PDF document

- 1 -

INDIVIDUAL RETURN
SAGINAW DUE May 1, 2023 2022 S-1040
Your First Name and Initial Last Name Social Security Number FILING STATUS MARRIED FILING SEPARATELY
SINGLE Enter Spouse's SSN # and Full Name
If Joint, Spouse's First Name and Initial Last Name Spouse's Social Security Number MARRIED FILING JOINT NAME:
MARRIED FILING SEPARATELY SSN#
Mailing Address City/Town State Zip Code TOTAL EXEMPTIONS

RESIDENCY STATUS - MUST COMPLETE ADDRESS & EMPLOYER SECTION ON PAGE 2
RESIDENT ENTER ALL INCOME INCLUDING WAGES, TIPS, BONUSES, SICK PAY, RETIREMENT BUYOUTS, ETC, EARNED IN AND OUTSIDE
THE CITY OF SAGINAW.
NO
STAPLES PART-YEAR RESIDENT INCLUDE ALL INCOME AND WAGES EARNED DURING RESIDENCY AND WAGES EARNED IN THE CITY OF SAGINAW WHILE A
NON-RESIDENT.
NONRESIDENT IF YOU WORKED FOR AN EMPLOYER IN THE CITY OF SAGINAW ONLY, PUT TOTAL WAGES IN COLUMN SUBJECT TO TAX. IF YOU WORKED IN AND
OUTSIDE THE CITY OF SAGINAW FOR AN EMPLOYER, GO TO PAGE 2 AND USE THE NONRESIDENT WAGE ALLOCATION.
INCOME From Federal Return Not Subject to Tax Subject to Tax
1 Wages, salaries, tips, bonuses, sick pay, retirement buyouts, etc. 1 00
ATTACH 2. Taxable Interest and Ordinary Dividends. (RESIDENTS & PART-YEAR RESIDENTS ONLY) 2 00
COPY OF 3. Alimony received. 3 00
PAGE 1 & 4. Business income. (Attach copy of federal Schedule C) 4 00
SCHEDULE 5. Capital gains or losses. (Attach copy of federal Schedule D) 5 00
1 OF 6. Other gains or losses. (Attach copy of federal Form 4797) 6 00
FEDERAL 7. Taxable IRA distributions. (Attach copy of Form 1099-R) 7 00
RETURN 8. Taxable pension distributions. (Attach copy of Form 1099-R) 8 00
9. Rental real estate, royalties, partnerships, trusts, etc. (Attach copy of federal Sch. E) 9 00
10. Subchapter S Corp distributions/dividends (Attach copy of federal Schedule K-1) Residents Only. 10 NOT APPLICABLE 00
11. Farm income or (loss). (Attach copy of federal Schedule F) 11 00
ATTACH 12. Military pay and Unemployment NOT TAXABLE TO CITY 12 NOT TAXABLE NOT TAXABLE 00
W-2's 13. Social security benefits. NOT TAXABLE TO CITY 13 NOT TAXABLE NOT TAXABLE 00
AND 14. Other income. List type and amount. Type Amount $ 14 00
FORMS 15. Total income. Add lines 1 through 14. 15 00
HERE DEDUCTIONS See instructions. Deductions must be allocated on the same basis as related income.
16. Individual Retirement Account deduction. (Attach copy of SCHED 1 of federal return & evidence of pmt) 16 00
17. Self Employed SEP, SIMPLE and qualified plans. (Attach copy of SCHED 1 of fed rtrn & evidence of pmt) 17 00
18. Employee business expenses. (See Instructions and attach copy of federal Form 2106) 18 00
19. Moving expenses. (Into taxing area only) (attach copy of federal Form 3903) 19 00
20 Alimony paid. DO NOT INCLUDE CHILD SUPPORT (Attach copy of SCHEDULE 1 of federal return) 20 00
21 Renaissance Zone deduction. (ATTACH ORIGINAL CERTIFICATE) 21 00
22 Total deductions. Add lines 16 through 21 22 00
23 Total income after deductions. Subtract line 22 from line 15. 23 00
24 Amount for exemptions. (Number of exemptions, _____ x $750) MUST COMPLETE EXEMPTION SCHEDULE ON PAGE 2 24 00
ATTACH 25 Total income subject to tax. Subtract line 24 from line 23 25 00
CHECK 26 Tax at MULTIPLY LINE 25 BY .015 (Resident) .0075 (Non-Resident) % (Partial Resident-from table) 26 00
OR PAYMENTS AND CREDITS (If line 26 exceeds $100 see instructions for making estimated tax payments)
MONEY 27 Tax withheld by your employer (ATTACH 2022 W-2 FORMS showing Saginaw Tax Withheld) 27 00
ORDER 28 Payments on 2022 Declaration of Estimated Income Tax payments with an extension and credits forward from 2021 28 00
HERE 29 Tax paid to another city and for tax paid by a partnership. (ATTACH COPY OF OTHER CITY'S RETURN) 29 00
30 Total payments and credits. Add lines 27 through 29 30 00
31. If tax (line 26) is larger than payments(line 30) you OWE TAX. Please enter amount due and submit payment with 31
return. Or enter bank information for ELECTRONIC BANK WITHDRAWAL TAX DUE 00
32. If payment(line 30) is larger than tax (line 26) ENTER OVERPAYMENT OVERPAYMENT
33. Overpayment to be HELD and APPLIED TO 2023 estimated tax. CREDIT FORWARD ( )
34. DONATIONS for annual fireworks, please donate $1.00 or more DONATION ( )
35. REFUND subtract line 33 & 34 from line 32, this is your total refund
REFUND 00
ELECTRONIC 36 Mark one: Refund - Direct Deposit Pay Tax Due - Electronic funds withdrawal
REFUND OR a. Routing number
PAYMENT
INFORMATION b. Account number C. Account Type: Checking Savings

