CITY OF LAPEER INDIVIDUAL INCOME TAX RETURN       DUE May 1, 2023         2022 L-1040 
 TAXPAYER’S FIRST NAME, MIDDLE INITIAL, AND LAST NAME                                                                    YOUR SOCIAL SECURITY NUMBER      Check here if you itemized deductions on your 
                                                                                                                                                          2022 federal tax return                          
 IF JOINT RETURN, SPOUSE’S FIRST NAME, MIDDLE INITIAL, AND LAST NAME                                                     SPOUSE’S SOCIAL SECURITY NUMBER  Deceased:   Taxpayer                      Date________________ 
                                                                                                                                                                               Spouse               Date________________ 
 CURRENT HOME ADDRESS (NUMBER AND STREET INCLUDING APARTMENT NUMBER)                                                     IF MARRIED, IS SPOUSE FILING A SEPARATE RETURN?   YES                               NO     
                                                                                                                         If Yes - Spouse’s Name and SSN:  
 CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE                                                                           ENTER NAME AND ADDRESS USED ON 2021 RETURN IF DIFFERENT 
                                                                                                                          
RESIDENCY STATUS:        RESIDENT          NONRESIDENT         PART-YEAR RESIDENT FROM   ________/_______/2022 TO _______/________/2022  
 
 EXEMPTIONS 1a    Yourself     65 or over     Blind     Disabled    Deaf   1b.   Spouse    65 or over    Blind    Disabled     Deaf 
         Name of Dependent                                                 Social Security Number                        Relationship  Date of Birth      Number of boxes checked                                    
 1c.                                                                                                                                                      Number of dependents listed   
 1d.                                                                                                                                                                                                                 
 1e.                                                                                                                                                      Total Exemptions                                           
 1f.                                                                                                                                                      (Enter on line 17)                                         
                  INCOME   Resident-report all income earned regardless of where earned. Nonresident-report all income earned in City. Include Wages, Tips and other Compensation  
                                                      (Deferred compensation distributions, sick pay etc.). Wages earned in and out of the City by the same employer should be allocated on Page 2, line 27. 
  ATTACH TO                        Employer’s Name                                                                        Where you work                   Column A                                                Column B                 
  BACK OF THIS                                                                                                                                            Income Tax Withheld                       Wages from W-2, Box 1 
     RETURN     2a                                                                                                                                                                           .00                    .00 
     COPY OF    2b                                                                                                                                                                           .00                    .00 
  PAGES 1&2 OF  2c                                                                                                                                                                           .00                    .00 
     FEDERAL    2d                                                                                                                                                                           .00                    .00 
  FORM 1040 
 AND REQUIRED   2e Total for additional employers from attached sheet                                                                                                                        .00                    .00 
  SCHEDULES     3       TOTAL COMPENSATION AND LAPEER TAX WITHHELD                                                                                        3a                                .00     3b                          .00 
                4   Taxable interest                                                                                                                          Attach copy of Page 1 of Federal 1040 4                            .00 
                5   Ordinary dividends                                                                                                                      Attach copy of Page 1 of Federal 1040   5                            .00 
                6   Business and farming income from Page 2, line 28f                                                                        Attach copy of Federal Schedule C                      6                            .00 
       
