                                                                                            4
    dependents listed on       
    1g. Enter number of other                                                                                                                                                                                                 3
                                                                              2`
                       on line 1d                                                                                                                                                                                             1
    dependent children listed 
       Enter number of              1f.      Date of Birth       Relationship  Social Security Number                  Last Name                             First Name                                                       #
                                                                               Check box if you can be claimed as a dependent on another person's tax return List Dependents 1c.                                             1d.
                       1a and 1b                                                                                                          1b. Spouse
    boxes checked on  lines 
       1e. Enter the number of                                                                                                                               1a. You SCHEDULE
                                               Disabled     Deaf Blind         65 or over      Regular        Date of birth (mm/dd/yyyy)                     EXEMPTIONS 
12MI-HPK220MI-HPK2                                                                                                                                           HP-1040, PAGE 2
                                                            Taxpayer's SSN                                                 Taxpayer's name






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