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Massachusetts Department of Revenue

Form 3M

Income Tax Return for Clubs and Other

Organizations not Engaged in Business for Profit

2016

F or calendar year 2016 or taxable year beginning

, 2016 and ending .

Name of organization

Federal Identification number

Mailing address

City/Town

State

Zip

Phone number

Date of organizaton

Organization’s books are in care of

Principal organization activity

Mailing address

City/Town

State

Zip

Phone number

Fill in if:

Amended return (see “Amended Return” in instructions)

Amended return due to federal change

Final return

Computation of tax

11 5.1% income, including interest from Mass. banks.* List sources and amounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1

12 Interest and dividend income (from Massachusetts Schedule B, line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2

13 Total 5.1% income. Add line 1 and line 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

14 Tax on 5.1% income. Multiply line 3 by .051 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4

15 Taxable 12% capital gains (from Massachusetts Schedule B, line 29) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5

16 Tax on 12% capital gains. Multiply line 5 by .12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6

17 Tax on long-term capital gains (from Massachusetts Schedule D, line 17; not less than “0”). . . . . . . . . . . . . . . . . . . . . . 3 7

18 Additional tax on installment sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 8

19 Total tax. Add lines 4, 6, 7 and 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9

10 2015 overpayment applied to your 2016 estimated tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 10

11 2016 Massachusetts estimated tax payments (do not include amount in line 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 11

12 Payments made with extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 12

Declaration

I declare under the pains and penalty of perjury that to the best of my knowledge, the information contained herein is accurate and complete.

Signature

Date

Phone number

Title

Name of firm

PTIN or SSN

Signature of paid preparer

Date

Employer Identification number

Address