Form 1-Nr/py - Mass. Nonresident/part-Year Resident Tax Return - 2012 Page 3
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62012 FORM 1-NR/PY, PAGE 3
SOCIAL SECURITY NUMBER
FIRST NAME
M.I.
LAST NAME
0 0
16
Child under age 13, or disabled dependent/spouse care expenses (from worksheet) . . . . . . . . . . . . . . . . . . . . . 3 16
17
Number of dependent member(s) of household under age 12, or dependents age 65 or over (not you or your spouse) as of December 31, 2012,
or disabled dependent(s)
(only if single, head of household or married filing joint return and not claiming line 16).
0 0
Nonresidents multiply result by line 14g;
× $3,600
=
Not more than two: a. 3
. . . . . . . . . . . 3 17
part-year residents multiply result by line 2
18
Rental deduction.
Total rental deduction cannot exceed $3,000 ($1,500 if married filing separately). See instructions.
0 0
0 0
÷
=
Total Massachusetts rent paid in 2012: a. 3
2
. . . . . . . . . . . . . . . . . . . . . . . . . 3 18
Nonresidents, during 2012 did you have a family home or any other dwelling outside Massachusetts to which you generally or customarily
returned or intend to return in the future?
Yes
No. If Yes, you do not qualify for this deduction.
0 0
19
Other deductions from Schedule Y, line 17 (enclose Schedule Y) . . . . . . . . . . . . . . . . . . . . . . . . . . 3 19
0 0
20
TOTAL DEDUCTIONS. Add lines 15 through 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 20
0 0
21
5.25% INCOME AFTER DEDUCTIONS. Subtract line 20 from line 12. Not less than “0” . . . . . . . . . . 21
Exemption amount
Nonresidents multiply line 22a by line 14g.
0 0
0 0
22
(from line 4f) . . . . a.
. . . . . . . . . . 3 22
Part-year residents multiply line 22a by line 2
23
5.25% INCOME AFTER EXEMPTIONS. Subtract line 22 from line 21. Not less than “0.”
0 0
If line 21 is less than line 22, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24
INTEREST AND DIVIDEND INCOME from Schedule B, line 38. Not less than “0.”
0 0
(enclose Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 24
0 0
25
TOTAL TAXABLE 5.25% INCOME. Add lines 23 and 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26
TAX ON 5.25% INCOME (from tax table). If line 25 is more than $24,000, multiply by .0525.
Note: If choosing the optional 5.85% tax rate, multiply line 25 and the amount in Schedule D,
0 0
line 21 by .0585. See instructions; fill in oval 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27
12% INCOME from Schedule B, line 39. Not less than “0” (enclose Schedule B).
0 0
0 0
× .12 = . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
a. 3
28
TAX ON LONG-TERM CAPITAL GAINS (from Schedule D, line 22). Not less than “0.” Enclose
0 0
Schedule D. If filing Sched. D-IS, Installment Sales, fill in oval and enclose Schedule D-IS 3
3 28
If excess exemptions were used in calculating lines 24, 27 or 28, fill in oval (see instructions) 3
29
Credit recapture amount (enclose Schedule H-2; see instructions).
0 0
BC
EOA
LIH
HR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 29
3
0 0
30
Additional tax on installment sale (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 30
31
If you qualify for No Tax Status, fill in oval and enter “0” on line 32. Complete Schedule
NTS-L-NR/PY 3
0 0
32
TOTAL INCOME TAX. Add lines 26 through 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
CREDITS
0 0
33
Limited Income Credit. Complete and enclose Schedule NTS-L-NR/PY . . . . . . . . . . . . . . . . . . . . . . . 3 33
0 0
34
Credits from Schedule Z, line 9 (enclose Schedule Z). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 34
0 0
35
Credits from Schedule Z, line 12 (part-year residents only; enclose Schedule Z). . . . . . . . . . . . . . . 3 35
0 0
36
INCOME TAX AFTER CREDITS. Subtract total of lines 33 through 35 from line 32. Not less than “0” 36
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