DIVISIO OF RVU D XIO OR HR M R I C R For the year January December, 07, or other tax year beginning H 00R-CM OF P CMI onresident lien Income ax Return DS CO I S L COMMOWLH OF H ORHR MRI ISLDS L H L D M M O W L I Form I CI L S DS L IS R OF F W R CO M MO O R H H H M OF, 07, and ending M O F F I 07, 0 Last name Identifying number (see instructions) Present home address (number, street, and apt no, or rural route) If you have a PO box, see instructions Individual Check if: state or rust Foreign country name Single resident of Canada or Mexico or single US national Other single nonresident alien Married resident of Canada or Mexico or married US national If you checked box or above, enter the information below Filing Status Check only one box xemptions Foreign province/state/county (i) Connected With CMI rade/ Business ttach Form(s) W-, 0-S, SS-0S, RRB-0S, and 888- here lso attach Form(s) 099-R if tax was withheld djusted Gross Income (iii) Spouse s identifying number Yourself If someone can claim you as a dependent, do not check box 7a Spouse Check box 7b only if you checked box or above and your spouse did not have any CMI gross income c Dependents: (see instructions) Income Married resident of South Korea Other married nonresident alien Qualifying widow(er) with dependent child (see instructions) (ii) Spouse s last name 7a b () First name If more than four dependents, see instructions Last name () Dependent s identifying number () Dependent s relationship to you () if qualifying child for child tax credit (see instr) d otal number of exemptions claimed 8 Wages, salaries, tips, etc ttach Form(s) W- 9a axable interest b ax-exempt interest Do not include on line 9a 9b 0a Ordinary dividends b 0b Scholarship and fellowship grants ttach Form(s) 0-S or required statement (see instructions) Business income or (loss) ttach Schedule C or C-Z (Form 00) Capital gain or (loss) ttach Schedule D (Form 00) if required If not required, check here Other gains or (losses) ttach Form 797 a IR distributions a b axable amount (see instructions) 7a Pensions and annuities 7a 7b axable amount (see instructions) 8 Rental real estate, royalties, partnerships, trusts, etc ttach Schedule (Form 00) 9 Farm income or (loss) ttach Schedule F (Form 00) 0 Unemployment compensation Other income List type and amount (see instructions) otal income exempt by a treaty from page, Schedule OI, Item L ()(e) Combine the amounts in the far right column for lines 8 through his is your total 7 8 9 0 ducator expenses (see instructions) Health savings account deduction ttach Form 8889 Moving expenses ttach Form 90 Deductible part of self-employment tax ttach Schedule S (Form 00) Self-employed health insurance deduction (see instructions) Penalty on early withdrawal of savings Scholarship and fellowship grants excluded IR deduction (see instructions) Student loan interest deduction (see instructions) Domestic production activities deduction ttach Form 890 dd lines through Subtract line from line his is your adjusted gross income For Disclosure, Privacy ct, and Paperwork Reduction ct otice, see instructions Foreign postal code 7 8 9 0 } Boxes checked on 7a and 7b o of children on 7c who: lived with you did not live with you due to divorce or separation (see instructions) Dependents on 7c not entered above dd numbers on lines above 8 9a 0a b 7b 8 9 0 Form 00R-CM (07)
Form 00R-CM (07) Page 7 mount from line (adjusted gross income) 7 ax and 8 Itemized deductions from page, Schedule, line 8 Credits 9 Subtract line 8 from line 7 9 0 xemptions (see instructions) 0 axable income Subtract line 0 from line 9 If line 0 is more than line 9, enter -0- ax (see instructions) Check if any tax is from: a Form(s) 88 b Form 97 lternative minimum tax (see instructions) ttach Form xcess advance premium tax credit repayment ttach Form 89 dd lines, and Foreign tax credit ttach Form if required 7 Credit for child and dependent care expenses ttach Form 7 8 Retirement savings contributions credit ttach Form 8880 8 9 Child tax credit ttach Schedule 88, if required 9 0 Residential energy credits ttach Form 9 0 Other credits from Form: a 800 b 880 c dd lines through hese are your total credits Subtract line from line If line is more than line, enter -0- Other axes Payments Made to the CMI Refund Self-employment tax ttach Schedule S (Form 00) Unreported social