Allocation of Individual Income Tax to Guam or the

Commonwealth of the Northern Mariana Islands (CNMI) Form 5074 OMB No. 1545-0803

 Attach to Form 1040. Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 60

Name(s) shown on Form 1040 Your social security number

Guam CNMI

Income From Guam or the CNMI Reported on Form 1040

1 Wages, salaries, tips, etc. 1

2 Taxable interest 2

3 Ordinary dividends 3

4 Taxable refunds, credits, or offsets of state and local income taxes 4

5 Alimony received 5

6 Business income or (loss) 6

7 Capital gain or (loss) 7

8 8

9

Other gains or (losses)

9

10

IRA distributions (taxable amount)

10

11

Pensions and annuities (taxable amount)

11

12

Rental real estate, royalties, partnerships, S corporations, trusts, etc.

12

13

Farm income or (loss)

13

14

Unemployment compensation

14

15

Social security benefits (taxable amount)

15

16

Other income. List type and amount 

16 Total income. Add lines 1 through 15 

Adjusted Gross Income From Guam or the CNMI Reported on Form 1040

Student loan interest deduction 19 19

21

One-half of self-employment tax

21

22

Self-employed health insurance deduction

22

23

Self-employed SEP, SIMPLE, and qualified plans

23

24

Penalty on early withdrawal of savings

24

25

Alimony paid

25

26

Add lines 17 through 26

26

27

Adjusted gross income. Subtract line 27 from line 16 

27

Payments of Income Tax to Guam or the CNMI

33 33

29 Payments on estimated tax return filed with Guam or the CNMI

Income tax withheld from your wages while employed by the U.S.

Government as a civilian in Guam or the CNMI

29

30

Income tax withheld from your wages while employed as a member of

the U.S. Armed Forces in Guam or the CNMI

30

31

Income tax withheld from your wages earned in Guam or the CNMI

other than amounts on lines 29 through 31

31

32

Total payments. Add lines 29 through 32 

32

Instructions

Form 5074 (2003)

Part III

Part I

Part II

Cat. No. 42243X

20

Moving expenses

20

Section references are to the Internal Revenue Code.

Purpose of form. This form provides information to the

United States so the IRS can figure the individual income tax

that is due to Guam or the CNMI.

Who must file. Use this form if all three of the following

apply.

1. You file a U.S. income tax return on Form 1040.

3. At least $5,000 of the gross income on your return is from

Guam or CNMI sources.

These requirements apply whether you file a single or joint

return.

2. You report adjusted gross income of $50,000 or more.

28 28

(Continued on back)

For Paperwork Reduction Act Notice, see back of form.

Tuition and fees deduction

17 Educator expenses

18 IRA deduction

17

18

2003
Form 5074 (2003) Page 2

This Section is for IRS Use Only

Income tax reported on Form 1040. Include any recapture of education credits 34

Credit for child and dependent care expenses

34

37

Credit for the elderly or the disabled

35

39

Foreign tax credit

51

40

Credits from Forms 8396 and 8859

37

38

Add lines 37 through 45 46

39

Subtract line 46 from line 36. If the result is zero or less, enter -0- 47

40

44

42

43

Tax on qualified plans, including IRAs, and other tax-favored accounts

44

48

46

Other Chapter 1 taxes. Include any tax from Form 4970

47

Taxes to be allocated. Add lines 47 through 49 

48

Guam CNMI

49

Divide the amount on page 1, line 28, by the adjusted gross income

reported on Form 1040. Enter the result as a decimal (rounded to

at least three places) . .

Tax allocated to Guam or the CNMI. Multiply line 50 by line 51

Enter the amount from page 1, line 33

Tax due. Subtract line 53 from line 52

51

38

Adoption credit

36

Paperwork Reduction Act Notice. We ask for the

information on this form to carry out the Internal Revenue

laws of the United States. You are required to give us the

information. We need it to ensure that you are complying

with these laws and to allow us to figure and collect the right

amount of tax.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is:

You are not required to provide the information requested

on a form that is subject to the Paperwork Reduction Act

unless the form displays a valid OMB control number. Books

or records relating to a form or its instructions must be

retained as long as their contents may become material in

the administration of any Internal Revenue law. Generally, tax

returns and return information are confidential, as required by

section 6103.

If you have comments concerning the accuracy of these

time estimates or suggestions for making this form simpler,

we would be happy to hear from you. See the Instructions

for Form 1040.

Recordkeeping 2 hr., 57 min.

Learning about the 

law or the form 7 min.

Preparing the form 50 min.

Copying, assembling, and

Sources of income. The rules for determining the sources of sending the form to the IRS 16 min.

income are explained in sections 861 through 865.

Penalty for failure to provide information. If you fail to

provide the required information, you may have to pay a

$100 penalty for each failure unless you can show the failure

was due to reasonable cause and not willful neglect. This

penalty is in addition to any criminal penalty provided by law.

● If you are a citizen but were not a resident of one of these

jurisdictions at the end of your tax year, file your income tax

return with the jurisdiction where you are a citizen.

Additional information. For more details, see Pub. 570, Tax

Guide for Individuals With Income From U.S. Possessions. To

get Pub. 570, see Quick and Easy Access to Tax Help and

Forms in the Instructions for Form 1040.

● If you are married filing jointly, file your return in the

jurisdiction of the spouse with the higher adjusted gross

income (without regard to community property laws) for the

tax year.

Where to file. Attach this form to your income tax return.

Then, use this chart to see where to file.

The United States

Guam

CNMI

Internal Revenue Service Center

Philadelphia, PA 19255-0215

USA

Department of Revenue and Taxation

Government of Guam

P.O. Box 23607

GMF, GU 96921

Division of Revenue and Taxation

Commonwealth of the Northern

Mariana Islands

P.O. Box 5234, CHRB

Saipan, MP 96950

IF, at the end of the tax

year, you were a

resident of . . .

THEN file that jurisdiction’s

tax return with the . . .

Education credits

Child tax credit

52

53

54

42

43

49

50

52

53

54

Form 5074 (2003)

Alternative minimum tax

Add lines 34 and 35

35

36

50

51

52

53

54

41 Retirement savings contributions credit 41

45 Other credits 45