Worksheet For Form 1040me, Schedule A, Line 14 - 2012 Page 2

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Maine Minimum Tax

Income Modiﬁ cation Worksheet for the

Exclusion Items Worksheet, Line b above

1. ADDITIONS - see instructions

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

b Net Operating Loss Adjustment (see instructions; attach a schedule showing your calculation) ............................................... ________________

c Maine Public Employees Retirement System Contributions ....................................................................................................... ________________

d Domestic Production Activities Deduction Add-back ................................................................................................................... ________________

e Bonus Depreciation Add-back (see instructions) ......................................................................................................................... ________________

Maine Capital Investment Credit Bonus Depreciation Add-back (see instructions) ................................................................... ________________

g Fiduciary Adjustment - additions only (attach a copy of your 2011 federal Schedule K-1) .................................................... ________________

h Other (see instructions). List the type and amount of income items included (attach a separate schedule,

if necessary) ______________________________________________________________________________ ................. ________________

Deductible costs incurred in the production of Maine exempt income (see instructions) ....................................................... ______________

Any loss, deduction or other expense attributable to income from an ownership interest

in a pass-through entity ﬁ nancial institution (see instructions) ................................................................................................... ________________

Total additions (Add lines 1a through 1j) .................................................................................................................................. ________________

2. SUBTRACTIONS - see instructions

U.S. Government Bond interest ................................................................................................................................................ ________________

Social Security and Railroad Retirement Beneﬁ ts ..................................................................................................................... ________________

Pension Income Deduction ........................................................................................................................................................ ________________

Interest from Maine Municipal General Obligation, Private Activity and Airport Authority Bonds ..................................................

_______________

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

NOTE: If you itemized deductions in 2011, complete worksheet below ............................................................................ ________________

Maine Public Employees Retirement System Pick-Up Contributions paid to the taxpayer during 2011

which have been previously taxed by the state .......................................................................................................................... ________________

Contributions to Qualiﬁ ed Tuition Programs - 529 Plans ............................................................................................................ ________________

Fiduciary Adjustment-deductions only (attach a copy of your 2011 federal Schedule K-1) .................................................. ________________

Bonus Depreciation and Section 179 Recapture (See instructions) .......................................................................................... ________________

Other. List (see instructions). Do not enter non-Maine income on line 2j ............................................................................. ________________

Deductible costs of producing income exempt from federal tax, but subject to Maine tax ......................................................... ________________

Total Subtractions (add lines 2a through 2k) ........................................................................................................................... ________________

Net Modiﬁ cation (subtract line 2l from line 1k — enter here and on line b, Maine Minimum Tax - Exclusion

Items Worksheet above [may be a negative amount]) ............................................................................................................... ________________

Maine Minimum Tax — Worksheet for Line 2e of the Income Modiﬁ cation Worksheet above

For individuals who claimed a deduction for long-term care insurance premiums in 2011. Complete this worksheet only if you claimed Maine itemized

deductions in 2011 and your 2011 federal Schedule A, line 4 is greater than zero or you were self-employed in 2011 and your 2011 federal Form 1040, line

29 is greater than zero.

1. Enter total amount of long-term care insurance premiums paid during 2011: .......................... $

2. Enter amount from 2011 federal Schedule A, line 1 ................................................................................................................... ________________

3. Enter amount of long-term care premiums included in line 2 above ......................................................................................... ________________

4. Divide line 3 by line 2 ................................................................................................................................................................. __ . __ __ __ __

5. Enter 2011 federal Schedule A, line 4 minus federal Form 6251, line 2 $ __________________ .

Multiply this amount by the percentage on line 4 above and enter result here ........................................................................... ________________

6. Enter the amount of long-term care insurance premiums included on 2011 federal Form 1040, line 29 _ ...............................

7. Subtract line 5 and line 6 from line 1. Enter result here and on Maine Minimum Tax - Income Modiﬁ cation

Worksheet, line 2e above ........................................................................................................................................................... ________________