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

 HP-1040                          INDIVIDUALHIGHLANDRETURN DUE APRILPARK30, 2023                      2022                                                       22MI-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 2023                                                              Amount of credit to 2023 >>  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: 12/01/2022

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

                                                     Taxpayer's name                                                                          Taxpayer's SSN
HP-1040, PAGE 2                                                                                                                                                                               22MI-HPK2
EXEMPTIONS                                                    Date of birth (mm/dd/yyyy)                          Regular       65 or over    Blind      Deaf   Disabled
SCHEDULE                          1a. You                                                                                                                                   1e. Enter the number of  
                                                                                                                                                                                     boxes checked on  lines 
                                  1b. Spouse                                                                                                                                         1a and 1b
1d.                     List Dependents 1c.           Check box if you can be claimed as a dependent on another person's tax return
#                                 First Name                            Last Name                Social Security Number                     Relationship      Date of Birth 1f.      Enter number of 
                                                                                                                                                                                     dependent children listed 
1                                                                                                                                                                                    on line 1d 
2`
3                                                                                                                                                                           1g. Enter number of other 
                                                                                                                                                                                     dependents listed on       
4                                                                                                                                                                                    line 1d 
5
6                                                                                                                                                                           1h. Total exemptions (Add 
                                                                                                                                                                                     lines 1e, 1f and 1g; enter 
7                                                                                                                                                                                    here and also on page 1, 
8                                                                                                                                                                                    line 21a)
EXCLUDED WAGES SCHEDULE (See instructions. Resident wages generally not excludible)  
W-2                               COLUMN A                   COLUMN B                            COLUMN C                 W-2  COLUMN A                       COLUMN B                          COLUMN C
 #                                EMPLOYER'S ID      RESIDENT EXCLUDED        NONRESIDENT EXCLUDED                        #    EMPLOYER'S ID                RESIDENT EXCLUDED          NONRESIDENT EXCLUDED 
                                                             WAGES                               WAGES                                                        WAGES                                 WAGES
 1                                                                      .00                                      .00      6                                                 .00                                 .00
 2                                                                      .00                                      .00      7                                                 .00                                 .00
 3                                                                      .00                                      .00      8                                                 .00                                 .00
 4                                                                      .00                                      .00      9                                                 .00                                 .00
 5                                                                      .00                                      .00      10                                                .00                                 .00
DEDUCTIONS SCHEDULE (See instructions; deductions allocated on same basis as related income)                                                                                                 DEDUCTIONS
1.                      IRA deduction  (Attach copy of page 1 of federal return & evidence of payment)                                                                             1                            .00
2.                      Self-employed SEP, SIMPLE and qualified plans  (Attach copy of page 1 of federal return)                                                                   2                            .00
3.                      Employee business expenses  (See instructions and attach copy of federal Form 2106)                                                                        3                            .00
4.                      Moving expenses  (Into Highland Park area only)  (Attach copy of federal Form 3903)                                                                        4                            .00
5.                      Alimony paid  (DO NOT INCLUDE CHILD SUPPORT.  Attach copy of page 1 of federal return)                                                                     5                            .00
6.                      Renaissance Zone deduction  (Attach Schedule RZ OF 1040)                                                                                                   6                            .00
7.                                Total deductions (Add line 1 through line 6, enter total here and on page 1, line 19)                                                            7                            .00
PAYMENTS AND CREDITS SCHEDULE
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                            .00
2.                      Tax payments other than tax withheld (Estimated income tax payments, extension payment, partnership payments and credit forward)                           2                            .00
3.                      Credit for tax paid to another city  (Residents attach a copy of other city's return; not allowed for nonresidents)                                        3                            .00
4.                                Total payments and credits  (Add lines 1 through 3, enter total here and on page 1, line 24)                                                     4                            .00
ADDRESS SCHEDULE (Where taxpayer (T), spouse (S) or both (B) resided during year and dates of residency)
 MARK                             ADDRESS (INCLUDE CITY, STATE & ZIP CODE) Start with address used on last year's return. If the address is the same as                                 FROM             TO
T, S, B                           listed on page 1 of this return, print "Same." If no return filed, list reason. Continue listing residence addresses from this year.             MONTH      DAY    MONTH      DAY

THIRD PARTY DESIGNEE
Do you want to allow another person to discuss this return with the Income Tax Office?                                     Yes, complete the following         No
Designee's                                                                                                                                    Phone                         Personal identification 
name                                                                                                                                          No.                           number (PIN)
                                  Under the penalty of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief it is 
                                  true, correct and complete.  If prepared by a person other than taxpayer, the preparer's declaration is based on all information of which preparer has any knowledge.
SIGN                              TAXPAYER'S SIGNATURE - If joint return, both spouses must sign Date (MM/DD/YY)        Taxpayer's occupation                 Daytime phone number           If deceased, date of death 
HERE 
===>
                                  SPOUSE'S SIGNATURE                                             Date (MM/DD/YY)        Spouse's occupation                                                  If deceased, date of death 

                                  SIGNATURE OF PREPARER OTHER THAN TAXPAYER                                                                   Date (MM/DD/YY)    PTIN, EIN or SSN
                                                                                                                                                                 Preparer's phone no.
                                  FIRM'S NAME (or yours if self-employed), ADDRESS AND ZIP CODE                                                                             NACTP    
            PREPARER'S  SIGNATURE                                                                                                                                           software    
                                                                                                                                                                            number 
                                                                                                                                                                                                    Revised: 12/01/2022