Telefile Worksheet 1, 2 - 1998 - Massachusetts Department Of Revenue Page 2

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RETAIN FOR YOUR RECORDS. THIS WORKSHEET

1998 Telefile Worksheet 2

WILL NOT BE PROCESSED IF MAILED.

Winnings, Fees & Other Misc. Income — If you do not have any other income to report, go to line 14.

11. Taxable Pension and Annuities (from U.S. 1040A, line 11b; or 1040, line 16b) Enter total in line 11c. If any of these

distributions include previously taxed contributions, make the necessary adjustment by completing the following:

a. Total pensions and annuities (from U.S. 1040A, line 11a; or 1040, line 16a) . . . . . 11a. $ _______________

b. Contributions previously taxed by Massachusetts included in line 11a . . . . . . . . . . 11b. $ _______________

c. Taxable pensions and annuities (subtract item b from item a and enter the result here). . . . . . . . . . . . 11c.

d. Total Massachusetts withholding for pensions and annuities (from box 10 of all Forms 1099-R) . . . . . . 11d.

Do not include in line 11c any contributory pensions from the U.S. Gov’t., the Commonwealth of Massachusetts or its political sub-

divisions, or any noncontributory pensions or survivorship benefits from the U.S. uniformed services (Army, Navy, Marine Corps, Air

Force, Coast Guard, commissioned corps of the Public Health Service and National Oceanic and Atmospheric Administration).

12. Winnings and Fees (enter total of all winnings and fees). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.

a. Total Mass. withholding for winnings and fees (from box 14 of Form W-2G or box 11 of Form 1099-MISC) 12a.

13. 12% Interest and Dividend Income If the only interest you received was from Massachusetts banks and you have no dividend

income, do not complete this section. If you need to make adjustments or exclude amounts other than Mass. bank interest, you

cannot Telefile. If the total amount of interest income you received from sources other than Massachusetts banks and/or dividend

income was less than or equal to $1,000, complete the following:

a. Total interest income (from U.S. Telefile, item C; U.S. 1040EZ, line 2; or 1040A or

1040, lines 8a and 8b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13a. $ _______________

b. Total dividend income (from U.S. Schedule 1, part II, line 6; or U.S. Schedule B,

part II, line 6; or if U.S. Schedule B not filed, from 1040A or 1040, line 9) . . . . . . . 13b. $ _______________

c. Total (add item a and item b and enter the result here) . . . . . . . . . . . . . . . . . . . . 13c. $ _______________

d. Massachusetts bank interest (from line 10 of worksheet) . . . . . . . . . . . . . . . . . . . 13d. $ _______________

e. Taxable 12% interest and dividend income (subtract item d from item c and enter the result here) . . . 13e.

Other Information

14. Total amount of rent you paid for your principal residence in 1998. If none, enter zero . . . . . . . . . . . . . . 14.

List your landlord’s name:

15. Estimated Tax Payments. If you made estimated tax payments in 1998, enter amount here . . . . . . . . . . . . 15.

If you are claiming a 1997 overpayment applied to your 1998 estimated taxes, you cannot Telefile

16. Earned Income Credit. Enter number of qualifying children

Enter amount from U.S. return . . . . . . . . . 16.

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Social Security number(s) of qualifying children

17. Do you want to contribute to the Organ Transplant Fund? If yes, amount. . . . . . . . . . . . . . . . . . . . . . . . . 17.

18. Do you want to contribute for Endangered Wildlife Conservation? If yes, amount . . . . . . . . . . . . . . . . . . 18.

19. Do you want to contribute to the Massachusetts AIDS Fund? If yes, amount . . . . . . . . . . . . . . . . . . . . . . 19.

20. Do you want to contribute to the Massachusetts United States Olympic Fund? If yes, amount . . . . . . . . 20.

After completing this worksheet, dial (617) 660-1998 or (413) 827-7100.

Telefile will tell you the following amounts. Enter the amounts in the boxes provided.

21. Total tax for 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.

22. Amount of your refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.

Direct deposit of refund. See next page for more information. Check type of account: Checking

Savings

Routing number (first two digits must be 01–12 or 21–32):

Account number:

23. Amount of tax due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.

Pay by credit or check card. See inside back cover for more information. If you paid by credit or

check card, enter your authorization number here:

“Sign” your return.

You (and your spouse, if filing jointly) must be present to authenticate the filing of your return. Telefile will

assign you a 9-digit confirmation number. Do not hang up until you receive this number; it is your proof of filing.

Confirmation number

Date you telefiled