security and Medicare tax from Form: a 7 b 899 7 7 8 ransportation tax (see instructions) 8 9a Household employment taxes from Schedule H (Form 00) 9a b First-time homebuyer credit repayment ttach Form 0 if required 9b 0 axes from: a Form 899 b Instructions; enter code(s) 0 dd lines through 0 his is your total tax MI withheld from: a Form(s) W-CM and 099 a b Form(s) 880 b c Form(s) 888- c d Form(s) 0-S d 0 estimated tax payments and amount applied from 0 return dditional child tax credit ttach Schedule 88 et premium tax credit ttach Form 89 7 xcess social security and tier RR tax withheld (see instructions) 7 8 Credit for federal tax paid on fuels ttach Form 8 9 Credits from Form: a 9 b Reserved c 888 d 9 70 Credit for amount paid with Form 00-C 70 7 dd lines a through 70 hese are your total payments 7 7 If line 7 is more than line, subtract line from line 7 his is the amount you overpaid 7 7 mount of line 7 you want refunded to you If Form 8888 is attached, check here 7 mount You Owe hird Party Designee Sign Here Keep a copy of this return for your records 7 mount of line 7 you want applied to your 08 estimated tax 7 7 mount you owe Subtract line 7 from line For details on how to pay, see instructions 7 7 stimated tax penalty (see instructions) 7 Do you want to allow anothe r person to discuss this return with the Division of Revenue and axation? (see instructions) Designee's name Phone no ( ) Personal Identification umber (PI) YesComplete below Under penalties of perj ury I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete Declaration of preparer (other than taxpayer) is based on all information of which the preparer has any knowledge Your signature Date Your occupation in the CMI Daytime phone number ( ) o Paid Preparer Use Only Print/ype preparer s name Preparer s signature Date Firm s name Check if self-employed Firm s I PI Firm s address Phone no Form 00R-CM (07)
Form 00R-CM (07) Page Schedule Itemized Deductions (see instructions) 07 axes You Paid State and local income taxes Caution: If you made a gift and received a in return, see instructions Gifts to CMI Charities Gifts by cash or check If you made any gift of $0 or more, see instructions Other than by cash or check If you made any gift of $0 or more, see instructions You must attach Form 88 if the amount of your deduction is over $00 Carryover from prior year dd lines through Casualty and heft Losses Casualty or theft loss(es) ttach Form 8 See instructions Job xpenses and Certain Miscellaneous Deductions 7 Unreimbursed employee expenses job travel, union dues, job education, etc You must attach Form 0 or Form 0-Z if required See instructions 8 ax preparation fees 8 9 Other expenses See instructions for expenses here List type and amount to deduct 7 9 0 dd lines 7 through 9 0 nter the amount from Form 00R-CM, line 7 Multiply line by % (00) Other Miscellaneous Deductions Subtract line from line 0 If line is more than line 0, enter -0- Other see instructions for expenses to deduct here List type and amount otal Itemized Deductions on page of Form 00R-CM: $09,900 if you checked box $8,0 if you checked box or, or $,90 if you checked box,, or? o Your deduction is not limited dd the amounts in the far right column for lines through lso enter this amount on Form 00R-CM, line 8 Yes Your deduction may be limited See the Itemized Deductions Worksheet in the instructions to figure the amount to enter here and on Form 00R-CM, line 8 Form 00R-CM (07)
Form 00R-CM (07 ) Page (see instructions) ature of income Dividends paid by: CMI corporations a Foreign corporations b Interest: Mortgage a Paid by foreign corporations b Other c Industrial royalties (patents, trademarks, etc) Motion picture or V copyright royalties Other royalties (copyrights, recording, publishing, etc) Real property income and natural resources royalties Pensions and annuities 7 8 Capital gain from line 8 below 9 Gambling Residents of Canada only nter net income in column (c) If zero or less, enter -0- Winnings Losses 0c Gambling winnings Residents of countries other than Canada ote Losses not allowed Other (specify) dd lines a through in columns (a) through (d) Multiply line by rate of tax at top of each column nter amount of income under the appropriate rate of tax (see instructions) (a) 0% (b) % (c) 0% a x on inc ome not effec tively c onnec ted with a CMI