MAIL ALL RETURNS (PAYMENTS/TAX DUE, REFUNDS & NO REFUND/NO TAX DUE) TO: INCOME TAX OFFICE
1315 S WASHINGTON
SAGINAW, MI 48601
Page 1

- 2 -

                                    FAILURE TO FILL OUT EMPLOYMENT INFORMATION/EXEMPTION SCHEDULE AND ADDRESSES
                    OR FAILURE TO ATTACH DOCUMENTATION OR ATTACHING INCORRECT OR INCOMPLETE DOCUMENTATION
                    WILL DELAY PROCESSING OF RETURN AND MAY RESULT IN  DEDUCTIONS AND LOSSES BEING DISALLOWED
   REQUIRED--MUST BE FILLED OUT COMPLETELY       (NOT COMPLETING WILL DELAY PROCESSING YOUR RETURN )
EMPLOYERS -  LIST ALL EMPLOYERS DURING 2022 & ACTUAL JOB LOCATION ( if more than 4 list on separate sheet & attach)
                                                                                             FROM                             TO
                                  ADDRESS OF ACTUAL WORK                                                                                        Total Wages from 
                                  LOCATION (may be different from                                                                               Box 1 on W2 from Saginaw Tax 
 EMPLOYERS                              address on W-2)                                     Month      Day Month                        Day     employer         Withheld

