Form 1040ME 1040ME form booklet (forms and instructions)

00 00 00 REFUND 33b 00 28 29 INCOME TAX OVERPAID If line 27e is larger than line 26 enter amount overpaid (Line 27e minus line 26 ) INCOME TAX UNDERPAID If line 26 is larger than line 27e enter amount underpaid (Line 26 minus line 27e ) 2829 00 00 30 USE TAX (SALES TAX) (See instructions ) 30 00 30a SALES TAX ON CASUAL RENTALS OF LIVING QUARTERS (See instructions ) 30a 00 34b 00 a My designated state of legal residence was (Enter state) 3a all items of income gain interest dividends royalties and other items of income of a nancial institution subject to the Maine franchise tax that are included in your federal adjusted gross income due to an ownership share in the nancial institution that is a partnership S corporation or entity disregarded as separate from its owner the total of capital gains and ordinary income resulting from depreciation recapture pursuant to Code sections 1245 and 1250 realized on the sale of multifamily affordable housing property certi ed by the Maine State Housing Authority A copy of the MSHA certi cate must be attached to the return c Total Modi cations: line 5a minus line 5b (may be a negative amount) Chickadee Check off Farm income/loss h Other (See instructions) List the type and amount of income items included (Attach supporting documentation) 1h IF YOU ARE OVER 65 AND/OR BLIND SEE THE INSTRUCTIONS ON PAGE 2 AND CLAIM THE ADDITIONAL AMOUNT AS ALLOWED List the source of each amount claimed in the space provided and attach supporting documentation when claiming an amount on this line Enter on this line: Occupation 1c During 2012: Unless otherwise indicated enter Yes or No on each line Quality Child Care Investment Tax Credit for DHHS certi ed Safe Harbor" Resident (treated as a nonresident): General Safe Harbor Maine was my domicile in 2012 I did not maintain a permanent place of abode in Maine I maintained a permanent place of abode outside Maine and I spent no more than 30 days of 2012 in Maine Individuals qualifying under the safe harbor rule will be treated as a nonresident for Maine individual income tax purposes File Form 1040ME and Schedule NR or NRH Foreign Safe Harbor I spent at least 450 days in a foreign country during any 548 day period that begins or ends during the tax year The taxpayer must also meet other eligibility criteria If you qualify for the Foreign Safe Harbor you will be considered a Safe Harbor Resident and treated as a nonresident for the 548 day period even though you were domiciled in Maine Total eligible military pension income included in your federal adjusted gross income 6 Unemployment Compensation Weekdays 8:00 a m 5:00 p m Call this number if you have a tax balance due currently being collected by Maine Revenue Services that you would like to resolve www maine gov/revenue/forms $ 0 $ 6 000 $ 5 $ 30 000 $ 36 000 $ 29 $ 6 000 00 $ $ $ $ $ $ $ 6 000 00 $25 Other $ 1 $25 Other $ 2 $25 Other $ 3 $25 Other $ 4 $25 Other $ 5 $25 Other $ 6 $25 Other $ 7 $25 Other $ 8 $60 000 and up 08% of Form 1040ME Line 16 (207) 624 7894 to order (Month) (Day) (Year) (Month) (Day) (Year) (NOTE: Married persons ling separate Maine income tax returns must complete separate worksheets for each spouse) (Part year residents/Nonresidents/ Safe Harbor residents see instructions on page 14 ) (See instructions at www maine gov/revenue/forms) Enclose with your Form 1040ME (See page 3) **If necessary use Worksheet C (Employee Apportionment Worksheet) for Part Year Residents/Nonresidents/ Safe Harbor Residents to calculate the amount for line 1 Column E For a copy of Worksheet C go to the Maine Revenue Services web site at: www maine gov/revenue/forms or call (207) 624 7894 (to order) *1202100* *1202101* *1202103* *1202111* *For NextGen Accounts enter 043000261 on line 33c and the account owner s 9 digit social security number on line 33d (do not enter hyphens) *NOTE: If the amount on line 7 above is less than your allowable standard deduction use the standard deduction If Married Filing Separately however both spouses must either itemize or use the standard deduction *Use this column only if ling married joint return