Allocation of Individual Income Tax to Guam or the

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

Department of the Treasury  Attach to Form 1040.

Internal Revenue Service

Attachment

Sequence No. 60

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) City, town or post office, state, commonwealth or territory, and ZIP code Apt. no.

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

17 IRA deduction 17

19

One-half of self-employment tax

19

20

Self-employed health insurance deduction

20

21

Self-employed SEP, SIMPLE, and qualified plans

21

22

Penalty on early withdrawal of savings

22

23

Alimony paid

23

24

Add lines 17 through 25

24

25

Adjusted gross income. Subtract line 26 from line 16 

25

Payments of Income Tax to Guam or the CNMI

32 32

28 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

28

29

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

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

29

30

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

other than amounts on lines 28, 29, and 30

30

31

Total payments. Add lines 28 through 31 

31

Instructions

Form 5074 (2001)

Part III

Part I

Part II

Cat. No. 42243X

18

Moving expenses

18

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. 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.

Archer MSA deduction

26 26

(Continued on back)

For Paperwork Reduction Act Notice, see back of form.

Student loan interest deduction

27 27

For calendar year 2001, or other tax year beginning , 2001, and ending , 20

2001
Form 5074 (2001) Page 2

This Section is for IRS Use Only

Income tax reported on tax return. Include any recapture of education credits 33

Credit for child and dependent care expenses

33

36

Credit for the elderly or the disabled

34

38

Foreign tax credit

49

39

Other credits

36

37

Add lines 36 through 43 44

38

Subtract line 44 from line 35. If the result is zero or less, enter -0- 45

39

43

41

42

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

43

46

44

Other Chapter 1 taxes. Include any tax from Form 4970

45

Taxes to be allocated. Add lines 45 through 47 

46

Guam CNMI

47

Divide the amount on page 1, line 27, 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 48 by line 49

Enter the amount from page 1, line 32

Tax due. Subtract line 51 from line 50

49

37

Adoption credit

35

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 8 min.

Preparing the form 49 min.

Copying, assembling, and

sending the form to the IRS 17 min.

Sources of income. The rules for determining the sources of

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 of which 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 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

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

50

51

52

41

42

47

48

50

51

52

Form 5074 (2001)

Alternative minimum tax

Add lines 33 and 34

34

35

48

49

50

51

52

40 Rate reduction credit 40