Form 515 - Maryland Tax Return - 2012

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2012
FORM
FOR NONRESIDENTS EMPLOYED IN
515
MARYLAND WHO RESIDE IN JURISDICTIONS
THAT IMPOSE A LOCAL INCOME OR
$
EARNINGS TAX ON MARYLAND RESIDENTS
MARYLAND TAX RETURN
OR FISCAL YEAR BEGINNING __________2012, ENDING ___________
Social Security number
Spouse's Social Security number
Your First Name
Initial
Last Name
Spouse's First Name
Initial
Last Name
Present Address (No. and street)
City or Town
State
ZIP code
City, town or taxing Area
MD County
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)
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 and 2 to
2.
Married filing joint return or spouse had no income
5.
Qualifying widow(er) with dependent child
determine if you are required
to file.
3.
Married filing separately
6.
Dependent taxpayer (Enter 0 in Exemption Box (A) - See Instruction 7)
Spouse's Social Security number
CHECK ONE BOX
RESIDENCE INFORMATION
EXEMPTIONS
-
See Instruction 8
See Instruction 9. Check appropriate box(es). NOTE: If you are claiming dependents, you must
attach the Dependents' Information Form 502B to this form in order to receive the applicable exemption amount.
Enter 2-letter state code for your state of legal residence.
City, Borough
A
Yourself
Spouse
A. Enter No. Checked. . .
See Instruction 9 A. $____
County (PA)
or Township (PA)
Were you a resident for the entire year of 2012? Yes
No
Check
65 or over
65 or over
If no, attach explanation.
here for
B
X $1,000. . . . .
B.$____
B. Enter No. Checked. . .
Maryland
Are you or your spouse a member of the military? Yes
No
Blind
Blind
taxes
Did you file a Maryland income tax return for 2011? Yes
No
withheld
C. $____
C
Enter No. from line 3 of Dependent Form 502B. . . . . . . . .
See Instruction 9
If “Yes,” was it a
Resident or a
Nonresident return?
in error
Advise dates you resided within Maryland for 2012. If
none, enter “NONE.”
D Enter Total Exemptions (Add A, B and C). . . . . . . . . . .
. . .Total Amount D. $____
(See inst. 4)
FROM_______________ TO _____________
(2) MARYLAND
(1) FEDERAL
(3) NON-MARYLAND
INCOME AND ADJUSTMENTS INFORMATION (See Instruction 10)
INCOME (LOSS)
WAGE INCOME
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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Place
8
8. Other gains or (losses) (from federal Form 4797) . . . . . . . . . . . . . . . .
CHECK
or
9
9. Taxable amount of pensions, IRA distributions, and annuities . . . . . . . .
MONEY
10
10. Rents, royalties, partnerships, estates, trusts, etc. (Circle appropriate item)
ORDER
11
11. Farm income or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
on top
of your
12
12. Unemployment compensation (insurance) . . . . . . . . . . . . . . . . . . . . . .
W-2
13
13. Taxable amount of social security and tier 1 railroad retirement benefits . .
wage
and tax
14
14. Other income (including lottery or other gambling winnings) . . . . . . . . .
state-
15
15. Total income (Add lines 1 through 14) . . . . . . . . . . . . . . . . . . . . . . . .
ments
16
16. Total adjustments to income from federal return (IRA, alimony, etc.) . . .
and
ATTACH
17
17. Adjusted gross income (Subtract line 16 from line 15) . . . . . . . . . . . . .
HERE
Dollars
Cents
with
ADDITIONS TO INCOME (See Instruction 11)
ONE
18
18. Non-Maryland loss and adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
staple.
19
19. Other (Enter code letter(s) from Instruction 11) . . . . . . . . . . . . . . . . . . . . . .
20
20. Total Additions (Add lines 18 and 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21. Total federal adjusted gross income & Maryland additions (Add lines 17 (Column 1) and 20) . . . . . . . . .
21
SUBTRACTIONS FROM INCOME (See Instruction 12)
22
22. Taxable military income of nonresident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
23. Other (Enter code letter(s) from Instruction 12) . . . . . . . . . . . . . . . . . . . . .
24
24. Total Subtractions (Add lines 22 and 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25. Maryland adjusted gross income before subtraction of non-Maryland income
25
(Subtract line 24 from line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
COM/RAD-023
12-49

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