Form 502 Maryland Resident Income Tax Return

2011 ENDING 65 or over Blind City Town or Taxing Area here if you agree to receive your 1099G Income Tax Refund statement electronically Under penalties of perjury I declare that I have examined here if you authorize your paid preparer not to file electronically if you authorize your preparer to discuss this return with us Check in this box Initial Last Name MO DAy yEAR OR FISCAL YEAR BEGINNING or for late filing Place an M or P Spouse's Social Security number State Zip Code (D) Enter Total Exemptions (See Instruction 22) Total 1 Adjusted gross income from your federal return (See Instruction 11) 1a Wages salaries and/or tips (See Instruction 11) 10 Pension exclusion from worksheet in Instruction 13 12 Income received during period of nonresidence (See Instruction 26) 13 Subtractions from attached Form 502SU (See Instruction 13) 21 Amount from line 20 (taxable net income) GO TO TAX TABLE in the Resident Booklet Enter the tax on line 22 22 Maryland tax (from Tax Table or Computation Worksheet Schedules I or II) 23 Earned income credit (1/2 of federal earned income credit See Instruction 18) 24 Poverty level credit (See Instruction 18) 25 Other income tax credits for individuals from Part G line 8 of Form 502CR (Attach Form 502CR) 26 Business tax credits (Attach Form 500CR) 27 Total credits (Add lines 23 through 26) 28 Maryland tax after credits (Subtract line 27 from line 22) If less than 0 enter 0 29 Local tax (See Instruction 19 for tax rates and worksheet ) Multiply line 21 by your local tax rate or 30 Local earned income credit (from Local Earned Income Credit Worksheet in Instruction 19) 31 Local poverty level credit (from Local Poverty Level Credit Worksheet in Instruction 19) 32 Total credits (Add lines 30 and 31) 33 Local tax after credits (Subtract line 32 from line 29) If less than 0 enter 0 34 Total Maryland and local tax (Add lines 28 and 33) 35 Contribution to Chesapeake Bay and Endangered Species Fund (See Instruction 20) 36 Contribution to Developmental Disabilities Waiting List Equity Fund (See Instruction 20) 37 Contribution to Maryland Cancer Fund (See Instruction 20) 38 Total Maryland income tax local income tax and contributions (Add lines 34 through 37) 39 Total Maryland and local tax withheld (Enter total from and attach your W 2 and 1099 forms if MD tax is withheld) 4 Lump sum distributions (from worksheet in Instruction 12) 40 2011 estimated tax payments amount applied from 2010 return payment made with an extension request and Form MW506NRS 41 Refundable earned income credit (from worksheet in Instruction 21) 42 Refundable income tax credits from Part h line 6 of Form 502CR (Attach Form 502CR See Instruction 21) 43 Total payments and credits (Add lines 39 through 42) 44 Balance due (If line 38 is more than line 43 subtract line 43 from line 38) 45 Overpayment (If line 38 is less than line 43 subtract line 38 from line 43) 46 Amount of overpayment TO BE APPLIED TO 2012 ESTIMATED TAX 47 Amount of overpayment TO BE REFUNDED TO YOU (Subtract line 46 from line 45) See line 50 48 Interest charges from Form 502UP 49 TOTAL AMOUNT DUE (Add lines 44 and 48) IF $1 OR MORE PAY IN FULL WITH THIS RETURN 5 Other additions (Enter code letter(s) from Instruction 12) 502 RESIDENT 50b Routing Number 50c Account (9 digit) 7 Total federal adjusted gross income and Maryland additions (Add lines 1 and 6) 8 Taxable refunds credits or offsets of state and local income taxes included in line 1 above ADDITIONS TO INCOME (See Instruction 12) Address and telephone number of preparer ATTACh 11 Taxable Social Security and RRbenefits (Tier I II and supplemental) included in line 1 above ChECk Check here if you authorize us to share your tax information with the Medical Assistance Program for help finding health insurance CHECK ONE BOX Checking City or Town COM/RAD 009 11 49 Dates of Maryland Residence Daytime telephone no home telephone no CODE NUMBERS (3 digits per box) Deduction amount (Part year residents see Instruction 26 (l and m)) Dependent taxpayer (Enter 0 in Exemption Box (A) See Instruction 7)OffOff DIRECT DEPOSIT OF REFUND (See Instruction 22) Please be sure the account information is correct For Splitting Direct Deposit see Form 588 In order to comply with banking rules please check Dollars Cents Enter amount here: Enter No Checked from line 1 of Dependent Enter No Checked See Instruction 10 $ (B) Enter No Checked X $1 000 $ Exemption amount from Exemptions area above (See Instruction 10) EXEMPTIONS (A) FILING STATUS Form 502B FORM MARYLAND head of household OffOff here if this refund will go to an account outside the United States If checked see Instruction 22 For the direct deposit option complete the following information clearly and legibly 50a Type of account: INCOME INCOME TAX RETURN LOCAL TAX COMPUTATION Married filing joint return or spouse had no income 5 Married filing separately Spouse's Social Security number Maryland adjusted gross income (Subtract line 15 from line 7) DEDUCTION METHOD See Instruction 16 (All taxpayers must select one method and check the appropriate box) STANDARD DEDUCTION METHOD (Enter amount on line 17) ITEMIZED DEDUCTION METHOD (Complete lines 17a and 17b) MARYLAND TAX COMPUTATION MILITARY: If you or your spouse has non Maryland military income place an M in the box (See Instruction 26) MONEy Name of county and incorporated city town or specialtaxing area in which you resided on the last day of thetaxable period (See Instruction 6) Maryland County NAME SSN Net income (Subtract line 17 from line 16) NOTE: If you are claiming dependents you must attach the Dependent Form 502B to this form in order to receive the applicable exemption amount number on top of or 6 Total additions to Maryland income (Add lines 2 through 5) ORDER Other state of residence: PART YEAR RESIDENT Place Preparer s SSN or PTIN (required by law) Signature of preparer other than taxpayer Present Address (No and street) Print Using Blue or Black Ink Only Qualifying widow(er) with dependent child Revenue Administration Division Off Savings OffOff See Instruction 1 to determine if you are required to file See Instruction 10 See Instruction 10 $ (Add A B and C) See Instruction 26 If you began or ended legal residence in Maryland in 2011 place a P in the box Single (If you can be claimed on another person s tax return use Filing Status 6 ) 4 Social Security number Spouse Spouse s signature Date Spouse's First Name staple State and local income taxes included in federal Schedule A line 5 State retirement pickup Subtract line 17b from line 17a and enter amount on line 17 SUBTRACTIONS FROM INCOME (See Instruction 13) Tax exempt interest on state and local obligations (bonds) other than Maryland Taxable net income (Subtract line 19 from line 18) this return including accompanying schedules and statements and to the best of my knowledge and belief it is true correct and complete If prepared by a 110 Carroll Street Annapolis Maryland 21411 0001 person other than taxpayer the declaration is based on all information of which the preparer has any knowledge (It is recommended that you include your Social Security number on check ) Total Amount $ Total federal itemized deductions (from line 29 federal Schedule A) Total subtractions from Maryland income (Add lines 8 through 14) Two income subtraction from worksheet in Instruction 13 use the Local Tax Worksheet wage and tax 9 Child and dependent care expenses statements with ONE Your First Name your signature Date your W 2 Yourself