Form Ds-1 - Disability Income Exclusion - 2014
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Clear Form
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MONTANA
DS-1
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Rev 05 14
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2014 Disability Income Exclusion
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15-30-2110(10), MCA
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Social Security Numbers
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First Name and Initial
Last Name
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X X X X X X X X X
-
-
100
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Spouse’s First Name and Initial
Last Name
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-
-
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Column A (for
Column B (for
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single, joint,
spouse when
married filing
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separate,
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or head of
separately on
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household)
the same form)
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Complete lines 1 through 3 for retirement disability benefits that you received for a full week.
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1. Multiply the amount of the retirement disability benefits that you received per week
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by the number of weeks you received these benefits and enter the result ........... 1.
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2. Multiply $100 by the number of weeks you received retirement disability benefits
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and enter the result, but not more than $5,200 ..................................................... 2.
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3. Enter the smaller of line 1 or line 2 ........................................................................ 3.
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Complete lines 4 through 6 for retirement disability benefits that you received for a portion of a week.
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4. Enter the amount of the retirement disability benefits that you received for a portion
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of a week ...............................................................................................................4.
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5. Multiply $20 by the number of work days you received retirement disability benefits
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and enter the result................................................................................................5.
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6. Enter the smaller of line 4 or line 5 ........................................................................ 6.
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7. Add line 3 and line 6 and enter the result .............................................................. 7.
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8. Add the amounts on line 7, columns A and B, and enter the result ................................................. 8.
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9. Enter your Montana adjusted gross income before your disability income exclusion
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(see instructions) ...................................................................................................9.
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10. Add the amounts on line 9, columns A and B, and enter the result ............................................... 10.
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11. Your income limitation amount is entered here ............................................................................. 11.
$15,000
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12. Subtract line 11 from line 10 and enter the result, but not less than zero ...................................... 12.
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13. Subtract line 12 from line 8 and enter the result, but not less than zero. This is your partial
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retirement disability income exclusion. Enter this amount on Form 2, Schedule II, line 13 ..... 13.
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If you file your Montana tax return electronically, you do not need to mail this form to us unless we ask you for a copy. When you file electronically, you
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represent that you have retained the required documents in your tax records and will provide them upon the department’s request.
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