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 PH-1040X                         CITY OF PORT HURON                                                                                                                  TAX YEAR being amended: 
                                  AMENDED INDIVIDUAL INCOME TAX RETURN 
 Revised 11/20 
 
    Your first name and initial                                      Last name                                                                 Your social security number 
                                                                                                                                                                                
    If a joint return, spouse's first name and initial               Last name                                                                 Spouse's social security number 
                                                                                                                                                                                
    Home address (number and street or PO Box)                                                                          Apartment number     Is this the same name and address 
                                                                                                                                             as your original return? 
    City, town or post office, state and ZIP code                                                                                          
                                                                                                                                                                      Yes       No 
                                 
 RESIDENCY STATUS                Resident                        Nonresident                 Partial Resident           If a PARTIAL RESIDENT, enter the dates you lived in the city: 
  On original return                                                                                                  FROM:                                             TO:                    
  On this return                                                                                                      FROM:                                             TO:                    
                                                                                                                               
 FILING STATUS                    Single                         Married filing joint return Married filing separate return    
                                                                                                                               Note: you cannot change from joint to separate 
  On original return                                                                                                           returns after the due date for filing has passed 
  On this return 
 
                                                                                                                        A.                     B.                               C. 
                                                                                                                      On Original Return  Net Change                           Correct Amount 
                                                                                                                                           Increase  or 
 AMOUNT OF TAX                                                                                                                             (Decrease) 
 1. Total income . . . . . . . . . . . . . . . . . . . . . . . .                                                   1                                                           
                                                                                                                                                                               
 2.  Exemption credit. If changing, fill out part I on the back . . . . . .  .                                     2 
                                                                                                                                                                               
 3.  Taxable income. Subtract line 2 from line 1. If less than zero, enter -0-                                     3 
                                                                                                                                                                               
 4.  Tax. Residents 1% (.01), nonresidents ½ of 1% (.005), or Schedule L                                           4 
 PAYMENTS                                                                                                                                                                      
                                                                                                                   
 5.  Total Port Huron tax withheld . . . . . . . . . . . . . . . . .                                               5 
                                                                                                                                                                               
 6.  Estimated tax payments and amounts carried forward from last year                                             6 
                                                                                                                                                                               
 7.   Other credits .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .  7 
 8.  Amount paid with your original return plus any additional tax paid after it was filed . . . . . . . . . . . . .  .                                                8       
                                                                                                                                                                               
 9.  Total payments and credits. Add lines 5 through 8 in column C . . . . . . . . . . . . . . . . . . . . .  .                                                        9 
 REFUND OR BALANCE DUE                                                                                                                                                         
                                                                                                                                                                       
 10. Refund, if any, shown on your original return  .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .  10 
                                                                                                                                                                               
 11. Subtract line 10 from line 9, this is the net tax you paid to the city  .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .         11 
                                                                                                                                                                               
 12. If line 4 is more than line 11, subtract line 11 from line 4.  This is your tax due .............................. PAY BALANCE DUE                                12 
                                                                                                                                                                               
 13. If line 11 is more than line 4, subtract line 4 from line 11.  This is the amount you overpaid ................ OVERPAYMENT                                       13 
                                                                     Be sure to complete the back of the return 
                                                                                                                        
 I declare, under penalty of perjury, that the information in this return and attachments is true and                   I declare under penalty of perjury, that this return is based on all 
 complete to the best of my knowledge.                                                                                  information of which I have knowledge. 
 Your signature                                                                              Date                      
                                                                                                                        Preparer's name, address and ID number 
 X                                                                                                                     
 Spouse's signature - if a joint return BOTH MUST SIGN                                       Date                      
                                                                                                                       
 X                                                                                                                     
                                                                                                                       
                                                                                                                        Preparer's signature                                    Date  
 Make checks payable to:  City of Port Huron                     Mail to: Income Tax Division                          
 If paying in person, pay at the City Treasurer's Office.            100 McMorran Blvd. 
 To pay online, go to www.porthuron.org.                             Port Huron, MI  48060                              X 
  



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 PART I - Exemptions Complete this section if you are changing the number of exemptions claimed. Show the CORRECT information below. 
 Check all boxes that apply: 
                         extra exemptions if:                                             extra exemptions if: 
             65 or older blind     deaf       disabled                        65 or older blind deaf           disabled 
 You:                                                  Spouse: 
 
 Dependents                                                                                                     
  First name             Last name                     Social security number  Relationship to you              Number of exemptions claimed 
                                                                                                                on your original return: 
                                                                                                                                                
                                                                                                                Number of exemptions claimed 
                                                                                                                on this return:                 
                                                                                                                
                                                                                                                Difference:                     
 
 PART II - Explanation of Changes Explain why this return is being amended below. 






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