41 C.F.R. § 302-17.50
Current through July 31, 2024
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 |
41 C.F.R. §302-17.50