tra de or bus ines s dd c olumns (a) through (d) of line nter the total here and on Form 00R-CM line Capital Gains and Losses From Sales or xchanges of Property nter only the capital gains and losses from property sales or exchanges that are from sources within the CMI connected with a CMI business Do not include a gain or loss on disposing of a CMI real property interest; report these gains and losses on Schedule D (Form 00) Report property sales or (a) Kind of property and description (if necessary, attach statement of descriptive details not shown below) (b) Date acquired (mo, day, yr) (c) Date sold (mo, day, yr) (d) Sales price (e) Cost or other basis (f) LOSS If (e) is more than (d), subtract (d) from (e) (d) Other (specify) % % (g) GI If (d) is more than (e), subtract (e) from (d) connected with a CMI business on Schedule D (Form 00), Form 797, or both 7 dd columns (f) and (g) of line 7 ( ) 8 Combine columns (f) and (g) of line 7 nter the net gain here and on line 9 above (if a loss, enter -0-) 8 Form 00R-CM (07)
Form 00R-CM (07) Page Schedule OI Other Information (see instructions) nswer all questions B Of what country or countries were you a citizen or national during the tax year? In what country did you claim residence for tax purposes during the tax year? C Have you ever applied to be a green card holder (lawful permanent resident) of the United States? Yes o D Were you ever: US citizen? Yes o green card holder (lawful permanent resident) of the United States? Yes o If you answer Yes to () or (), see Pub 9, chapter, for expatriation rules that apply to you If you had a visa on the last day of the tax year, enter your visa type If you did not have a visa, enter your US immigration status on the last day of the tax year F Have you ever changed your visa type (nonimmigrant status) or US immigration status? Yes o If you answered Yes, indicate the date and nature of the change G List all dates you entered and left the CMI during 07 (see instructions) ote If you are a resident of Canada or Mexico D commute to work in the CMI at frequent intervals, check the box for Canada or Mexico and skip to item H Canada Mexico Date entered the CMI mm/dd/yy Date departed the CMI mm/dd/yy Date entered the CMI mm/dd/yy Date departed the CMI mm/dd/yy H Give number of days (including vacation, nonworkdays, and partial days) you were present in the CMI during: 0, 0, and 07 I Yes o J Yes o If Yes, did the trust have a US or foreign owner under the grantor trust rules, make a distribution or loan to a US person, or receive a contribution from a US person? Yes o K Did you receive total compensation of $0,000 or more during the tax year? Yes o If Yes, did you use an alternative method to determine the source of this compensation? Yes o L Income xempt from ax If you are claiming exemption from income tax under a CMI income tax treaty with a foreign country, complete () through () below See Pub 90 for more information on tax treaties nter the name of the country, the applicable tax treaty article, the number of months in prior years you claimed the treaty (a) Country (b) ax treaty article (c) umber of months claimed in prior tax years (d) mount of exempt income in current tax year (e) otal nter this amount on Form 00R-CM, line Do not enter it on line 8 or line Were you subject to tax in a foreign country on any of the income shown in (d) above? Yes o Yes o If Yes, attach a copy of the Competent uthority determination letter to your return Form 00R-CM (07)
DIVISIO OF RVU D XIO COMMOWLH OF H ORHR MRI ISLDS COMM OW LH OF H ORHR MR I ISLDS UL WG D SLRY D RIGS X RUR (See supplemental instructions) (For Form 00R-CM) Your name and initial Last ame D Social security number P R M O F F I C 07 If a joint return, spouse s name and initial Last ame Spouse s social security number Home ddress (number and street) City, town or post state, and ZIP code pt o IMPOR! You must enter your SS(s) above PR WG D SLRY X COMPUIO CMI wages and salaries from Form(s) W- and W-CM Other CMI wages and salaries not included in line otal CMI wages and salaries dd lines and mount on line not subject to the wage and salary tax (attach Schedule WSD) CMI wages and salaries Subtract line from line nnual wage and salary tax PR B RIGS X COMPUIO Gain from the sale of personal property One half of the gain from the sale of real property One half