P-1040X 
                                                     CITY OF PONTIAC INCOME TAX                                                                                                           Batch No. 
        CITY     OF                                                                                                                                                                       Verified 
  PONTIAC                                                     Amended Individual Return                                                                                                   Refund Approved 
        Flrs1 Name and Initial                                         las1Name                                                            Your Social Security Number                    0          letter     D Audit 
PLEASE             (If joint return of husband and wife, use first names and middle Initials of both)                                           Your Occupation                           Assess No. 

PRINTOR HomeAddress (NumberandStreetorRuralRoute)                                                                                 Spouse'sSocialSecurityNumber                            yourIfyouFederalare anEMPLOYEREMPLOYER, enter 
TYPE 
        City, Town or Pos1   on1ce                              State                        Postal.t:lp Code                                 Spouse's 0Coupat1on                         ldentlftcation No. here: 

THIS RETURN AMENDS           PREVIOUSLY FILED RETURN FOR CALENDAR YEAR,                                                       OR FISCAL YEAR                                   ENDED 
PLEASE ANSWER ALL QUESTIONS AND FILL IN APPLICABI..E ITEMS. 
ENTER NAME AND ADDRESS USED ON          ORIGINAL RETURN       (IF SAME AS ABOVE, WRITE "SAME'). IF  CHANOINO FROM                          SEPARATE TO JOINT RETURN, ENTER NAMES AND                            ADDRESSES USED ON 
ORIGINAL  RETURNS.    (NOTE: YOU CANNOT CHANGE FROM JOINT TO SEPARATE RETURNS AFTER THE DUE DATE HAS PASSED FOR                                         FiliNG SEPARATE RETURNS.) 
                                                                                                                                                       MARRIED FILING                     MARRIED FlUNG 
FlUNG                                                           RESIDENT            NONRESIDENT                           SINGlE                                JOINTLY                          SEPARATELY 
STATUS                On original return             .... .           0                  0                                    0                                                0                        0 
CLAIMED               On this return             _____     .. .       0                  0                                    0                                                D                        0 
PART I 
                                                                                                                                           A.                                     B. 
                                                     INCOME 
                                                                                                                                  As       originally           ~ncrea$8 Net ChangeorOecrea$8,                  Correctc.Amount 
                                                                                                                                  reported                                     explain on page 2) 
  1. Total Income Subject to Tax                                                                                       $                                        $                                       $ 
                                            TAX LIABILITY 
  2.  City of Pontiac Tax 
                                PAYMENTS AND CREDITS 
  3. Total Pontiac          Tax Withheld 
  4. Estimated Pontiac Income Tax Payments 
  5.    Other Credits 
  6. Amount        paid with original return  plus additional payments made after it was filed 
  7. Total payments and credits                  -addlines 3through           6, Column C 
                             REFUND OR BALANCE DUE 
  8. Amount of refund received or requested                     on    original return 
  9.    Net payments and credits-subtract line 8from line                        7, and enter result 
10.  If line 2,    Column C is more than line 9,                enter Balance Due. PAY IN                  FULL WITH THIS RETURN                                                                        $ 
11.     If line 2, Column    Cis less than line 9,              enter Refund to be received                                                                                                             $ 
PART II -        EXEMPTIONS 
  1.    Number of exem          tions claimed on original return 
  2.    Number of exem          tions claimed on this return 
  3.    Difference 
NOTE:  Explain any           increase in         exemptions in lines      4,  5 and 6 below. For decreases                                 in exemptions, no entries need to be made                                   on         lines 4, 
           5and 6 exptam;    I  .   thi sd  ecrease10.  P  art  Ill b eowI 
  4.    Additional Exemptions for Yourself -                    and                             Regular                       65 or over                Blind                     Enter number 
        Spouse (Check only those boxes not                                {Yourself      ....                                              0                                      of boxes 
        checked    on original return)                                        Spouse     ....                          8                   0            8}                        checked 
  5.    Enter first names of your dependent children who lived with you,  but were not claimed on original return                                                                                       .... 
                                                                                                                                                                               Enter number 

  6.    Other                Enler(a) NAMEfigure 1in the las1             (b) Rela-   home.lfbomlived(c) Monthsin your dependent(d)haveDid    (e)furnisheddependent'sAmountYOUfor furnished(J) Amountby .... 
        dependents 
        not                  column to right for     each                 tionship    or died during                   income                    support. If                           OTHERS 
                             name listed         (If more space 
        claimed                                                                     year also write                    af$600or                 100% write                             including 
                             is needed, atlach schedule)                              "B"    or "D"                    more?                     "ALL"                            dependent. 
        on 
        original 
        return                                                                                                                                                                                          .... 
                                                                                                                                                                                                        .... 
                                                                                                                                                                                                        .... 
PART Ill- EXPLANATION OF CHANGES (USE REVERSE SIDE) 
I declare thai I have filed an original rei urn and lhat I have examined this amended return, including accompanying schedules and statements, and to the bes1 of my knowledge and belief 
this amended retum is lrue, correct and complete. If prllp&flld by a person   olher than the taxpayer, his declaration is based on all information of which                                          he has any knowledge. 

