Form 1040me - Maine Individual Income Tax Booklet - 2012 Page 7
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202012
1040ME LONG FORM
Page 3
99
*1202111*
35
MAINE RESIDENTS ONLY: Check this box if you would like to receive a Maine Residents Property Tax and Rent Refund Application in 2013:
See for information about the Tax and Rent “Circuitbreaker” Program. THE APPLICATION WILL BE MAILED
TO YOU IN AUGUST 2013 unless your income on line 16 exceeds the income limits for this program.
If taxpayer is deceased,
If spouse is deceased,
IMPORTANT NOTE
enter date of death.
enter date of death.
(Month)
(Day)
(Year)
(Month)
(Day)
(Year)
Third Party
Do you want to allow another person to discuss this return with Maine Revenue Services?
Yes (complete the following).
No.
Designee
(See page 3)
Designee’s name
Phone no.
Personal identifi cation #:
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
SIGN
HERE
Your signature
Date signed
Your occupation
Keep a
copy of
this return
for your
records
Spouse’s signature (If joint return, both must sign)
Date signed
Spouse’s occupation
Preparer’s signature
Date
Preparer’s phone number
Paid
Preparer’s
Use
Only
Print preparer’s name and name of business
Preparer’s SSN or PTIN
ERRORS THAT DELAY PROCESSING OF RETURNS:
•
IF YOU ARE OVER 65 AND/OR BLIND, SEE THE INSTRUCTIONS ON PAGE 2 AND CLAIM THE
A
DDITIONAL AMOUNT AS ALLOWED.
• •
USE THE CORRECT COLUMN FROM THE TAX TABLE FOR YOUR FILING STATUS.
• •
IF YOU OVERPAID YOUR TAX, ENTER THE AMOUNT YOU WANT TO BE REFUNDED ON LINE 33B.
•
SOCIAL SECURITY NUMBERS THAT ARE NOT CORRECT.
• •
FILING STATUS AND NUMBER OF EXEMPTIONS INCOMPLETE.
•
W-2 FORMS ARE NOT ENCLOSED WITH THE RETURN.
•
ERRORS IN CALCULATION.
• •
AMOUNTS ENTERED ON WRONG LINE.
• •
USE BLACK OR BLUE INK. DO NOT USE RED INK.
•
BE SURE TO SIGN YOUR RETURN.
If requesting a REFUND, mail to: Maine Revenue Services, P.O. Box 1066, Augusta, ME 04332-1066
If NOT requesting a refund, mail to: Maine Revenue Services, P.O. Box 1067, Augusta, ME 04332-1067
DO NOT SEND PHOTOCOPIES OF RETURNS
Injured
Payment
Spouse
Plan
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