1 E N ORT HE. DIVISION OF REVENUE AND TAXATION. TH RN. OF. NORTHER. THE N. OF MA. H R. LT I. M. H. A. LT. AR. AN. E. Department of Finance NW. A. N WE A. I AN. I SL. MO. AN D. COM. A IS LA N. S. M MO. CO. Commonwealth of the Northern Mariana Islands D E. DS. E. C. TERRITORIAL INDIVIDUAL INCOME TAX RETURN. P. N. OF R. A. A. F ICIAL S EAL T N. M. E N F I. T O F. Form 1040cm 2017 For official use only For the year Jan. 1 - Dec. 31, 2017 or other tax year beginning , 2017 , ending , 20 See separate instructions Your first name and initial Last name Your social security number If a joint return, spouse's first name and initial Last name Spouse's social security number Home address (number and street).
2 If you have a Box, see instructions. Apt. no. Make sure the SSN(s). City, town or post office, state, and zip code. If you have a foreign address, also complete spaces below (see instructions). above and on line 6c are correct Foreign country name Foreign province/state/county Foreign postal code 1 Single 4 Head of household (with qualifying person). (See instructions) If the Filing qualifying person is a child but not your dependent, enter this child's Status 2 Married filing joint jointlyreturn (even(even if onlyif one only had one income). had income).
3 Check only full name here _____. 3 Married filing separately. Enter spouse's social security no. above one box and full name here } _____ 5 Qualifying widow(er) with dependent child 6a Yourself. If someone else can claim you as a dependent, do not check box 6a Boxes checked on 6a and Exemptions b Spouse .. 6b No. of your children on 6c c Dependents: (4) If child under age who: (2) Dependent's social (3) Dependent s 17 qualifying for child tax If more than security number relationship to you lived with you (1) First name Last name credit (see instructions).
4 Four (4) did not live with you dependents, due to divorce or see separation (see instructions). instructions Dependents on 6c and check not entered above here Add numbers on lines d Total number of exemptions claimed .. above SOURCE OF INCOME A. INCOME WITHOUT. B. INCOME WITHIN. C. TOTAL INCOME. 7 Wages, salaries, tips, etc W-2. etc. Attach Form(s) W-2 and and W-2CM.. W-2CM 7. Income 8a Taxable interest. Attach Schedule B if required .. 8a b Tax-exempt Tax-exemptinterest. DONOT. NOTinclude iincludeononline line8a8a ..8b . 9a Ordinary dividends. Attach Schedule B if required.
5 9a b Qualified dividends 9b 10. 10 Taxable refunds, credits, or offsets of state and local income taxes .. 11 Alimony received .. 11. If you did not get a 12 Business income or (loss). Attach Schedule C or C-EZ .. 12. W-2 and/or 13 Capital gain or (or(loss). loss). Attach Schedule SecheduleDDif ifrequired. notrequired, required,check checkhere here 13. W-2CM, see 14 Other gains or (losses). Atach AttachForm Form4797. 4797 .. 14. instructions. 15a IRA distributions 15a b Taxable amount .. 15b 16a Pensions and annuities 16a b Taxable amount .. 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc.
6 Attach Schedule E . 17. 18 Farm income or (loss). Attach Schedule F .. 18. 19 Unemployment compensation compensation .. 19. 20a Social security benefits 20 20a b b Taxable amount .. 20b 21a Gambling winnings. Attached Form(s). Attach Form(s) W .. W-2G .. 21a b Other income. List type and amount .. 21b 22a Total income,., Combine the amounts shown in each column for lines 7 through 21b 21 22a b Allocable percentage. (See supplemental Instructions Instructions) .. 22b % % 100%. 23 Educator expenses .. 23. 24 Certain business expenses of reservists, performing artists, and fee-basis government official.
7 Attach Form 2106 or 2106-EZ 24. 25 Health savings account deduction. Attach Form 8889 .. 25. 26 Moving expenses. Attach Form 3903 .. 26. 27 Deductible part of self-employment tax. Attach Schedule SE .. 27. 28 Self-employed SEP, SIMPLE, and qualified plans .. 28. Adjusted 29. 29 Self-employed health insurance deduction .. Gross 30 Penalty on early withdrawal of savings .. 30. Income 31a Alimony paid b Recipient's SSN 31a 32 IRA deduction .. 32. 33 Student loan interest deduction .. 33. 34 Tuition and fees. Attach Form 8917 .. 34. 35 Domestic production activities deduction.
8 Attach Form 8903 .. 35. 36 Add lines 23 through 35 .. 36. 37 Subtract line 36 from line 22a, column C. This is your adjusted gross income .. 37. For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions Page 1. Form 1040cm ( 2017 ). _____. Tax and 38 Amount from line 37 (adjusted gross income) .. 38. _____. Credits 39a Check if: You were born before January 2, 1953. Spouse was born before January 2, 1953. Blind. Blind. } Total boxes checked .. 39a b If your spouse itemizes on a separate return or you were a dual-status alien, check here.
9 39b _____. Standard Deduction 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin).. 40. _____. for 41 Subtract line 40 from line 38 .. 41 .. _____ .. People who 42. check any 42 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions. _____ .. box on line 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- .. 43.. _____. 39a or 39b or who can be 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44.
10 _____ _____. claimed as a 45. dependent, 45 Alternative minimum tax (see instructions). Attach Form 6251 .. _____. see 46 Excess advance premium tax credit repayment. Attach Form 8962 .. 46. instructions. _____. All others: 47 Add lines 44, 45, and 46 .. 47. Single or 48 Foreign tax credit. Attach Form 1116 if required .. 48. _____. M. separately, 49 Credit for child and dependent care expenses. Attach Form 2441 .. 49. _____. $6,350 50. 50 Education credits from Form 8863, line 19 .. _____. jointly or 51 Retirement savings contributions credit. Attach Form 8880.