Schedule M1home - First-Time Homebuyer Savings Account - 2017

*171791*

2017 Schedule M1HOME, First-Time Homebuyer Savings Account

If you are the account holder of more than one first-time homebuyer savings account, complete a separate Form M1HOME for each

account for which you are the account holder.

Your First Name and Initial

Last Name

Social Security Number

Registration Information

Bank Name

Date Account Opened

Account Number

End of Year Balance

Qualified Beneficiary

Date Qualified Beneficiary Named

Withdrawals from Account

Date of Withdrawal

Amount of Withdrawal

Purpose of Withdrawal

Round amounts to the nearest whole dollar.

Account Reporting

1 Amount of contributions made in 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Qualified withdrawals in 2017 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Non-qualified withdrawals in 2017 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Subtraction

4 Enter amount of interest earned on this savings account here and on line 41 of Schedule M1M

4

. . . . . . . . . . . . . . . . . . .

Addition

5 Subtract line 1 from line 3. If less than 0, stop here. You do not have an addition.

Do not complete the rest of this form. If you have a positive number, enter this amount on line 14

of schedule M1M and complete the next section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Additional Tax

6 Multiply line 5 by 10% (.10). Enter the amount here and on line 14 of Form M1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

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