EMPLOYEE'S SOCIAL SECURITY NUMBER
SPOUSE'S SOCIAL SECURITY NUMBER
PRINT OR TYPE
First names and initials of employee and spouse Last name
Home address (number and street) Apt. no.
City and State Zip Code
FORM FOR NONRESIDENT EMPLOYEES
OF THE CITY OF NEW YORK HIRED
ON OR AFTER JANUARY 4, 1973
NYC
1127
A. Payment
EMPLOYEE SPOUSE
Date current employment with the City of New York began:
.................................................................................................
Were you an employee of the City of New York for all of 2003?
........................................................................................
YES
NO
YES
NO
If "NO", enter period of 2003 employment by the City of New York:
.................................................................................
from: _____________ to: _____________ from: _____________ to: _____________
Were you a resident of New York City during any part of 2003?
........................................................................................
YES
NO
YES
NO
If "YES", enter period for which you were a New York City resident
.................................................................................
from: _____________ to: _____________ from: _____________ to: _____________
Did you earn any additional income in 2003 other than from the City of New York?
............................................
YES
NO
YES
NO
If "YES", state amount and include below in appropriate line (ATTACH COPIES OF W-2'S)
.........................................
$: ______________________ $ _________________________
A.
MARRIED FILING JOINTLY OR SURVIVING SPOUSE
B.
HEAD OF HOUSEHOLD
C.
SINGLE OR MARRIED FILING SEPARATELY
1. Wages, salaries, tips, etc. (attach copies of W-2's) ..................................................
2. Taxable interest income
..................................................................................................
3. Dividend income ...............................................................................................................
4. Taxable refunds of state and local income taxes (also enter on line 23 below) .......
5. Alimony received ..............................................................................................................
6. Business income (or loss) (attach copy of federal Schedule C or C-EZ) ............
7. Capital gain (or loss) (attach copy of federal Schedule D) .....................................
8. Other gains (or losses) (attach copy of federal Form 4797) ...................................
9. Taxable amounts of IRA distributions
...........................................................................
10. Taxable amounts of pensions and annuities...............................................................
11.
Rents, royalties, partnerships, estates, trusts, etc.
(attach copy of federal Sch. E) ..........
12. Farm income (or loss) (attach copy of federal Schedule F) ...................................
13. Unemployment compensation (insurance)..................................................................
14. Taxable amount of social security benefits (also enter on line 25 below) ..................
15. Other income (attach list) ...............................................................................................
16. Total (add lines 1 through 15)
.......................................................................................
17. Total federal adjustments to income (attach list of items) .......................................
18. FEDERAL ADJUSTED GROSS INCOME (line 16 less line 17) .....................................
NEW YORK ADJUSTED GROSS INCOME
NEW YORK ADDITIONS
19. Interest income on state and local bonds other than NYS and its localities.........
20. Public employee 414(h) retirement contributions .....................................................
21. Other (attach list) .............................................................................................................
22. Add lines 18 through 21 .................................................................................................
NEW YORK SUBTRACTIONS
23.
Taxable refunds of New York State and local income taxes
(
from line 4 above
) .........
24. Pensions of NYS and local governments and the federal government ..............
25. Taxable social security benefits (from line 14 above) ...................................................
26. Interest income on United States government bonds...............................................
27. Pension and annuity income exclusion
........................................................................
28. Other (attach list) ..............................................................................................................
29. Total subtractions (add lines 23 through 28)...............................................................
30. TOTAL NEW YORK INCOME (line 22a less line 29a) (transfer amount from
column B to line 45
) (for line 30b, see instructions) ................................................................
1b.
2b.
3b.
4b.
5b.
6b.
7b.
8b.
9b.
10b.
11b.
12b.
13b.
14b.
15b.
16b.
17b.
18b.
1a.
2a.
3a.
4a.
5a.
6a.
7a.
8a.
9a.
10a.
11a.
12a.
13a.
14a.
15a.
16a.
17a.
18a.
19a.
20a.
21a.
22a.
a.
23a.
24a.
25a.
26a.
27a.
28a.
29a.
30a.
19b.
20b.
21b.
22b.
23b.
24b.
25b.
26b.
27b.
28b.
29b.
30b.
2003
DO NOT WRITE IN THIS SPACE - FOR OFFICIAL USE ONLY
NYC Department or
Agency where employed
A
FILING STATUS
B
C
FEDERAL INCOME AND ADJUSTMENTS
-
Complete the federal amount (column A) enter-
ing the items as they appear on your New York State Income Tax Return (Form IT-200, IT-201 or IT-203).
COLUMN B
SECTION 1127 EMPLOYEE
(SEE INSTRUCTIONS
)
Employee Spouse
ATTACH A COMPLETE COPY OF YOUR NEW YORK STATE INCOME TAX RETURN INCLUDING ALL SCHEDULES
ATTACH WITHHOLDING STATEMENT AND CHECK HERE
Daytime telephone number
Payment Enclosed
FINANCE
NEW
YORK
Pay amount shown on line 56 - Make check payable to: NYC Department of Finance
COLUMN A
FEDERAL AMOUNT
*80010395*
80010395
NYC-1127 2003
AMENDED RETURN
www.nyc.gov/finance
Form NYC-1127 - 2003 Page 2
31. Medical and dental expenses .....................................................................................
31.
32. Taxes ................................................................................................................................
32.
