Form 1 - Massachusetts Resident Income Tax Return - 2013

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File pg. 1
YOU MUST COMPLETE AND
FOR PRIVACY ACT NOTICE,
ENCLOSE SCHEDULE HC
SEE INSTRUCTIONS.
orm 1
Massachusetts Resident Income Tax Return
2013
1. YOUR SOCIAL SECURITY NUMBER
FIRST NAME
M.I.
LAST NAME
2. SPOUSE’S SOCIAL SECURITY NUMBER
SPOUSE’S FIRST NAME
M.I.
LAST NAME
ADDRESS
CITY/TOWN/POST OFFICE/FOREIGN COUNTRY
STATE
ZIP + 4
Total
State Election Campaign Fund (this contribution will not change your tax or reduce your refund) . . . . . . . . . . . . . . .
$1 You
$1 Spouse if filing jointly . . . . .
You 3
Spouse
Fill in if veteran of U.S. armed forces who served in Operation Enduring Freedom, Iraqi Freedom or Noble Eagle 3
3 $
If taxpayer(s) is deceased, fill in appropriate oval(s) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Primary
Spouse
Under age 18 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
You 3
Spouse
Fill in if name/address has changed since 2012
3
1
FILING STATUS
Single
3
Fill in if noncustodial parent
3
(select one only)
Married filing joint return
(both must sign return)
Fill in if filing Schedule TDS (see instructions)
3
Married filing separate return
(enter spouse’s Social Security number in the appropriate space above)
Head of household
You are a custodial parent who has released claim to exemption for child(ren)
(see instructions) 3
2
EXEMPTIONS
Whole-dollar method only
a. Personal exemptions. If single or married filing separately, enter $4,400. If head of household, enter $6,800.
0 0
If married filing jointly, enter $8,800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
0 0
=
b. Number of dependents. (Do not include yourself or your spouse.)
Enter number 3
× $1,000
2b
You must enclose Schedule DI.
0 0
=
c. Age 65 or over before 2014:
You
Spouse
Enter number 3
× $ 700
2c
0 0
=
d. Blindness:
You
Spouse
Enter number 3
× $2,200
2d
e. 1. Medical/
0 0
0 0
0 0
+
=
Dental 3
2. Adoption 3
1
2
2e
From U.S. Schedule A, line 4
See instructions
0 0
f. TOTAL EXEMPTIONS. Add lines 2a through 2e. Enter here and on line 18 . . . . . . . . . . . . . . . . . . . . . . . 3 2f
INCOME
0 0
3
Wages, salaries, tips and other employee compensation (from all Forms W-2) . . . . . . . . . . . . . . . . . 3 3
0 0
4
Taxable pensions and annuities (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4
0 0
0 0
0 0
5
=
a. 3
b. 3
. . . . . . . . . . . . . . . a
b
5
Massachusetts bank interest
Exemption amount
Exemption: if married filing jointly, subtract $200 from line 5a; otherwise subtract $100 and enter result (not less than “0”).
If showing a loss, mark an X in box at left
5
6
Business/profession or farm income/loss (enclose Massachusetts Schedule C or U.S.
0 0
Schedule F). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6
7
If you are reporting rental, royalty, REMIC, partnership, S corporation, trust income/loss,
0 0
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7
0 0
8
a. Unemployment compensation. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 8a
0 0
b. Massachusetts state lottery winnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 8b
9
Other income (alimony, taxable IRA/Keogh distribution, winnings, fees) from Schedule X,
0 0
line 5 (enclose Schedule X; not less than “0”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9
0 0
10
TOTAL 5.25% INCOME. Add lines 3 through 9. (Be sure to subtract any loss(es) in lines 6 or 7) 10
SIGN HERE. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.
Your signature
Date
Print paid preparer’s name
Preparer’s SSN
or PTIN
3
/
/
Spouse’s signature (if filing jointly)
Date
Paid preparer’s phone
Paid preparer’s
(
)
EIN
3
/
/
May DOR discuss this return with the preparer?
3
Yes
3
Paid preparer’s signature
Date
Fill in if self-employed
I do not want my preparer to file my return electronically
3
/
/

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