J1040 CHECK RESIDENT □
FOR CALENDAR 2022 CITY OF JACKSON, MI INCOME TAX ONE NONRESIDENT □
OR FISCAL YEAR ENDING INDIVIDUAL RETURN BOX PART-YEAR □
YOUR SOCIAL SECURITY NUMBER SPOUSE'S SOCIAL SECURITY NUMBER DATE(S) OF BIRTH FILING STATUS:
RESIDENT FROM _____ TO _____
FIRST NAME(S) AND INITIAL(S) LAST NAME TELEPHONE
HOME ( ) SINGLE JOINT
WORK ( )
(STREET OR RURAL ROUTE) DO NOT USE P.O. BOX Your Occupation
EMPLOYERS NAME & LOCAL ADDRESS
_____________________________
CITY, TOWN OR POST OFFICE STATE POSTAL ZIP CODE Spouse's Occupation
_____________________________
EXEMPTIONS: a. □ YOURSELF □ 65 & Over SPOUSE □ □ 65 & Over
Children are allowed their
own exemption even if being b. □ Blind □ Paraplegic □ Blind □ Paraplegic
claimed on parents return:
Dependents Check If age 2 or over dependent's No. of NO. OF BOXES
Did you file a 2021 City c. age 2 social security number Relationship months CHECKED ON a
Name (first, initial, and last name) if under
in your home AND b
Return? ............ : : NO. OF OTHER
DEPENDENTS
□ Yes □ No : : LISTED ON c
If yes, are the Name(s) : : TOTAL EXEMPTIONS
and Address the same? : : ADD NUMBERS
ENTERED ON
□ Yes □ No : : BOXES ABOVE
If no, list name and : :
address used on previous DO NOT ROUND
return: ....................................................................................... DROP CENTS
1A. TOTAL INCOME: (all W2's Schedules, 1099ʼs and / or documents to substantiate totals must be attached in order to process return) 1A. 00
RESIDENTS: enter total gross income for 2022. ........................................................
1B. 00
1B. NONRESIDENTS: enter gross wages from W-2, or Schedule 1, page 2 ...........................................
(If you have no additions or subtractions, carry this amount to line 4)
2. 00
2. ADDITIONS TO INCOME: (from page 2 Schedule 2R line C for Residents or 2NR line E for Non-Residents) 1120-S income is not taxable on individual return. ..
3. 00
3. SUBTRACTIONS FROM INCOME (From page 2 schedule 2R line M for Residents/Schedule 2NR line forI Non-Residents) 1120-S loss not deductible on individual return.
ATTACH ALL SCHEDULES AND EXPLANATIONS 4. 00
4. ADJUSTED INCOME (Add lines 1 and 2 less line 3.)............................................
5. 00
W-2'S HERE 5. EXEMPTIONS: Multiply the number of exemptions claimed by $600.00...............................
6. 00
6. TAXABLE INCOME (line 4 less line 5) ......................................................
7. TAX - Multiply amount on line 6 by one of the following:
A. RESIDENT ONLY - 1% (.01) ........................................................... 7. 00
B. NONRESIDENT ONLY - / % (.005)......................................................12
C. PART-YEAR RESIDENT - Tax from Schedule 4, line M........................................
PAYMENTS AND TAX CREDITS: ATTACH COPIES OF W2ʼS, 1099
8. Jackson tax withheld (You must attach copies of all W2ʼs to obtain credit for withholding.) 8. 00
9. 2022 Estimate payments (including carry forward credit from 2021 J-1040 ........... 9. 00
10. Credits for income tax paid to another Michigan municipality (Residents Only) or by 10. 00
a partnership. *Attach copy of other municipalities return.
11. TOTAL PAYMENTS AND CREDITS (Add lines 8, 9 and 10.) ...................................... 11. 00
(Make checks payable to City Treasurer.) (No payment necessary if less than $1.00)
12. BALANCE DUE: (line 7 larger than line 11)................................................... PAY WITH RETURN
12. 00
Direct Deposit- Routing Number □n Checking □ Savings
13. A. REFUND: (line 11 larger than 7.) Account Number 13A. 00
. . . . . refunds will not be made for less than $1.00 .............................................REFUND
CREDIT 13B. 00
ATTACH CHECK HERE 13. B. Credit to 2023 Estimated tax ...........................................................
13. C. Donate your refund to the City Parks and Recreation Fund ..................................... 13C. 00
14. Interest and penalty, will be assessed, after April 30th ........................................... 14. 00
15. TOTAL AMOUNT DUE add lines 12 & 14 (Do not enter refunds) ................................... 15. 00
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, his declaration is based on all information of which he has any knowledge.
SIGN SIGN HERE ...............................................................................................(Taxpayer's signature and date) (Signature of preparer other than taxpayer and date)
HERE
SIGN HERE ...............................................................................................(Spouse's signature and date) (Address) (Telephone)
MAIL RETURNS TO: CITY INCOME TAX DIVISION, 161 W. MICHIGAN AVE., JACKSON, MI 49201 Page 1
MAKE CHECKS PAYABLE TO: TREASURER, CITY OF JACKSON DUE ON OR BEFORE APRIL 30TH.