Form 1040me - Maine Individual Income Tax - Long Form

*0402102*

SCHEDULES 1 & 2

See instructions on pages 9 and 10.

Enclose with your Form 1040ME

*0402102*

Attachment Sequence No.

Name(s) as shown on Form 1040ME

Your Social Security Number

SCHEDULE 1 — INCOME MODIFICATIONS

1 ADDITIONS to federal adjusted gross income.

a Income from municipal and state bonds, other than Maine ................................................. 1a

b Net Operating Loss Recovery Adjustment (Attach a schedule showing your calculation) .. 1b

c Maine State Retirement Contributions ................................................................................. 1c

d Fiduciary Adjustment - additions only (Attach a copy of your federal Schedule K-1) .......... 1d

e Bonus Depreciation and Section 179 Add-back (See instructions) ..................................... 1e

Health Savings Accounts Add-back (See instructions) ........................................................ 1f

g Other (See instructions). List the type and amount of income items included (attach

supporting documentation) ________________________________________

............. 1g

h Total additions (Add lines 1a through 1g) ............................................................................ 1h

2 SUBTRACTIONS from federal adjusted gross income.

a U.S. Government Bond interest included in federal adjusted gross income ....................... 2a

b State Income Tax Refund (Only if included in federal income) ............................................ 2b

c Social Security and Railroad Retirement Benefits included in federal adjusted gross

income (See instructions) .................................................................................................... 2c

d Pension Income Deduction (Complete and attach the worksheet on back) ........................ 2d

e Interest from Maine Municipal General Obligation and Private Activity Bonds included in

federal adjusted gross income ............................................................................................. 2e

Premiums for Long-Term Care Insurance (Do not include health insurance premiums on this line)

NOTE: If you itemize deductions or are self-employed, complete and attach the worksheet on page 20 2f

g Maine State Retirement System Pick-Up Contributions paid to the taxpayer during 2004

which have been previously taxed by the state ................................................................... 2g

h Federal Work Opportunity Credit/Empowerment Zone Credit ............................................. 2h

Fiduciary Adjustment-deductions only (Attach a copy of your federal Schedule K-1) .... 2i

Bonus Depreciation and Section 179 Recapture (See instructions) ................................... 2j

k Other. List _______________________________ (See instructions) .............................. 2k

(Nonresidents and Part-year residents - Do not enter non-Maine income)

Total Subtractions (Add lines 2a through 2k) ....................................................................... 2l

3 Net Modification (Subtract line 2l from line 1h — enter here and on 1040ME, page 1, line 15

[If negative, enter a minus sign in the box to the left of the number]) ....................................... 3

SCHEDULE 2 — ITEMIZED DEDUCTIONS

4 Total itemized deductions from federal Form 1040, Schedule A, line 28 .................................. 4

5 a Income taxes imposed by this state or any other taxing jurisdiction or general sales taxes

included in line 4 above from federal Form 1040, Schedule A, line 5. (See instructions if

Form 1040ME, line 14 exceeds $142,700 [$71,350 if Married Filing Separately]) .............. 5a

b Deductible costs, included in line 4 above, incurred in the production of Maine exempt

income (See instructions) .................................................................................................... 5b

c Amounts included in line 4 that are also being claimed for the Family Development

Account Credit on Maine Schedule A, line 18 ...................................................................... 5c

d Amount included in line 4 attributable to income from an ownership interest in a

pass-through entity financial institution ................................................................................ 5d

6 Deductible costs of producing income exempt from federal income tax, but taxable by

Maine (See instructions) ............................................................................................................ 6

7 Line 4 minus lines 5a, b, c, and d plus line 6. Enter result here and on 1040ME, page 1, line 17 .. 7

Note: If the amount on line 7 is less than your allowable standard deduction, use the standard deduction.

If Married Filing Separately, however, both spouses must either itemize or use the standard deduction.

Form 1040me - Maine Individual Income Tax - Long Form - 2004 Page 3

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