Form 515 - Maryland Tax Return - 2004
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1
2FOR NONRESIDENTS EMPLOYED IN MARYLAND WHO
FORM
2004
RESIDE IN JURISDICTIONS OF DELAWARE, NEW YORK
515
AND PENNSYLVANIA THAT IMPOSE A LOCAL INCOME OR
EARNINGS TAX ON MARYLAND RESIDENTS
NONRESIDENT
$
MARYLAND TAX RETURN
LOCAL TAX
(OR FISCAL YEAR BEGINNING
2004, ENDING
SOCIAL SECURITY #
SPOUSE’S SOCIAL SECURITY #
Last Name
Your First Name
Initial
Last Name
Spouse’s First Name
Initial
PRESENT ADDRESS (No. and street)
Zip Code
City or Town
State
Maryland
City, town or taxing area
Name of county and incorporated city, town
County
or special taxing area in which you were
employed on the last day of the tax period
(See Instructions)
EXEMPTIONS
YOUR FILING STATUS
—
—
See Instruction 2 to determine if you are required to file.
See Instruction 9
Exemption Amount
Enter No.
(A) Yourself
Spouse
(A)
$2,400 $ ____________
1.
Single
(If you can be claimed on another person’s tax return, use Filing Status 6)
Checked
Check here if you are:
Spouse is:
2.
Married filing joint return or spouse had no income
(B)
(B)
$1,000 $ ____________
Enter No.
Checked
3.
Married filing separately
65 or over
Blind
65 or over
Blind
SPOUSE’S SOCIAL SECURITY NUMBER
4.
Head of household
(C)
$2,400 $ ____________
Enter Total
(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. _______________________________________
65
(D) Other Dependents:
(D)
$2,400
$ ____________
or over
Regular
Enter Total
If not a resident for a full year, give dates.
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 tax period?
________________________________ __ __ __-__ __-__ __ __ __
Did you file a Maryland income tax return for 2003? 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 AND ADJUSTMENTS INFORMATION (See Instruction 10)
INCOME (LOSS)
INCOME (LOSS)
INCOME (LOSS)
1
1.
Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
2.
Taxable interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
3.
Dividend income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
4.
Taxable refunds, credits or offsets of state and local income taxes . . . . . .
5
5.
Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
6.
Business income or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
7.
Capital gain or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
8.
Other gains or (losses) (from federal Form 4797) . . . . . . . . . . . . . . . . . . .
9
9.
Taxable amount of pensions, IRA distributions, and annuities . . . . . . . . .
10
10.
Rents, royalties, partnerships, estates, trusts, etc. (Circle appropriate item) . .
11
11.
Farm income or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
12.
Unemployment compensation (insurance) . . . . . . . . . . . . . . . . . . . . . . . .
13
13.
Taxable amount of social security and tier 1 railroad retirement benefits . . .
14
14.
Other income (including lottery or other gambling winnings) . . . . . . . . . .
15
15.
Total income (Add lines 1 through 14) . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
16.
Total adjustments to income from federal return (IRA, alimony, etc.) . . . .
17
17.
Adjusted gross income (Subtract line 16 from line 15) . . . . . . . . . . . . .
Dollars
Cents
ADDITIONS TO INCOME (See Instruction 11)
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
04-49
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