     ATTACH     7   Capital gains or losses                                                                                                                     Attach copy of Federal Schedule D   7                            .00 
     W-2        8   Rental real estate, royalties, partnerships, trusts, etc. from Page 2, line 30d                                  Attach copy of Federal Schedule E                              8                            .00 
     FORMS      9   Other income total from Page 2, line 31f                                           (UNEMPLOYMENT IS NOT TAXABLE INCOME TO THE CITY)                                             9                            .00 
     HERE       10      TOTAL INCOME ADD LINES 3B THROUGH 9                                                                                                                                         10                          .00 
                DEDUCTIONS 
                11 Individual Retirement Account                                                   Attach copy of Federal 1040 Schedule 1                 11                               .00 
                12 Employee business expenses                                                      Attach copy of Federal Schedule 2106                   12                               .00 
     ENCLOSE 
  CHECK OR      13 Moving expenses                                                                                   Attach Federal Form 3903 or list     13                               .00 
     MONEY      14 Alimony paid – DO NOT INCLUDE CHILD SUPPORT             Attach copy of Federal 1040 Schedule 1                                         14                               .00 
     ORDER      15      TOTAL DEDUCTIONS.  ADD LINES 11 THROUGH 14                                                                                                                                  15                          .00 
     FOR TAX    16      TOTAL INCOME AFTER DEDUCTIONS.  SUBTRACT LINE 15 FROM LINE 10                                                                                                               16                          .00 
     DUE        17   Amount for exemptions.  Number of exemptions ________ times exemption amount of $600.00                                                                                        17                          .00 
     (DO NOT 
     STAPLE     18      TOTAL INCOME SUBJECT TO TAX.  SUBTRACT LINE 17 FROM LINE 16                                                                                                                 18                          .00 
     TO                   CALCULATE CITY OF LAPEER TAX :                                                                                                                                             
     RETURN) 
                19      Multiply Line 18 by .01 for Residents, .005 for Nonresidents or amount from Part-year resident Schedule P                                                                   19                          .00 
                PAYMENTS AND CREDITS     (If line 24 exceeds $100 see instructions for making estimated tax payments) 
                20 Tax withheld by your employer from line 3a above                                                                                                                                 20                          .00 
                21 Payments on 2022 Declaration of Estimated Income Tax, extension and credit forward                                                                                               21                          .00 
                22 Credit for tax paid to another city and/or for tax paid by a partnership. Attach copy of other city’s return                                                                     22                          .00 
                23      TOTAL PAYMENTS AND CREDITS ADD LINES 20 THROUGH 22                                                                                                                          23                          .00 
 TAX DUE                24. If tax (line 19 is larger than payments (line 23)                                         >>>>   PAY WITH RETURN                                                        24                          .00 
                        Check, money order or for direct withdrawal mark 27 a, c, d, e, f below                                                                   
 OVERPAYMENT            25. If payments (line 23) are larger than tax (line 19)                                                       >>>>   REFUND                                                 25                          .00 
                        For direct deposit mark 27 b, d, e, f below 
 CREDIT TO 2023         26. Overpayment to be HELD and APPLIED TO 2023 ESTIMATED TAX                >>>>   CREDIT FORWARD                                                                           26                          .00 
 ELECTRONIC REFUND OR PAYMENT INFORMATION                          27 a.  TAX DUE – DIRECT WITHDRAWAL                                                                                                     
                                                                                                                                                     b.  REFUND – DIRECT DEPOSIT                 
 c. Electronic funds withdrawal effective date:       ______/______/______                          d.  Account Type:     SAVINGS                                    CHECKING                                                                                 
                                                                           (if blank, default is date return processed) 
  
 e. Routing No. MUST BE 9 DIGITS ___ ___ ___ ___ ___ ___ ___ ___ ___   f. Account No.   ___ ____ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___   

                                                                            SIGNATURES ARE REQUIRED ON PAGE 2 
MAKE CHECK OR MONEY ORDER PAYABLE TO: CITY OF LAPEER OR PAY WITH ELECTRONIC FUNDS WITHDRAWAL 
MAIL RETURN TO: Lapeer City Income Tax Department, 576 Liberty Park, Lapeer, MI  48446                                                             2022 L-1040 PAGE 1 

            FAILURE TO ATTACH DOCUMENTATION OR ATTACHING INCORRECT OR INCOMPLETE DOCUMENTATION 
            WILL RESULT IN DEDUCTIONS AND LOSSES BEING DISALLOWED OR DELAY PROCESSING OF RETURN 
 
  27. WAGE ALLOCATION - FOR NONRESIDENT WORKING INSIDE AND OUTSIDE OF LAPEER FOR SAME EMPLOYER 
  COMPUTATION OF LAPEER WAGES OF A NONRESIDENT WHO WORKS BOTH IN AND OUTSIDE OF LAPEER FOR THE SAME EMPLOYER. 
  WAGES FROM LINE 27f ARE TO BE ENTERED ON THE APPROPRIATE LINE OF PAGE 1, LINES 2a THROUGH 2e, COLUMN “Wages from W-2, Box 1” 
  27a Employer Name. (A COMPUTATION MUST BE MADE FOR EACH EMPLOYER)                                                            1                    2         3                         4 
  27b Actual number of days or hours worked for employer. (DO NOT INCLUDE WEEKENDS OFF,                                                                                                  
  HOLIDAYS, SICK OR VACATION DAYS, ETC. IN AMOUNTS ON 27b and 27c 
  27c Actual number of days or hours worked in Lapeer                                                                                                                                    
  27d Percentage of days or hours worked in Lapeer. Line 27c divided by line 27b                                                                 %        %                           %           % 
  27e Total wages shown on LW-2 or W-2 box 1.                                                                                                   .00       .00                     .00            .00 
  27f Wages earned in Lapeer. Line 27e multiplied by percentage on line 27d                                                                     .00       .00                     .00            .00 
    Enter on page 1, column B, lines 2a through 2e, the Lapeer wages from 27f for each employer 
 
