PDF document

- 1 -

CLEAR FORM
CITY OF PONTIAC RESIDENT INDIVIDUAL INCOME TAX RETURN
P-1040R Due April 30, 2023 or next business day 2022
Your first name & initial Last name Birthdate Your Social Security Number--REQUIRED

If joint, spouse's first name & initial Last name Birthdate
Spouse's Social Security Number
Physical home address (Number and street or rural route) include apartment # if any.

City, town or post office State Zip code Daytime phone Evening phone

Taxpayer only
Part Year Resident from _____/_____/_____ to _____/_____/_____ Spouse only If married, is spouse filing Yes No
Former Address: Both a separate return?
Schedule 1 Exemption Amount
Regular 65 or over Blind Regular 65 or over Blind
YOURSELF SPOUSE 1. Number of boxes checked to the left 1.
DEPENDENTS
Name (first, middle initial, and last name) Social Security Number Relationship How many months
If more than four dependents, attach an additional schedule. living in your home

2.
2. Number of dependent children and/or other dependents which you listed on your federal return
3.
3. Total number of exemptions--add lines 1 and 2 and enter on line 5 of RETURN SUMMARY below
Schedule 2 Wage Detail ATTACH PONTIAC COPY OF FORM(S) W-2 Column A Column B
Enter gross wages, salaries, commission, tips, sick pay, etc earned everywhere. Pontiac tax Total wages from
Employer's name Street address of actual work location(s) withheld Box 1 of W-2
.00 .00
.00 .00
.00 .00
.00 .00
Do not include S.U.B. pay Totals 1a. .00 1b. .00
Schedule 3 Payments
1. Tax withheld by your employer from line 1a. of Schedule 2 above 1. .00
2. 2022 estimated payments, credit from 2021 P-1040R, payment with extension 2. .00
3. Credit for tax paid to another city--from Page 2, Worksheet 1 3. .00 Attach copy of other return
4. Credit for taxes paid by partnership on behalf of partner (Provide name and Tax ID) 4.. .00
5. Total payments--enter here and on line 8 of RETURN SUMMARY below 5. .00
1. Total wages, salaries and tips from Schedule 2, line 1b. Attach your W-2 form(s) 1. .00
RETURN 2. Other income/loss from Page 2, Schedule 4, line 11 2. .00
SUMMARY 3. Deductions from Page 2, Schedule 5, Line 5 (Enter as negative amount) 3. .00
4. Combine lines 1, 2 and 3. This is your total Pontiac income 4. .00
Exemptions 5. Enter number of exemptions from Schedule 1, line 3 here ___ then multply by $600.00 and enter in box 5 5. .00
Taxable Income 6. Subtract line 5 from line 4. This is your taxable income 6. .00
7. Multiply line 6 by one percent (.01) This is your Pontiac tax Tax >>>
PONTIAC TAX
If you prepared Schedule L for Part-Year resident, enter the tax amount and check the box. 7. .00
Payments 8. Total of Pontiac payments from Schedule 3, line 5 Payments >>> 8. .00
Tax 9. If tax (line 7) is larger than payments (line 8) enter amount you owe. MAKE CHECK
PAYABLE TO CITY OF PONTIAC OR PAY WITH A DIRECT ELECTRONIC WITHDRAWAL Pay With
Due (Mark pay tax due-direct withdraw, line 14b, and complete lines 14 c,d,e & f) Return >>> 9. .00
Overpayment 10. If payments (line 8) are larger than tax (line 7) ENTER OVERPAYMENT Overpayment >>> 10. .00
Credit to 2023 11. Amount of overpayment to be held and applied to your 2023 estimated tax Credit to 2023 >>> 11. .00
Donation 12. Overpayment donated to City of Pontiac Donation >>> 12. .00
13. Amount of overpayment to be refunded (For direct deposit, mark refund box,
Refund
line 14a, and complete lines 14 c,d,e & f) Refund >>> 13. .00
Direct Deposit 14. Direct deposit refund or direct withdrawal payment Mark one: 14a Refund-direct deposit 14b Pay tax due-direct withdraw
or c. Routing number e. Type of account: Checking Savings
Direct Payment d. Account number
I have read this return. Under the penalties of perjury, I declare that to the best of my knowledge and belief the return is true, correct and accurately lists all amounts and sources
of Pontiac income I received during the tax year. If prepared by a person other than the taxpayer, his/her declaration is based on all information of which he/she has any knowledge.
Your signature Spouse's signature if joint return Paid preparer's signature
PLEASE
SIGN HERE Date Your occupation Date Spouse's occupation Address
YOU MUST ATTACH A COPY OF PAGES 1 AND 2 OF YOUR 2022 FEDERAL 1040
If payment is included mail return to: City of Pontiac 1040 Payments; PO Box 530; Eaton Rapids, MI 48827-0530
If no payment is included mail return to: Income Tax Division; City of Pontiac; PO Box 530; Eaton Rapids, MI 48827-0530