                                                                                                                                                                                     Enter total on page 
                                                                         Enter total on page one, in box 1                                                                             one, line 27
EXEMPTIONS SCHEDULE
                    Date of birth       Regular                65 & over   Blind                               Box A.  Number of boxes checked                                       Box A
You
Spouse
                                                                                                               Box B.   Number of dependents                                         Box B
DEPENDENTS                                                                                                   (attach copy of Page 1 of Federal Return)
                                                                                                               Box C.  Total Exemptions                                              Box C
                    Attach Copy of Federal Return Page 1                                                   (Add Box A and Box B) 
                                                                                                                                        Enter Box C amount on page 1
ADDRESSES                               Enter name and address used on 2021 return. (If same as 2022 write "SAME". If none filed, please give reason. )
LIST ALL ADDRESSES WHERE YOU RESIDED IN 2022 (if more than 2,  list on separate sheet and attach)
INDICATE:                T = TAXPAYER           S = SPOUSE                    B  =  Both                                                        FROM                               TO
 T,S, B                                     ADDRESS                                                                                MONTH       DAY                  MONTH                  DAY

SCHEDULE A - NONRESIDENT WAGE ALLOCATION  (If you were a resident at any time during the year, do not use this Schedule)
If you worked by remote from your home outside the City of Saginaw for hours approximating your regular shift during COVID, use schedule below
and attach a letter of verification from your employer.
EMPLOYER NAME:   (A COMPUTATION MUST BE MADE FOR EACH EMPLOYER)                                                                 Example
A. Actual number of days worked everywhere for employer during 2021 (do not include vacation,
 weekends off, holiday and sick days)                                                                                                   100
B. Actual number of days worked outside the City of Saginaw                                                                             20
C. Subtract line   from line B    A                                                                                                     80
D. Percentage of days worked in the City of Saginaw (Line   divided by LineC                 A )                                        80%               %                   %                         %
E. Total wages shown on W-2, box 1                                                                                              $20,000
F. Wages earned in the Saginaw City.  Line   multiplied by percentage on line E              D                                  $16,000
                    Enter amount from line F on page 1, line 1, in column Subject to Tax
SCHEDULE B - EXCLUDIBLE INTEREST AND DIVIDEND INCOME (FOR USE BY RESIDENTS ONLY)
Excludible Interest Income                                                                                 Excludible Dividend Income
Interest income from federal return                                                                        Dividend income from federal return
Excludible interest income                                                                                 Excludible dividend income
      Interest from federal obligations                                                                         Dividend from federal obligations
      Interest from Subchapter S corp                                                                           Other excludible dividend income 
     Other excludible interest income 
     Total excludible interest income                                                                           Total excludible dividend income
     Taxable interest income                                                                                    Taxable dividend income
SCHEDULE C - BUSINESS INCOME, BUSINESS ALLOCATION FORMULA AND PROFIT OR LOSS (ATTACH FEDERAL SCHEDULE C).
SCHEDULE D - SALE OR EXCHANGE OF PROPERTY (ATTACH FEDERAL FORM SCHEDULE D)
SCHEDULE E - SUPPLEMENTAL INCOME (ATTACH FEDERAL FORM SCHEDULE E)
1.  Rents (Excludable by NON-RESIDENTS only on property located outside the City of Saginaw)
2.  Partnerships (Excludable by NON-RESIDENTS only on partnerships located outside the City of Saginaw)
3.  Other (Identify)
4.  Total Excludable Supplemental Income (Add Lines 1, 2 and 3)
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. (           )
I declare that I have examined this return (including accompanying schedules and statements) and to the best of my knowledge and belief it is true, correct
and complete.  If prepared by a person other than taxpayer, the preparer's declaration is based on all information of which preparer has any knowledge.
                                                                                                             /     /                                                                       /        /
SIGN                TAXPAYERS' SIGNATURE- If joint return, both taxpayers must sign.                       DATE                 PRINT NAME OF PREPARER                                 DATE
                                                                                                            /     /             (              )
                    SPOUSE'S SIGNATURE                                                                     DATE                 PREPARER'S PHONE NUMBER
        Some cities are using new communications methods. If your City participates and you would like email notifications regarding important changes and income tax 
        related information, please provide your email address. No City will email you asking for your social security number.
                    Email address: __________________________________________________________________________________________________
                                                                                 PAGE 2

PDF file checksum: 896983320

(Plugin #1/9.12/13.0)