Schedule Z - Other Credit - 2012, Schedule Rf - Other Refundable Credits

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File pg. 6

SOCIAL SECURITY NUMBER

FIRST NAME

M.I.

LAST NAME

Note: If claiming other credits on Form 1, line 30 or Form 1-NR/PY, lines 34 or 35, you must complete and enclose Schedule Z with your return.

Schedule Z Other Credits.

2012

Enclose with Form 1 or Form 1-NR/PY. Do not cut or separate these schedules.

PART 1. CREDITS

0 0

Lead Paint (you must enclose Schedule LP). Not less than “0” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1

a. Total number of units in line(s) 1a and 3a of Schedule LP. . . . . . . . . . . . 3 1a

Economic Opportunity Area (you must enclose Schedule EOAC). Not less than “0”

Economic Development Incentive Program

0 0

Certificate number . . . . . . . . . . . . . . . . . . . . . . . . 3

. . . . . . . 3 2

0 0

Septic (you must enclose Schedule SC). Not less than “0” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3

Brownfields. Not less than “0”

0 0

Certificate number . . . . . . . . . . . . . . . . . . . . . . . . 3

. . . . . . . 3 4

Low-Income Housing. Not less than “0”

0 0

Building identification number . . . . . . . . . . . . . . 3

. . . . . . . 3 5

Historic Rehabilitation. Not less than “0”

0 0

Certificate number . . . . . . . . . . . . . . . . . . . . . . . . 3

. . . . . . . 3 6

Film Incentive. Not less than “0”

0 0

Certificate number . . . . . . . . . . . . . . . . . . . . . . . . 3

. . . . . . . 3 7

Medical Device. Not less than “0”

0 0

Certificate number . . . . . . . . . . . . . . . . . . . . . . . . 3

. . . . . . . 3 8

Add lines 1 through 8. Not less than “0”. Nonresidents and part-year residents, enter the result

here and on Form 1-NR/PY, line 34. Part-year residents, also complete lines 10 through 12, if

0 0

applicable. Full-year residents, also complete lines 10 through 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

PART 2. CREDITS FOR FULL-YEAR AND PART-YEAR RESIDENTS ONLY

0 0

Income tax paid to another state or jurisdiction (from worksheet). Not less than “0” . . . . . . . . . . . 3 10

Enter two-letter state or jurisdictional postal code. . . 3

0 0

Solar and wind energy (you must enclose Schedule EC). Not less than “0” . . . . . . . . . . . . . . . . . . . 3 11

PART 3. TOTALS

Add lines 10 and 11. Not less than “0”. Part-year residents, enter the result here and on Form

0 0

1-NR/PY, line 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Full-year residents only. Add lines 9 and 12. Not less than “0”. Enter the result here and on

0 0

Form 1, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Schedule RF Other Refundable Credits

0 0

Refundable film credit (you must enclose Schedule RFC). Not less than “0” . . . . . . . . . . . . . . . . . . . 3 1

Refundable dairy credit (see instructions)

0 0

Not less than “0”. Certificate number . . . . . . . . . 3

. . . . . . . 3 2

Refundable conservation land tax credit

0 0

Not less than “0”. Certificate number . . . . . . . . . 3

. . . . . . . 3 3

Total refundable credits. Add lines 1 through 3. Not less than “0”. Enter result here and on Form 1,