  28.  BUSINESS AND FARMING INCOME 
  28a Net profit (or loss) from business, profession or farm.  (ATTACH FEDERAL SCHEDULE C OR SCHEDULE F                                                                                          .00 
  28b Allocation percentage from line 29g below. (IF ALL BUSINESS WAS CONDUCTED IN LAPEER ENTER 100%)                                                                                            % 
  28c Allocated net profit (loss).  Multiply line 28a by line 28b                                                                                                                                .00 
  28d Applicable portion of net operating loss carryover.  (ATTACH SCHEDULE)                                                                                                                     .00 
  28e Applicable portion of retirement plan deduction.     Check type of plan     KEOGH                                        SEP               SIMPLE (Attach federal schedule)                .00 
  28f Total. Lines 28c less lines 28d and 28e.  ENTER HERE AND ON PAGE 1 LINE 6                                                                                                                  .00 
 
  29.  BUSINESS ALLOCATION FORMULA-                                                                                                 
         FOR NONRESIDENT BUSINESS INCOME EARNED INSIDE AND OUTSIDE THE CITY OF LAPEER     
                                                                                                                                     COLUMN 1             COLUMN 2                      COLUMN 3 
  BUSINESS FEIN:                                                                                                                     LOCATED              LOCATED IN                    PERCENTAGE 
                                                                                                                                    EVERYWHERE            LAPEER                        (COLUMN 2 
  29a Average net book value of real tangible personal property                                                                                       .00                         .00   DIVIDED BY 
  29b Annual gross rent paid on real property multiplied by 8.                                                                                        .00                         .00   COLUMN 1) 
  29c Total property.  Add lines 29a and 29b                                                                                                          .00                         .00             % 
  29d Total wages, salaries and other compensation of all employees                                                                                   .00                         .00             % 
  29e Gross receipts from sales made or services rendered                                                                                             .00                         .00             % 
  29f Total percentages. Add the percentages computed in column 3 lines 29c, 29d and 29e                                                                                                          % 
  29g Business Allocation Percentage.  Divide line 29f by the number of factors used ENTER HERE AND ON LINE 28B ABOVE                                                                             % 
 
  30.  RENTAL REAL ESTATE, ROYALTIES, PARTNERSHIPS, TRUSTS, ETC. 
  THE FEDERAL RULES CONCERNING PASSIVE LOSSES ARE APPLICABLE TO LOSSES DEDUCTED ON THIS RETURN. SUBCHAPTER S GAINS ARE NOT TAXABLE AND 
  SUBCHAPTER S LOSSES ARE NOT DEDUCTIBLE ON INDIVIDUAL RETURNS UNDER THE LAPEER INCOME TAX ORDINANCE. 
  30a Rental real estate from federal Schedule E.  (ATTACH FEDERAL SCHEDULE E AND FORM 8582)                                                                                                     .00 
  30b Partnership, estates, trusts from federal Schedule E. (ATTACH FEDERAL SCHEDULE E AND SCHEDULE K-1)                                                                                         .00 
  30c Subchapter S distributions.  (ATTACH A COPY OF FEDERAL SCHEDULE K-1)                                                                                                                       .00 
  30d Total.  Add lines 30a, 30b and 30c. ENTER HERE AND ON PAGE 1, LINE 8                                                                                                                       .00 
 
  31.  OTHER INCOME 
  OTHER INCOME INCLUDES: GAMBLING & LOTTERY WINNINGS, ALIMONY RECEIVED, PROFIT SHARING PLAN DISTRIBUTIONS, PREMATURE IRA DISTRIBUTIONS, 
  PREMATURE PENSION PLAN DISTRIBUTIONS, ETC. ATTACH COPIES OF ALL FEDERAL SCHEDULES AND FORMS 1099. 
                           RECEIVED FROM                                                                                           KIND OF INCOME                                       AMOUNT 
  31a                                                                                                                                                                                            .00 
  31b                                                                                                                                                                                            .00 
  31c                                                                                                                                                                                            .00 
  31d                                                                                                                                                                                            .00 
  31e                                                                                                                                                                                            .00 
  31f Total. Add lines 31a through 31e.  ENTER HERE AND ON PAGE 1, LINE 9                                                                                                                        .00 
   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. ___________________  Personal ID Number(PIN)____________ 
  
 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. 
  
 ___________________________________________________/____/____   _______________________________________________/____/____ 
 TAXPAYER’S SIGNATURE – If joint return both husband and wife must sign.       DATE      SIGNATURE OF PREPARER OTHER THAN                                 TAXPAYER                          DATE 
 __________________________________________________/____/____     ________________________________________________________ 
 SPOUSE’S SIGNATURE                                                                                           DATE            PREPARER’S ADDRESS 
  
 Date of birth: Taxpayer_____________________________ Spouse______________________ PREPARER’S PHONE NUMBER (_______) ___________________________________   
  
 DAYTIME PHONE NUMBER (_______) ___________________________________________  Taxpayer email___________________________________________________________                       
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