of the net income from leasing of real property Interest, dividends, rents, royalties a Gross winnings from any gaming, lottery, r etc b Less amount excludable (attach Form(s) W-G) c Balance Subtract line b from line a Other income subject to the MI, unless excludable under the earnings tax 7 otal income subject to the earnings tax dd lines thru, c, and 8 nnual earnings tax a b c 7 8 PR C OL CHPR X DU/(OVRPYM) Wage and salary tax and earnings tax dd line part and line 8 part B ducation tax credit (attach Schedule C) ax after education tax credit Subtract line from line, but not less than zero nter total wage and salary tax and earnings tax withheld and amount paid in 07 Combined wage and salary and earnings tax due or overpaid Subtract line from line If negative, enclose with parenthesis COMPL FORM OS-0 -COMPUIO OF O-RFUDBL CRDI D PPLICIO FOR RB O CMI SOURC X BFOR COMPLIG PR D PR D CHPR 7 X D RB OFFS Chapter 7 tax underpayment after non-refundable credit nter amount from Form OS-0, line, part B Chapter 7 tax overpayment after non-refundable credit nter amount from Form OS-0, line 0, part B Rebate offset amount nter amount from Form OS-0, line, part B Chapter 7 liability or (overpayment) after rebate offset amount dd lines through ax on overpayment of credits stimated tax penalty 7 otal Chapter 7 liability or (overpayment) dd lines, and 7 ( ( ) ) Page
UL WG D SLRY D RIGS X RUR Page 7 PR COMBID DU OR (OVRPYM) otal amount due or (overpaid) dd line PR C and line 7 of PR D If negative, enclose amount in parenthesis ( ) If line is an overpayment, enter amount you want credited to your 08 SIMD X et (overpaid) dd lines and of this part his is your refund/rebate ( ) If there is amount due on Part, line above: Offset against the dditional Child ax Credit (CC) on Part F and/or the Refundable merican Opportunity Credit (ROC) on Part G below, if any Please complete those parts to determine your remaining tax due Otherwise, pay this amount If there is remaining tax due and the return is filed and/or the tax is paid after the due date, tax due is subject to penalty and interest charges Use the Penalties and Interest Worksheet below to calculate your penalties and interest Please include these charges in your payment; otherwise, the Division of Revenue and axation will bill you Penalties and Interest Worksheet nter the amount from Part, line nter the sum of Part D, line, Part F, line and Part G, line If line is greater than line, subtract line from line Otherwise, stop here here are no penalties Failure to pay penalty * Failure to file panalty * * Calculate interest at prevailing rates as published by the IRS from the due date until the tax and penalties are fully paid 7 otal penalties and interest dd lines, and When making your payment, include this amount with the tax due shown on Part, line 7 * Multiply the amount on line by 0% for each month or fraction of a month until the date that all taxes, failure to pay penalties and interest have been paid * * Multiply the amount on line by % for each month or fraction of a month until the date that all taxes, failure to file penalties and interest have been paid PR F dditional Child ax Credit Computation (attach Schedule 88) Special otice his part is provided to enable the Division of Revenue and axation to process your claim of the dditional Child ax Credit (CC) Schedule 88 Please note that the CC is being paid by the United States reasury he Division of Revenue and axation is only facilitating your CC claim as agreed upon between the CMI Department of Finance and the United States reasury By applying for the CC refund and allowing it to be processed by the Division of Revenue and axation, you are giving the Division of Revenue and axation authorization to release tax information to the Internal Revenue Service (IRS) See Supplemental Instructions for Part F, line regarding rebate offset amount dditional Child ax Credit nter the amount from line of Schedule 88 nter the amount due from line, Part above dditional Child ax Credit refund Subtract line from line, but not less than zero mount you still owe If line is greater than line Subtract line from line, otherwise enter zero PR G Refundable ducation ax Credit (attach Form 88) nter the amount from Form 88, Line 8 nter amount still owed from line, Part above ducation Credit refund Subtract line from