Schedule Sk-1 - Shareholder'S Massachusetts Information

FOR PRIVACY ACT NOTICE,

PRINT IN BLACK INK

SEE INSTRUCTIONS.

Schedule SK-1

Shareholder’s Massachusetts Information

2011

TAXPAYER IDENTIFICATION NUMBER

NAME OF SHAREHOLDER

ADDRESS

CITY/TOWN/POST OFFICE

STATE

ZIP + 4

FEDERAL IDENTIFICATION NUMBER

NAME OF S CORPORATION

ADDRESS

CITY/TOWN/POST OFFICE

STATE

ZIP + 4

Type of shareholder:

Individual resident

Individual nonresident

Trust or estate

Bank

Exempt organization

Did the S corporation participate in one or more installment sales transactions?:

Yes

If Yes, indicate whether information has been communicated to the shareholder to calculate an addition to Massachusetts tax under M.G.L. Ch. 62C,

Sec. 32A based on the following Internal Revenue Code (IRC) provisions (check all that apply):

IRC 453A

IRC 453(l)(2)(B)

If showing a loss, mark an X in box at left

Shareholder’s Distributive Share

Massachusetts ordinary income or loss (from Schedule S, line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Separately stated deductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Add lines 1 and 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Credits available

a. Taxes paid to another jurisdiction (residents only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a

b. Lead Paint Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b

c. Economic Opportunity Area Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4c

d. Economic Development Incentive Program Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4d

e. Brownfields Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4e

f. Low-Income Housing Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4f

g. Historic Rehabilitation Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4g

h. Refundable Film Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4h

i. Film Incentive Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4i

j. Medical Device Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4j

k. Refundable Dairy Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4k

l. Refundable Life Science Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4l

m.Life Science Company Investment Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4m

n. Life Science Company FDA User Fee Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4n

o. Life Science Company Research Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4o

p. Refundable Economic Development Incentive Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4p

q. Conservation Land Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4q

r. Total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4r

BE SURE TO CONTINUE SCHEDULE SK-1 ON OTHER SIDE.

Schedule Sk-1 - Shareholder'S Massachusetts Information - 2011

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