Schedule Sk-1 - Shareholder'S Massachusetts Information - 2001

2001

Schedule SK-1

Massachusetts

Shareholder’s

Department of

Massachusetts Information

Revenue

For calendar year 2001 or taxable year beginning

and ending

Shareholder’s name

S corporation’s name

Street address

Street address

City/Town

State

Zip

City/Town

State

Zip

Shareholder’s Social Security or Federal Identification number

S corporation’s Federal Identification number

Type of entity: Individual

Trust or estate

Note to each shareholder: The S corporation has completed the information on this

tax schedule. Refer to Shareholder’s Instructions for Schedule SK-1 on the back before

If an individual, check the appropriate box: Resident

Nonresident

entering information from this tax schedule on your tax return.

Shareholder’s Distributive Share

For a nonresident shareholder eligible to apportion, enter in column (b) the amount of the shareholder’s share of each applicable distributive share item

multiplied by the apportionment percentage in Form 355S, Schedule F, line 5. For line 8, enter the amount of the shareholder’s share without apportionment.

For all other shareholders, enter in column (b) the amount of the shareholder’s share of each applicable distributive share item.

(a) Distributive share line

(b) Shareholder’s Mass.

(c) Form 1, 1-NR/PY or 2 filers, use the amount in

distributive amount

column (b) to complete the following schedules:

11 Massachusetts ordinary income or loss (from Schedule S, line 20)

12 Separately stated deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13 Combine lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 1 or 1-NR/PY, Schedule E, Part II, or Form 2

14 Credits:

Taxes paid to another state or jurisdiction (for

residents only)

Lead paint

EOA

FEC

Brownfields

Low Income Housing . . . . . . . . . . . . . . . . . . . . .

See SK-1 instructions

15 Net income or loss from rental real estate activity(ies)

(from Schedule S, line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See SK-1 instructions

16 Net income or loss from other rental activity(ies)

(from Schedule S, line 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See SK-1 instructions

17 5.6% interest from Massachusetts banks (from Schedule S, line 25)

See SK-1 instructions

18 Interest on U.S. obligations (from Schedule S, line 24) . . . . . . . . . .

See SK-1 instructions

19 Non-Massachusetts state and municipal bond interest

(from Schedule S, line 27) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See SK-1 instructions

10 Other interest and dividend income (from Schedule S, line 26) . . . .

See SK-1 instructions

11 Royalty income (from Schedule S, line 28) . . . . . . . . . . . . . . . . . . .

See SK-1 instructions

12 Other Income (from Schedule S, line 29) . . . . . . . . . . . . . . . . . . . . .

See SK-1 instructions

13 Short-term capital gains (from Schedule S, line 30) . . . . . . . . . . . . .

Forms 1, 1-NR/PY or 2, Sch. B

14 Short-term capital losses (from Schedule S, line 31) . . . . . . . . . . . .

Forms 1, 1-NR/PY or 2, Sch. B

15 Gain on the sale, exchange or involuntary conversion

of property used in a trade or business and held for

one year or less (from Schedule S, line 32) . . . . . . . . . . . . . . . . . . .

Forms 1, 1-NR/PY or 2, Sch. B

16 Loss on the sale, exchange or involuntary conversion

of property used in a trade or business and held for

one year or less (from Schedule S, line 33) . . . . . . . . . . . . . . . . . . .

Forms 1, 1-NR/PY or 2, Sch. B

17 Long-term capital gain or loss (from Schedule S, line 34)* . . . . . . .

Forms 1, 1-NR/PY or 2, Sch. D

18 Net gain or loss under Section 1231 (from Schedule S, line 35)*. . . .

Forms 1, 1-NR/PY or 2, Sch. B & D

19 Other long-term gains and losses (from Schedule S, line 36)*. . . . .

Forms 1, 1-NR/PY or 2, Sch. B & D

20 Long-term gains on collectibles (from Schedule S, line 37)* . . . . . .

Forms 1, 1-NR/PY or 2, Sch. B & D

21 Differences and adjustments, if any (from Schedule S, line 38) . . . .

*The S corporation may provide each shareholder with a breakdown of long-term capital gains and losses by the applicable holding period(s). If the S corporation does not do

so, all long-term capital gains and losses are to be reported as being held for more than one year but not more than two years, and excluding long-term gains on collectibles

taxed at 5%.

Shareholder’s Basis Information

(a) Number of shares

(b) Amount

22 Federal basis as of 12-31-85, or later year, if applicable

(See instructions and specify year here: ___________ )

23 Massachusetts basis

24 Net Massachusetts

25 Net federal adjustments

26 Massachusetts basis

at beginning of year

adjustments

at end of year (23 + 24)

Stock

Indebtedness