Sign             Your Signature                                                                 Dale                                       Signature of preparer other than taxpayer                            Dale 
Here             Spouse'ssignature      ~filing jointly,  BOTH mus1sign evan ifonly one hadincome)                                         Address 
MAIL TO:  City Treasurer, Income Tax Division, 
Page 1           47450 Woodward Avenue, Pontiac, Michigan 48342                                                                            Preparer's Employer No.                or Social Security No. 
                 P.O. Box 530, Eaton Rapids, MI 48827-0530

PART Ill -EXPLANATION OF CHANGES 

                                           Instructions for City of Pontiac Form P-1040X 
                                                           Amended Individual Return 
USE OF FORM P-1040X 
Fonn P-l040X can only be filed after you have filed your original return.                         It is designed to expedite processing and should be used to 
correct an individual tax return filed for any year. 
ATTACHMENTS TO THE RETURN 
If any of the schedules as originally filed on your individual tax return require adjustments, you should attach a copy of the schedule, with 
the corrected figures only, to support the change.         Enter the word "amended"               and your name, address                  and       social security number on  all 
attached sheets or schedules. 
Forexample,  aifSchedule L          was attachedto the original return and the changes involve                       amountsreportedontheSchedule L, a revised 
Schedule L should be attached to the    amendedreturn; or, ifSchedule L was erroneously                          notfiledwiththeoriginal return, attach a completed 
Schedule L to the amended return. 
If only part of a schedule is to be amended, it is only necessary to fill in that portion of the schedule which is applicable. 
If you   are correcting wages, withholding tax credit.       or other employee compensation,                         ATIACH COPY B                  OF    ANY ADDmONAL OR 
CORRECI'ED FORMS PW-2               OR W-2 received since your original return was filed. 
INSTRUCTIONS FOR FILLING IN PART I OF FORM P-1040X 
Column "A"    -   Entries in this column are the amounts shown on your original return or as later corrected and closed on the basis of an 
                  examination of your original return. 
Column "B"    -   Entries are the increases or decreases in the figures reported in Column A.                                No entty should be reported in Column B           if 
                   Column A    is unchanged.     All entries in Column B must be                  explained in Part ill. 
Column "C"    -Entries reported in this column are the corrected                 totals after taking into account increases or decreases in                          Column B. If 
                   there is no change, enter the same amount as             shown in Column A. 
Line 1  -     The entty on this line is the amount of income after deducting exemptions                          on which the tax was computed. If your return has 
              already been audited, enter the    corrected figure        for the above-mentioned applicable line. 
Line 2  -     This line should report   your City of Pontiac tax.        The     City of Pontiac Income              Tax became           effective on Januai}'  1,  1968.     The 
              resident rate is 1% and the non-resident rate is WYo. 
Line 3  -     Enter your total Pontiac Tax withheld. If you are reporting a change in your Pontiac withholding tax credit. attach Copy B                                       of 
              anyadditional orcorrected Forms        PW-2  or W-2        received since   youroriginal return                     wasfiled. 
Line 4  -     Enter Credit claimed for payments made on a City of Pontiac Declaration of Estimated Tax for the year you are amending. 
Line 5   -    Enter other credits, if any, not reported    on lines 3, 4, or 6. 
Line 6  -     Enter the amount actually paid with your original return. Also, include any payments made on assessments of tax for the year 
              you are amending. 
Line 8  -     Enter the amount of refund received or expected to be received from your original return. Any refund due from your original 
              return will be refunded separately and must be subtracted from your credits claimed on this return. 
Line lO  -    If your tax, line 2,  Column C, is greater than your credit. line 9, Column C, the balance due must be paid with this return. Make 
              check or money order payable to "Treasurer, City of Pontiac." 
Line 11  -    If you are entitled to a refund larger than that claimed on your original return, your amended return should show ONLY THE 
              ADDmONAL REFUND DUE. This amount will be refunded separately from                                      that shown on your original return, as stated in 
              the instruction for line 8. 
INSTRUCTIONS FOR FILLING IN PARTS II AND         Ill OF FORM P-1040X 
Partll   -    Complete lines  2I,   and3 inall cases. Complete lines 4,          5, and6ifthenumber ofexemptions claimed                                  onthisreturn exceeds the 
              number of exemptions originally claimed. Enter on lines 4,               5 and 6 only these additional exemptions. 
Part III  -   For each change reported in Column B, enter the line reference from Part 1 and explain, in detail, the reasons for the change. 
              Show all computations and attach any evidence to verify the changes reported.                          If more space is needed, attach additional sheets. 
WHERE TO FILE 
Mail your return and any remittance due to: 
     CITYCITY TREASURERTREASURER--- CITYINCOMEOF PONTIACTAXDMSION,INCOME TAX47450DIVISION,WoodwardP.O.Avenue,Box 530,Pontiac,EatonMichiganRapids, MI48342.48827-0530.
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