33. Interest expense
............................................................................................................
33.
34. Gifts to charity .................................................................................................................
34.
35. Casualty and theft losses .............................................................................................
35.
36. Job expenses and most other miscellaneous deductions (see instructions and
attach detailed schedule) ..............................................................................................
36.
37. Other miscellaneous deductions (attach detailed schedule) ................................
37.
38. TOTAL ITEMIZED DEDUCTIONS (from federal Schedule A, line 28) .......................
38.
39.
State, local and foreign income taxes on line 32 and Sect. 1127 liability if deducted elsewhere
..
39.
40. Subtract line 39 from line 38 .......................................................................................
40.
41. Other adjustments .........................................................................................................
41.
42. Total of lines 40 and 41 ..................................................................................................
42.
43. New York State itemized deduction adjustment (if line 30 is $100,000 or less,
enter "0") (otherwise see instructions) .....................................................................
43.
44. New York State itemized deduction before limitation percentage (line 42 less line 43) .
44.
44a. College tuition itemized deduction....................................................................................
44a.
44b.
Add lines 44 and 44a........................................................................................................
44b.
45. Amount from line 30, column B, page 1 (total New York City income) .............................................................................
45.
46.
NEW YORK CITY DEDUCTION:
(See Instructions)
a. Compute limitation percentage:
line 30, column B
$
=
line 30, column A
$
46a.
b. ( ) only one box
Standard deduction (enter amount from instructions) ..............................................................................................
Itemized deduction - $_____________________
X
_____________________
=
amount from line 44b % from line 46a
..............................................
46b.
47. Line 45 less line 46b .......................................................................................................................................................................
47.
48.
NEW YORK DEPENDENT EXEMPTION FROM NYS RETURN
No exemption is allowed for employee or spouse.
(If married filing separately for Section 1127 purposes, apply the limitation percentage from line 46a.)
(see instructions)
(
_____________
X 1000
)
X
____________ %
=
# of exemptions % from line 46a
............................................................................................................
48.
49. New York City income subject to Section 1127 (line 47 less line 48)
...................................................................................
49.
50. Liability on amount from line 49 (see liability rate schedules and instructions) .................................................................
50.
51. Liability for other New York City taxes (see instructions) ........................................................................................................
51.
52. Total of lines 50 and 51...............................................................................................................................................
52.
53. Nonrefundable credits:
a. NYC household credit from IT-201 Instructions NYC table IV, V or VI ..... 53a.
b. UBT Paid Credit (see instructions) .................................................................... 53b.
c. Other NYC taxes (see instructions) ................................................................... 53c.
d.
NYC Claim of Right Credit from Form IT-201-ATT, line 80 or IT-203-B, line 65 (attach Form IT-257)
..
53d.
e.
New York City School Tax Credit (see instructions)..........................................
53e.
TOTAL of lines 53a through 53e
.............................................................................................................................................
53.
54. Total Liability. Subtract line 53 from line 52. If line 53 is greater than line 52, enter “0” .......................................... 54.
55.
Payment pursuant to agreement under City Charter §1127 (from Form 1127.2).............................................................................
55.
56. BALANCE DUE - if line 54 is larger than line 55, enter balance due. Enter payment amount on line A, page 1 (See Instr.)............. 56.
57. OVERPAYMENT - if line 54 is smaller than line 55, enter overpayment (See Instr.)
REFUNDS CANNOT BE PROCESSED UNLESS COMPLETE COPY OF NYS RETURN,
INCLUDING ALL SCHEDULES, AND WAGE AND TAX STATEMENT (FORM 1127.2) ARE ATTACHED.
......................................................
57.
%
If you itemized deductions
on federal Form 1040, fill
in lines 31 through 44, as
reported on your New
York State return (IT-201-
ATT, Part I or IT-203-ATT,
Schedule C) and attach
federal Schedule A.
If claiming the New York
standard deduction, skip
lines 31 through 44 and
continue on line 45.
Part-year employees must prorate
standard deduction and dependent
exemption amounts based on number
of months employed by NYC.
I hereby certify that this return, including any accompanying rider, is, to the best of my knowledge and belief, true, correct and complete.
I authorize the Dept. of Finance to discuss this return with the preparer listed below. (see instructions) ..............................YES
CERTIFICATION
SIGN
HERE
PREPARER
'S
USE ONLY
YOUR SIGNATURE
ADDRESS
DATE
DATE
EIN OR SSN OR PTIN
SPOUSE
'S SIGNATURE
(if both are City employees sub-
ject to Charter §1127 and filing a joint Form NYC-1127)
SIGNATURE OF PREPARER OTHER THAN TAXPAYER
ATTACH:
1. Complete copy of NYS Income Tax Return, including all schedules
2. Wage and withholding statement (Form 1127.2)
3. Copy of federal Schedule A, if itemizing deductions
4. Copies of all W-2's, if applicable
5. If claiming line of duty injury deduction, provide verification from agency
PAY FULL AMOUNT SHOWN ON LINE 56
Make remittance payable to the
order of:
NYC DEPARTMENT OF FINANCE
Payment must be made in U.S.
dollars, drawn on a U.S. bank.
To receive proper
credit, you must enter
your correct Social
Security Number on
your tax return and
remittance.
MAIL TO:
NYC Dept. of Finance
P. O. Box 5090
Kingston, NY 12402-5090
%
OR
*80020395*
80020395