Form 1 - Massachusetts Resident Income Tax Return - 2014 Page 3
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2014 FORM 1, PAGE 3
SOCIAL SECURITY NUMBER
FIRST NAME
M.I.
LAST NAME
32
Voluntary fund contributions:
0 0
0 0
a. Endangered Wildlife Conservation 3 32a
d. Massachusetts U.S. Olympic . . . . . . . 3 32d
0 0
0 0
b. Organ Transplant . . . . . . . . . . . . . 3 32b
e. Mass. Military Family Relief . . . . . . . . 3 32e
0 0
0 0
c. Massachusetts AIDS . . . . . . . . . . . 3 32c
f. Homeless Animal Prevention And Care 3 32f
0 0
Total. Add lines 32a through 32f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
0 0
33
Use tax due on Internet, mail order and other out-of-state purchases (from worksheet) . . . . . . . . . 3 33
34
Health Care penalty. Not less than “0” (from worksheet; be sure to enclose Schedule HC):
0 0
0 0
0 0
0 0
a. 3
+ b. 3
– c. 3
. . . a + b – c = 34
You
Spouse
Federal healthcare penalty
0 0
35
INCOME TAX AFTER CREDITS, CONTRIBUTIONS, USE TAX and HC PENALTY. Add lines 31–34 . . . . 35
36
Massachusetts income tax withheld (enclose all Massachusetts Forms W-2, W-2G, 2-G,
0 0
PWH-WA, LOA and certain 1099s, if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 36
37
2013 overpayment applied to your 2014 estimated tax (from 2013 Form 1, line 45 or
0 0
Form 1-NR/PY, line 50; do not enter 2013 refund) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 37
0 0
38
2014 Massachusetts estimated tax payments (do not include amount in line 37) . . . . . . . . . . . . . 3 38
0 0
39
Payments made with extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 39
40
Earned Income Credit:
0 0
0 0
a. Number of qualifying children 3
Amount from U.S. return 3
× .15 = . . . . . . . 3 40
0 0
41
Senior Circuit Breaker Credit (enclose Schedule CB) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 41
0 0
42
Other refundable credits from Schedule RF, line 5 (enclose Schedule RF) . . . . . . . . . . . . . . . . . . . . 3 42
0 0
43
TOTAL. Add lines 36 through 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
44
OVERPAYMENT. If line 35 is smaller than line 43, subtract line 35 from line 43. If line 35 is larger
0 0
than line 43, go to line 47. If line 35 and line 43 are equal, enter “0” in line 46 . . . . . . . . . . . . . . . . 3 44
0 0
45
Amount of overpayment you want APPLIED to your 2015 ESTIMATED TAX . . . . . . . . . . . . . . . . . . 3 45
46
THIS IS YOUR REFUND. Subtract line 45 from line 44.
0 0
Mail to: Massachusetts DOR, PO Box 7000, Boston, MA 02204 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 46
Direct Deposit of Refund. See instructions.
Type of account (you must select one): 3
Checking
Savings
3
3
Routing number (first two digits must be 01–12 or 21–32)
Account number
47
TAX DUE. Subtract line 43 from line 35. Pay online at , or use
0 0
Form PV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 47
Pay in full. Write Social Security number(s) on lower left corner of check and be sure to sign check.
Make payable to Commonwealth of Massachusetts. Mail to: Massachusetts DOR, PO Box 7003, Boston, MA 02204.
Add to total in line 47, if applicable:
0 0
0 0
0 0
Interest 3
Penalty 3
M-2210 amount 3
Exception. Enclose Form M-2210
3
BE SURE TO SIGN RETURN ON PAGE 1 AND ENCLOSE SCHEDULE HC.
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