line, but not less than zero mount you still owe If line is greater than line Subtract line from line, otherwise enter zero hird Party Designee Sign Here Keep a copy of this return for your records Do you want to allow another person to discuss this return with the Division of Revenue and axation? Designee's name Phone no ( ) Personal Identification umber (PI) YesComplete the following Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge Your signature Date Your occupation in the CMI Daytime phone no ( ) o Paid Prepairer Use Only Print/ype preparer s name Firm s name Firm s address Preparer s signature Date Check if self-employed Firm s I Phone no PI DDLI: PRIL, 08
COMMOWLH OF H O FF Y ICI OR L H S R MRI L Form OS-0 ISLDS DIVISIO OF RVU D XIO COMMOWLH OF H ORHR MRI ISLDS COMPUIO OF O-RFUDBL CRDI D PPLICIO FOR RB O CMI SOURC ICOM X (For Form 00R-CM) See instructions Last name D Social security number COMMO P WLH R M OF H ORHR O F F MR I I ISLDS C 07 Please ype or Print in Ink If a joint return, spouse Home address (number and street) City Last name pt o Spouse s social security number IMPOR! You must enter your SS(s) above PR - on-refundable Credits Wage and salary tax and earnings tax Business gross revenue tax a) b) c) ame ax ID o User fees paid Fees and taxes imposed under CMC 0(e) otal non-refundable credits (add lines through ) PR B - Rebate Computation otal MI 7 otal MI payments made 8 otal non-refundable credits (enter amount from line, Part ) 9 Rebate Base (adjusted CMI source tax) Subtract line 8 from line If zero or less, enter -0) 0 MI overpayment (If line 7 is greater than line 9, subtract line 9 from line 7, otherwise, enter -0-) MI underpayment (If line 9 is greater than line 7, subtract line 7 from line 9, otherwise, enter -0-) Rebate offset amount Calculate this amount as determined by the rebate base (line 9) using the rebate table provided in Part B of the instructions a) b) c) 7 8 9 0 hird Party Designee Sign Here Do you want to allow another person to discuss this return with the Division of Revenue and axation? Designee's name Phone no ( ) Personal Identification umber (PI) YesComplete the following Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct and complete Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge o Keep a copy of this return for your records Your signature Date Your occupation in the CMI Daytime phone no ( ) Paid Preparer Use Only Print/ype preparer s name Firm s name Preparer s signature Date Check if self-employed Firm s I PI Firm s address Phone no Page 8
Instructions for Form OS-0 -Computation of on-refundable Credit and pplication for Rebate on CMI Source Income ax 07 PR O-RFUDBL CRDIS nter the wage and salary tax and earnings tax as shown on line, Part C of the nnual Wage and Salary and arnings ax Return nter the amount of business gross revenue tax paid or accrued during the taxable year under CMC Chapter For partners enter your share of BGR in the partnership as applicable If you have more than one business name, list each one separately with its respective I and amount of BGR his is the tax under CMC 0 nter the amount of user fees paid during the taxable year under CMC nter the amount of fees and taxes paid or accrued during the taxable year under CMC 0(h), in lieu of the tax under CMC 0 dd all amounts shown in lines through his is your total non-refundable credit PR B RB COMPUIO nter the tax as shown on line of Form 00R-CM 7 nter the total payments made for the taxable year as shown on line of Form 00R-CM 8 nter the total non-refundable credits from line, part 9 Subtract line 8 from line If zero or less, enter zero 0 If line 7 is greater than line 9, subtract line 9 from line 7, otherwise, enter zero If line 9 is greater than line 7, subtract line 7 from line 9, otherwise, enter zero Calculate the rebate offset amount as determined by the rebate base (line 9) using the rebate table below nter the result here RB BL IF RB BS (line 9) IS: H RB OFFS MOU IS: XMPL: ot over $0,000 90% of the rebate base Rebate base X 90% $ 0,00-$00,000 $8,000 plus 70% of the rebate base over $0,000 Rebate base - 0,000 X 70% + 8,000 Over $00,000 $7,000 plus 0% of the rebate base over $00,000 Rebate base - 00,000 X 0% + 7,000 by mail, please send to: DIVISIO OF RVU D XIO POS OFFIC BOX CHRB SIP, MP 990 DDLI: PRIL, 08 Form OS-0 for Form 00R-CM (07) Page 9