Form 5074 Allocation of Individual Income Tax to Guam or the Commonwealth of the Northern Mariana Islands (CNMI) 2005. Summary: This is an example of Form 5074 (2005) with these line items completed:

“Name(s) shown on Form 1040” field contains Tracy Grey

“Your social security number” number field contains 111-00-2222

Under “Part I: Income From Guam or the CNMI Reported on Form 1040”:

“6. Business income or (loss)” Guam field contains 20,000 “16. Total income. Add lines 1 through 15” Guam field contains 20,000

Under “Part II: Adjusted Gross Income From Guam or the CNMI Reported on Form 1040”:

“21. One-half of self-employment tax” Guam field contains 1,413 “29. Add lines 17 through 28” Guam field contains 1,413 “30. Adjusted gross income. Subtract line 29 from line 16” Guam field contains 18,587

Under “Part III: Payments of Income Tax to Guam or the CNMI”:

“31. Payments on estimated tax return filed with Guam or the CNMI” Guam field contains 1,409 “35. Total payments. Add lines 31 through 34” Guam field contains 1,409