2011
MARYLAND
FORM
503
RESIDENT
$
INCOME TAX RETURN
115030049
Social Security number
Spouse's Social Security number
Your First Name
Initial
Last Name
Spouse's First Name
Initial
Last Name
Present Address (Number and street)
City or Town
State
Zip Code
Maryland county
City, town or taxing area
Name of county and incorporated city, town or special
taxing area in which you were a resident on the last day
of the taxable period. (See Instruction 6)
FILINg STATUS
1.
Single (If you can be claimed on another person’s tax return, use Filing Status 6.)
4.
head of household
See Instruction 1 to determine
2.
Married filing joint return or spouse had no income
5.
Qualifying widow(er) with dependent child
if you are required to file.
CHECK ONE BOX
6.
Dependent taxpayer (Enter 0 in Exemption Box (A) - See Instruction 7)
3.
Married filing separately
Spouse's Social Security number
EXEMPTIONS
(A)
Yourself
Spouse
See Instruction 10
(B)
65 or over
Blind
65 or over
Blind
(1)
(C) Dependents
(3)
(4)
(5)
(2)
(6)
(7)
Check if Dep
If (4) is checked, does child have
Regular
65 or over
Social Security
Relationship
under age 19
health insurance now
First Name
Last Name
yES
NO
yES
NO
Check here if you authorize us to share your tax information with the Medical Assistance Program for help finding health insurance.
NOTE: If you are claiming more than two dependents, you must use Form 502.
(A) Enter No. Checked
x $3,200 . . . . . . . $ __________________
(B)
Enter No. Checked . . . . . . . . . . . . .
X $1,000
$ ___________________
(C) Enter No. Checked
(D)
Enter Total Exemptions
in Columns 6 & 7
x $3,200 . . . . . . . $ __________________
(Add A, B and C) . . . . . . . . . . . . . .
Total Amount
$ ___________________
1
1. Adjusted gross income from your federal return (See Instruction 11) (If amount is $100,000 or more, stop and use Form 502) ....................
1a. Wages, salaries and/or tips (See Instruction 11) .......................................................
1a
2
2. Standard deduction (See Instruction 16) ...............................................................................................................................................................
3
3. Net income (Subtract line 2 from line 1) ...............................................................................................................................................................
4
4. Exemption amount as computed above ................................................................................................................................................................
Place
5
5. Taxable net income (Subtract line 4 from line 3. GO TO TAX TABLE) .....................................................................................................................
ChECk
6
6. Maryland tax from Tax Table .................................................................................................................................................................................
or
MONEy
7
7. Earned income credit
7a
7b
Poverty level credit
(See Instruction 18) Total ....................
ORDER
8
8. Maryland tax after credits (Subtract line 7 from line 6) If less than 0, enter 0. ...................................................................................................
on top of
.
your W-2
0
___ ___ ___ ___ ........................
9
9. Local tax (See Instruction 19 for tax rates and worksheet.) Multiply line 5 by your local tax rate
wage and
10
tax
10a
10. Local: Earned income credit
Poverty level credit
10b
(See Instruction 19) Total ..................
statements
11
11. Local tax after credits (Subtract line 10 from line 9) If less than 0, enter 0. ........................................................................................................
and
ATTACh
12
12. Total Maryland and local tax (Add lines 8 and 11) ................................................................................................................................................
hERE
13
13. Contributions to Chesapeake Bay and Endangered Species Fund .........................................................................................................................
with ONE
staple.
14
14. Contributions to Developmental Disabilities Waiting List Equity Fund ....................................................................................................................
15
15. Contributions to Maryland Cancer Fund ................................................................................................................................................................
16
16. Total Maryland income tax, local income tax and contributions (Add lines 12 through 15) ...........................................................................
17
17. Total Maryland and local tax withheld (Enter total from and attach your W-2 and 1099 forms if MD tax is withheld) ..........................................
18
18. Refundable earned income credit (from worksheet in Instruction 21) ...................................................................................................................
19
19. Total payments and credit (Add lines 17 and 18) .................................................................................................................................................
20
20. Balance due (If line 16 is more than line 19, subtract line 19 from line 16) .........................................................................................................
REFUND
21
21. Overpayment (If line 16 is less than line 19, subtract line 16 from line 19) See line 24 .............................................. This is your
22
22. Interest charges from Form 502UP
or for late filing
(See Instruction 22) Total . . . . . . . . . . . . . . . .
23
23. TOTAL AMOUNT DUE (Add lines 20 and 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IF $1 OR MORE, PAY IN FULL WITH THIS RETURN
COM/RAD-020
11-49