You should provide the information required in the “Statement of Income and Tax Filing Status” as follows:
Statement of Income and Tax Filing Status - One-Year Process
The following information, which my agency will use in calculating the RITA to which I am entitled, was shown on the Federal, state, and local income tax returns that I (or my spouse and I) filed for the 20 ____ tax year (this should be the most recent year in which you filed). | |
Federal Filing status: | |
☐ Single | ☐ Head of Household |
☐ Married Filing Jointly | ☐ Qualifying Widow(er) |
☐ Married Filing Separately | |
(a) Taxable income as shown on my (our) IRS Form 1040: $ ____ | |
Significant future changes in income (including cost of living raises) that you can foresee for the current year: | |
__Increase __Decrease __No Foreseeable Changes | |
(b) Approximate net amount of this (these) change(s): $ ____ | |
(c) Predicted taxable income for the current tax year 20 ____ = Sum of (a) and (b) = $ ____ | |
State you are moving out of: ________ | |
Filing status for the state moving out of: ________ | |
Marginal Tax Rate: ____% | |
State you are moving into: ________ | |
Filing status for the state moving into: ________ | |
Marginal Tax Rate: ____% | |
Locality you are moving out of: ________ | |
Filing status for the locality moving out of: ________ | |
Marginal Tax Rate: ____% | |
Locality you are moving into: ____ | |
Filing status for the locality moving into: ________ | |
Marginal Tax Rate: ____% | |
The above information is true and accurate to the best of my (our) knowledge. I (we) agree to notify the appropriate agency official of any significant changes to the above so that appropriate adjustments to the RITA can be made. | |
__________________ | __________ |
Employee's signature | Date |
__________________ | __________ |
Spouse's signature (if filing jointly) | Date |