Form 515 - Maryland Tax Return - 2001
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1
2FOR NONRESIDENTS EMPLOYED IN MARYLAND WHO RESIDE IN JURISDICTIONS
01
2 2 0 0
FORM
OF DELAWARE, NEW YORK AND PENNSYLVANIA THAT IMPOSE A LOCAL INCOME
515
OR EARNINGS TAX ON MARYLAND RESIDENTS
MARYLAND TAX RETURN
$
NONRESIDENT
LOCAL TAX
(OR FISCAL YEAR BEGINNING
2001, ENDING
)
Your first name
Last name
Initial
S O C I A L
S E C U R I T Y
N U M B E R ( S )
R E Q U I R E D
Spouse’s first name
Last name
Initial
Present address (No. 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
employed on the last day of the taxable period. (See Instruction 6)
EXEMPTIONS
YOUR FILING STATUS
—
—
See Instruction 2 to determine if you are required to file.
See Instruction 10
Exemption Amount
(A) Yourself
Spouse
(A)
$2,100 $ ______________
1.
Single
(If you can be claimed on another person’s tax return, use Filing Status 6)
Check here if you are:
Spouse is:
2.
Married filing joint return or spouse had no income
(B)
(B)
$1,000 $ ______________
3.
Married filing separately
65 or over
Blind
65 or over
Blind
SPOUSE’S SOCIAL SECURITY NUMBER
4.
Head of household
(C)
$2,100 $ ______________
Enter No.
(C) Dependent Children:
5.
Qualifying widow(er) with dependent child
Name(s)
Social Security number(s)
6.
Dependent taxpayer
________________________________ __ __ __-__ __-__ __ __ __
(Enter 0 in Exemption Box (A)—See Instruction 7)
________________________________ __ __ __-__ __-__ __ __ __
RESIDENCE INFORMATION
________________________________ __ __ __-__ __-__ __ __ __
Enter your state of legal residence. _______________________________________
(D) Other Dependents:
(D)
$2,100 $ ______________
If not a resident for a full year, give dates.
Enter No.
FROM _____________________ TO _____________________
Name(s) and Relationship(s)
Social Security number(s)
In what local taxing jurisdiction did you reside on the last day of the taxable period?
________________________________ __ __ __-__ __-__ __ __ __
________________________________ __ __ __-__ __-__ __ __ __
Did you file a Maryland income tax return for 2000? Yes
No
Total
(E) Enter Total Exemptions (Add A, B, C and D)
(E)
$ ____________
If “Yes,” was it a
Resident or a
Nonresident Return?
Amount
FEDERAL
MARYLAND
NON-MARYLAND
INCOME (LOSS)
INCOME AND ADJUSTMENTS INFORMATION (See Instruction 10)
INCOME (LOSS)
INCOME (LOSS)
1.
Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2.
Taxable interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3.
Dividend income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4.
Taxable refunds, credits or offsets of state and local income taxes . . . . . . . . .
4
5.
5
Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.
Business income or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7.
Capital gain or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8.
Other gains or (losses) (from federal Form 4797) . . . . . . . . . . . . . . . . . . . . .
8
9.
Taxable amount of pensions, IRA distributions, and annuities . . . . . . . . . . . . .
9
10.
Rents, royalties, partnerships, estates, trusts, etc. (Circle appropriate item) . . . . .
10
11.
Farm income or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
12.
Unemployment compensation (insurance) . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
13.
Taxable amount of social security and tier 1 railroad retirement benefits . . . . . . .
13
14.
Other income (including lottery or other gambling winnings) . . . . . . . . . . . . . .
14
15.
Total income (Add lines 1 through 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
16.
Total adjustments to income from federal return (IRA, alimony, etc.) . . . . . . . .
16
17.
Adjusted gross income (Subtract line 16 from 15) . . . . . . . . . . . . . . . . . . .
17
ADDITIONS TO INCOME (See Instruction 11)
Dollars
Cents
18
18.
Non-Maryland loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
19.
Other (Enter code letter(s) from Instruction 11)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
20.
Total Additions (Add lines 18 and 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
21.
Total federal adjusted gross income & Maryland additions (Add lines 17 (Column 1) and 20) . . . . . . . . . . . . . . . . . . . .
SUBTRACTIONS FROM INCOME (See Instruction 12)
22
22.
Non-Maryland income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
23.
Other (Enter code letter(s) from Instruction 12)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
24.
Total Subtractions (Add lines 22 and 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
25.
Maryland adjusted gross income (Subtract line 24 from line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
COM/RAD-023
01-49
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