- 2 -

                                CITY OF PONTIAC RESIDENT INDIVIDUAL INCOME TAX RETURN
Page 2                                                                   P-1040R                                                                  2022
Schedule 4            Other Income/Loss
PART YEAR RESIDENTS INCLUDE ONLY INCOME/LOSS ATTRIBUTABLE TO PERIOD OF RESIDENCY
                                                                             Less interest on 
                                                                             obligations from the 
                                                                             United States or 
1. Interest income from Federal return                   1a.             .00 subordinate units.        1b.           .00       1c.                .00
2. Dividend income from Federal return                   2a.             .00          U.S. dividends 2b.             .00       2c.                .00
    Net income/loss from business or profession--attach 
3.  Federal Schedule C
                                                         3a.             .00   SEP deduction           3b.           .00       3c.                .00
4. Net income/loss from rents/royalties--Federal Schedule E, page 1  (All federal schedules must be attached.)                 4.                 .00
5. Income/loss from partnerships--attach Federal Schedule E, page 2                                                            5.                 .00
6. Income/loss from the sale or exchange of property per your federal forms. (Capital gains)--Federal Schedule D/Form 8949     6.                 .00
7. Distributions from Subchapter S corporations--attach Federal Schedule K-1                                                   7.                 .00
8. Income from estates/trusts--Federal Schedule E, page 2                                                                      8.                 .00
9. Distributions from profit sharing plans, or premature distributions from pension plans and/or IRAs.                         9.                 .00
    Other income (alimony received (see instructions), gambling winnings from lotteries, casinos, bingo halls, racetracks, 
10. taxable scholarships, etc.) Include copy of Part I of Schedule 1 from Federal 1040, and any supporting schedules.
                                                                                                                               10.                .00
11. Total--combine lines 1c. through 10--enter here and on page 1, line 2 of return summary                                    11.                .00

Schedule 5            Deductions
PART YEAR RESIDENTS ALLOCATE DEDUCTIONS FOR PERIOD OF RESIDENCY
1. IRA deduction--attach Schedule 1 of Federal 1040      (No deduction is allowed for contributions to a ROTH IRA)             1.                 .00
2. Employee business expenses--see instructions and attach detailed list                                                       2.                 .00
3. Moving expenses--see instructions and attach Federal 3903                                                                   3.                 .00
4. Alimony paid--see instructions and attach Schedule 1 of Federal 1040.                                                       4.                 .00
5. Total--add lines 1 through 4--enter here and on page 1, line 3 of RETURN SUMMARY                                            5.                 .00

Worksheet 1           Credit for Tax Paid to Another City

1. Total income earned in other city after deductions (before exemptions) from 2022 non-resident city return                   1.                 .00
2. Less:  exemption amount from Pontiac RETURN SUMMARY--page 1, line 5                                                         2.                 .00
3. Comparative income subject to tax by other city. (Line 1 less Line 2)                                                       3.                 .00
4. Credit tax rate 1/2% (0.005)                                                                                                4.                 .005
5. Multiply line 4 by line 3--enter here and on page 1, Schedule 3 (Payments), line 3                                          5.                 .00
    (Credit is limited to actual tax liability from other city's return)
Part year residents:  Include income on line 1 of this worksheet only to the extent that it is taxable by Pontiac as a resident
                      and taxable by another city that imposes an income tax as a non-resident
Note: You must complete a separate Worksheet 1 for each city in which you filed a non-resident return
                                YOU MUST ATTACH A COPY OF PAGE ONE OF THE OTHER CITY'S RETURN
                                                     Summary of Required Attachments
    All Filers:                                                                       If Applicable:
    u All form W-2's                                                                  u     Federal Schedule 1
    u Page 1 and 2 of Federal Form 1040                                               u     Federal Form 3903
                                                                                      u     Federal Schedule C
    Filers Taking a Credit for Tax Paid to Another City:                              u     Federal Schedule D, Forms 8949, 4797, 6252
    u Copy of page one of the other city(ies) return                                  u     Federal Schedule E including Federal Schedule K-1 
                                                                                            for all S corporations shown on Schedule E, if any
                                                                                      u     Copies of all forms 1099-R for taxpayers under age 65

                                                                        IMPORTANT
    Detailed supporting schedules MUST be submitted with this return. Failure to attach schedules or attaching incomplete schedules can result in 
    deductions and losses being disallowed or delay the processing of your return until acceptable schedules are obtained.

                      If you have any questions regarding the City of Pontiac Income Tax, please call (248) 758-3236

                                                             Third Party Designee
Do you want to allow another person to discuss this return with the Income Tax Department?             Yes--Complete the following:               No

Designee's Name:                                                                      Phone No.  (         )

PDF file checksum: 2114220964

(Plugin #1/9.12/13.0)