Form 1040me - Maine Individual Income Tax Booklet - 2015 Page 5
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242015
MAINE INDIVIDUAL INCOME TAX
FORM 1040ME
99
For tax period
2 0 1 5
to
*1502100*
1/1/2015 to 12/31/2015 or
See instructions. Print neatly in blue or black ink only.
NOTE: If either spouse is deceased,
enter the date of death on Form 1040ME,
page 3 in the spaces provided above the
Your First Name
MI
signature area.
Your Last Name
Check here if this is an AMENDED return.
Your Social Security Number
Spouse’s First Name
MI
Spouse’s Social Security Number
Spouse’s Last Name
r
Home Phone Numbe
Current Mailing Address (PO Box, number, street and apt. no)
Work Phone Number
City or Town
State
ZIP Code
Foreign country name
Foreign province/state/county
Foreign postal code
Maine Property Tax Fairness Credit - Maine residents and part-year residents only - see Schedule PTFC. Check this box if you are
A
fi ling a return only to claim the Property Tax Fairness Credit on line 25d. Otherwise, leave this box blank. Follow the instructions on
Schedule PTFC.
1
Maine Clean Election Fund. Maine Residents Only.
2 Check here if you were engaged in COMMERCIAL
Check here if you, or your spouse, if fi ling jointly,
FARMING OR FISHING during 2015 .....................
You
Spouse
want $3 to go to this fund.
RESIDENCY STATUS (Check one)
12 CHECK IF:
You
Spouse
FILING STATUS (Check one)
were
was
3
Single
8
Resident
8a
“Safe Harbor” Resident
65 or over ........ 12a
12c
4
Married fi ling jointly (Even if only one had income)
5
Married fi ling separately. Enter spouse’s social
Blind................. 12b
12d
9
Part-Year Resident
security number and full name above.
10
Nonresident
6
Head of household (with qualifying person)
13 Enter the TOTAL number of
7
Qualifying widow(er)
11
Nonresident Alien
EXEMPTIONS claimed
with dependent child
on your federal return ....13
(Year spouse died
)
Check here if you are
fi ling Schedule NRH
Composite Return (Pass-through Entities ONLY)
.00
14
FEDERAL ADJUSTED GROSS INCOME. ............................................................... 14
.00
15
INCOME MODIFICATIONS. (From Schedule 1, line 3.) .......................................... 15
.00
16
MAINE ADJUSTED GROSS INCOME. (Line 14 plus or minus line 15.) ................. 16
.00
17
DEDUCTION.
Standard (See instructions on page 2) ................................. 17
Itemized (From Maine Schedule 2, line 7.)
.00
18
EXEMPTION. (See instructions.) ............................................................................................................... 18
Continue on page 2
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