Form 503 - Maryland Resident Income Tax Return - 2011 Page 2
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1
2MARYLAND
FORM
503
RESIDENT
PAgE 2
2011
INCOME TAX RETURN
115030149
NAME ________________________________ SSN _______________________________
DIRECT DEPOSIT OF REFUND (See Instruction 22) Please be sure the account information is correct. For Splitting Direct Deposit, see Form 588.
In order to comply with banking rules, please, check
here if this refund will go to an account outside the United States. If checked, see Instruction 22.
24. For the direct deposit option, complete the following information clearly and legibly.
24a. Type of account:
Checking
Savings
24b. Routing Number
24c. Account
(9-digit)
number
-
-
-
-
049
Daytime telephone no.
home telephone no.
CODE NUMBERS (3 digits per box)
Make checks payable and mail to:
Check
here if you authorize your paid preparer not to file electronically. Check
here if you agree to receive your
Comptroller of Maryland,
1099G Income Tax Refund statement electronically. Under penalties of perjury, I declare that I have examined this return, includ-
Revenue Administration Division
ing accompanying schedules and statements and to the best of my knowledge and belief it is true, correct and complete. If pre-
110 Carroll Street, Annapolis, Maryland 21411-0001
pared by a person other than taxpayer, the declaration is based on all information of which the preparer has any knowledge.
(It is recommended that you include your
Check here
if you authorize your preparer to discuss this return with us.
Social Security number on check.)
your signature
Date
Preparer’s SSN or PTIN (required by law)
Signature of preparer other than taxpayer
Spouse’s signature
Date
Address and telephone number of preparer
WHO MAY USE THIS FORM?
You may use this short form (Form 503) if you answer “NO” to ALL of these questions:
YES NO
YES NO
8.
Are you claiming a tax credit on Maryland
1.
Is your federal adjusted gross income $100,000
Form 500CR or Form 502CR?
or more?
9.
Were you a nonresident of Maryland?
2.
Are you claiming more than two dependents? If
so, you must use Form 502.
10.
Were you a part-year resident of
3.
Do you have a state pickup amount on your Form
Maryland?
W-2? If so, you must use Form 502.
11.
Does your return cover less than a
12- month period?
4.
Do you and your spouse both have income sub-
ject to Maryland tax and are filing a joint return?
12.
Were or are you a fiscal year taxpayer?
If yes, you are eligible for the two-income sub-
traction modification and must use Form 502.
13.
Will you want part or all of your refund
5.
Do you have any other Additions to Income or
credited to next year’s estimated account?
Subtractions from Income on your Maryland
14.
Do you have income from an estate or trust or
return? For example, if you are eligible to take the
a pass-through entity from a K-1 or other
pension exclusion, you must use Form 502.
statement? If yes, you must use Form 502.
6.
Do you want to itemize deductions?
7.
Did you make estimated payments in 2011; have
part or all of your 2010 refund applied to your
2011 estimated account; or make a payment with
an extension request, Form 502E?
COM/RAD-020
11-49
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