Form 1040me-El - Maine Individual Income Tax Declaration For Electronic Filing
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1*000210A00*
FORM 1040ME-EL
MAINE INDIVIDUAL INCOME TAX
DECLARATION FOR ELECTRONIC FILING
For tax year January 1 - December 31, 2000
*000210A00*
(See instructions on back)
Your First Name
Initial
Your Social Security Number
-
-
Your Last Name
Spouse's Social Security Number
-
-
Spouse's First Name
Initial
Home Phone Number
-
-
Spouse's Last Name
Work Phone Number
-
-
Home Address (number, street and apt. no.)
City/Town
State
Zip Code
,
,
.00
14.
Federal adjusted gross income ..................................................................... 14
,
,
.00
19.
Maine taxable income ................................................................................... 19
,
,
.00
26.
Maine net tax ................................................................................................ 26
,
,
.00
28d. Total payments and credits ........................................................................... 28d
,
,
.00
34a. Amount of overpayment to be credited to 2001 estimated tax ........................... 34a
,
,
.00
34b. Amount of overpayment to be refunded ........................................................ 34b
,
,
.00
35c. Total amount due .......................................................................................... 35c
(NOTE: Pay in full by April 17, 2001. See instructions)
DIRECT DEPOSIT OF REFUND
IF YOU WOULD LIKE YOUR REFUND SENT DIRECTLY TO YOUR BANK ACCOUNT FILL IN THE LINES BELOW.
34c Routing Number
34e Type of Account:
Checking
Savings
34d Account Number
TAXPAYER DECLARATION
o
I consent that my refund be directly deposited as designated above, and declare that the information shown on lines 34c through 34e is
correct. Completing the information above authorizes Maine Revenue Services to disclose my Social Security number(s), listed on this
form, to my financial institution for the sole purpose of depositing my income tax refund directly into my bank account.
o
I do not want my refund directly deposited to my account; or I am not receiving a refund.
Under penalties of perjury, I declare that I have compared the information contained on my electronic return with the information that I provided
to my electronic return originator and that the name(s), address and amounts shown above agree with the amounts on the corresponding lines
of my 2000 Maine electronic income tax return. To the best of my knowledge and belief, my return is true, correct and complete. I consent that
my return, including accompanying schedules and statements, be sent to Maine Revenue Services by my electronic return originator. This
declaration is to be mailed to: Maine Revenue Services, PO Box 9105, Augusta, ME 04332-9105.
F
_______________________________________________
________________________________________________
S ign
Your signature
Date
Spouse’s signature (if joint return, both must sign)
Date
Here
ELECTRONIC RETURN PREPARER DECLARATION
I declare that I have reviewed the taxpayer’s return and that the entries on this form are complete and correct to the best of my knowledge. I have
obtained the taxpayer’s signature before submitting the return to Maine Revenue Services, have provided the taxpayer with a complete copy of
the return including all schedules, and have followed all other requirements described in Publication IIT-ELF, Handbook for Electronic Filers of
Maine Individual Income Tax Returns (Tax Year 2000).
Originator’s
Date:
Your social security number or P-TIN:
____________________________________________________________
signature:
___________
__________________________
Electronic
EFIN:
Return
Firm’s name (or yours
__________________________________________________________
__________________________
Originator
if self-employed) and
Use Only
ZIP Code:
Phone:
address:
____________________________________________________________
___________
__________________________
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