and only if spouse separately earned an eligible pension 0 100 0 0 0 100 200 3 3 3 200 300 5 5 5 300 400 7 7 7 400 500 9 9 9 500 600 11 11 11 600 700 13 13 13 700 800 15 15 15 800 900 17 17 17 900 1 000 19 19 19 1 000 1 000 1 100 21 21 21 1 100 1 200 23 23 23 1 200 1 300 25 25 25 1 300 1 400 27 27 27 1 400 1 500 29 29 29 1 500 1 600 31 31 31 1 600 1 700 33 33 33 1 700 1 800 35 35 35 1 800 1 900 37 37 37 1 900 2 000 39 39 39 1 ADDITIONS to federal adjusted gross income a Income from municipal and state bonds other than Maine 1a 1 Endangered & Nongame Wildlife Fund 1 INCOME (Complete and attach Worksheets A and B on pages 1 Maine adjusted gross income from Form 1040ME page 1 line 16 1 1 Maine Clean Election Fund Maine Residents Only Check here if you or your spouse if ling jointly want $3 to go to this fund You Spouse 2 Check here if you were engaged in COMMERCIAL FARMING OR FISHING during 2012 1 NAME 1 1 RETIREMENT PLAN DISTRIBUTIONS Enter the amount from federal Form 1040 line 44 related to lump sum distributions (federal form 4972) $ 1 Total expenses paid for child care services included on federal Form 2441 10 000 10 100 325 201 261 17 000 17 100 812 512 623 10 100 10 200 329 203 266 17 100 17 200 819 517 630 10 200 10 300 336 206 270 17 200 17 300 826 521 637 10 300 10 400 343 211 275 17 300 17 400 833 526 644 10 400 10 500 350 215 279 17 400 17 500 840 530 651 10 500 10 600 357 220 284 17 500 17 600 847 535 658 10 600 10 700 364 224 288 17 600 17 700 854 539 665 10 700 10 800 371 229 293 17 700 17 800 861 544 672 10 800 10 900 378 233 297 17 800 17 900 868 548 679 10 900 11 000 385 238 302 17 900 18 000 875 553 686 10 000 17 000 10 MAINE CAPITAL INVESTMENT CREDIT (Enclose worksheet see instructions) 10 10 Number of Individual Day use Park Passes 1040ME is: 1040ME is: 11 000 11 100 392 242 306 18 000 18 100 882 557 693 11 100 11 200 399 247 311 18 100 18 200 889 562 700 11 200 11 300 406 251 315 18 200 18 300 896 566 707 11 300 11 400 413 256 320 18 300 18 400 903 571 714 11 400 11 500 420 260 324 18 400 18 500 910 575 721 11 500 11 600 427 265 329 18 500 18 600 917 580 728 11 600 11 700 434 269 333 18 600 18 700 924 584 735 11 700 11 800 441 274 338 18 700 18 800 931 589 742 11 800 11 900 448 278 342 18 800 18 900 938 593 749 11 900 12 000 455 283 347 18 900 19 000 945 598 756 11 000 18 000 11 Number of Vehicle Day use Park Passes 11 RESEARCH EXPENSE TAX CREDIT (See instructions) 11 12 000 12 100 462 287 351 19 000 19 100 952 602 763 12 100 12 200 469 292 356 19 100 19 200 959 607 770 12 200 12 300 476 296 360 19 200 19 300 966 611 777 12 300 12 400 483 301 365 19 300 19 400 973 616 784 12 400 12 500 490 305 369 19 400 19 500 980 620 791 12 500 12 600 497 310 374 19 500 19 600 987 625 798 12 600 12 700 504 314 378 19 600 19 700 994 629 805 12 700 12 800 511 319 383 19 700 19 800 1 001 634 812 12 800 12 900 518 323 387 19 800 19 900 1 008 638 819 12 900 13 000 525 328 392 19 900 20 000 1 015 643 826 12 000 18 000 14 42 000 48 000 38 12 000 19 000 12 RESEARCH & DEVELOPMENT SUPER CREDIT (See instructions) 12 12 TOTAL CONTRIBUTIONS AND PARK PASS PURCHASES (Add lines 9 10 and 11 Enter result here and on Form 1040ME line 31 12 13 000 13 100 532 332 396 20 000 20 100 1 022 647 833 13 100 13 200 539 337 401 20 100 20 200 1 029 652 840 13 200 13 300 546 341 405 20 200 20 300 1 036 656 847 13 300 13 400 553 346 410 20 300 20 400 1 043 661 854 13 400 13 500 560 350 414 20 400 20 500 1 052 668 861 13 500 13 600 567 355 419 20 500 20 600 1 060 675 868 13 600 13 700 574 359 423 20 600 20 700 1 069 682 875 13 700 13 800 581 364 428 20 700 20 800 1 077 689 882 13 800 13 900 588 368 432 20 800 20 900 1 086 696 889 13 900 14 000 595 373 437 20 900 21 000 1 094 703 896 13 000 20 000 13 Enter the TOTAL number of EXEMPTIONS claimed on your federal return 13 13 HIGH TECHNOLOGY CREDIT (Enclose worksheet see instructions) 13 14 FEDERAL ADJUSTED GROSS INCOME 14 00 14 MAINE MINIMUM TAX CREDIT (Enclose worksheet see instructions) 14 17 and 18): 17 FOREST MANAGEMENT PLANNING CREDIT (Supporting documentation must be included) 17 18 000 24 000 19 48 000 54 000 43 18 OTHER TAX CREDITS List (See instructions) 18 19 TAXABLE INCOME (Line 16 minus lines 17 and 18 ) 19 00 19 TOTAL CREDITS Add lines 4 through 18 19 1a Column A expenses paid for regular child care services included on line 1 1b Percentage of expenses paid Column A divide line 1a column A by line 1 Column B divide line 1a column B by line 1 1b 2 0 1 2 to 2 000 2 000 2 100 41 41 41 2 100 2 200 43 43 43 2 200 2 300 45 45 45 2 300 2 400 47 47 47 2 400 2 500 49 49 49 2 500 2 600 51 51 51 2 600 2 700 53 53 53 2 700 2 800 55 55 55 2 800 2 900 57 57 57 2 900 3 000 59 59 59 2 EARLY DISTRIBUTION FROM QUALIFIED RETIREMENT PLANS Enter the amount from federal Form 1040 line 58 related to early distributions $ 2 Income sourced to and taxed by ( other jurisdiction) included in line 1 2 2 Maine Children s Trust $5 2 RATIO OF INCOME: Divide line 1 Box C by line 1 Box A (If less than 0 enter 0 0000 If greater than 100 enter 1 0000) 2 SUBTRACTIONS from federal adjusted gross income a U S Government Bond interest included in federal adjusted gross income (See instructions) 2a b State Income Tax Refund (Only if included in federal adjusted gross income) 2b c Social Security and Railroad Retirement Bene ts included in federal adjusted gross income (See instructions) 2c d Pension Income Deduction (Complete and attach the worksheet on back) 2d e Interest from Maine Municipal General Obligation Private Activity and Airport Authority Bonds included in federal adjusted gross income (See instructions) 2e f Premiums for Long Term Care Insurance (Do not include health insurance premiums on this line) NOTE: If you itemize deductions or are self employed complete and attach the worksheet on back 2f g Maine Public Employees Retirement System Pick Up Contributions paid to the taxpayer during 2012 which have been previously taxed by the state 2g h Contributions to Quali ed Tuition Programs 529 Plans (See instructions) 2h i Fiduciary Adjustment subtractions only (Attach a copy of your federal Schedule K 1) 2i j Bonus Depreciation and Section 179 Recapture (See instructions) 2j k Other List (See instructions) 2k (Do not enter non Maine source income on line 2k) l Total Subtractions (Add lines 2a through 2k) 2l 00 00 00 00 00 00 00 00 00 00 00 00 20 INCOME TAX (Find the tax for the amount on line 19 in the tax table 2012 1040ME LONG FORM Page 2 2012 1040ME LONG FORM Page 3 2012 MAINE 2012 MAINE INCOME TAX TABLE 2012 SCHEDULE CP FORM 1040ME Charitable Contributions and Purchase of Park Passes For more information go to www maine gov/revenue/forms 99 *1202202* 2012 SCHEDULE NR FORM 1040ME Attachment Sequence No 10 SCHEDULE for CALCULATING the NONRESIDENT CREDIT PART YEAR RESIDENTS NONRESIDENTS and SAFE HARBOR RESIDENTS ONLY This schedule must be enclosed with your completed Form 1040ME If part year resident enter dates you were a Maine Resident from to 99 *1202106* 2012 Worksheet for Child Care Credit Schedule A Line 5 (Enclose with your Form 1040ME) 2012 Worksheet for Credit for Income Tax Paid to Other Jurisdictions Schedule A Line 7 FOR MAINE RESIDENTS ONLY 21 000 21 000 21 100 1 103 710 903 21 100 21 200 1 111 717 910 21 200 21 300 1 120 724 917 21 300 21 400 1 128 731 924 21 400 21 500 1 137 738 931 21 500 21 600 1 145 745 938 21 600 21 700 1 154 752 945 21 700 21 800 1 162 759 952 21 800 21 900 1 171 766 959 21 900 22 000 1 179 773 966 21 22 TAX ADDITIONS (From Maine Schedule A line 3 ) LOW INCOME TAX CREDIT (See instructions ) NOTE: You must le a return only if you are claiming a refund ) 21 22 00 00 22 000 22 000 22 100 1 188 780 973 22 100 22 200 1 196 787 980 22 200 22 300 1 205 794 987 22 300 22 400 1 213 801 994 22 400 22 500 1 222 808 1 001 22 500 22 600 1 230 815 1 008 22 600 22 700 1 239 822 1 015 22 700 22 800 1 247 829 1 022 22 800 22 900 1 256 836 1 029 22 900 23 000 1 264 843 1 036 23 000 23 000 23 100 1 273 850 1 043 23 100 23 200 1 281 857 1 050 23 200 23 300 1 290 864 1 057 23 300 23 400 1 298 871 1 064 23 400 23 500 1 307 878 1 071 23 500 23 600 1 315 885 1 078 23 600 23 700 1 324 892 1 085 23 700 23 800 1 332 899 1 092 23 800 23 900 1 341 906 1 099 23 900 24 000 1 349 913 1 106 23 TOTAL TAX (Line 20 plus line 21 minus line 22 ) 23 00 24 000 24 000 24 100 1 358 920 1 113 24 100 24 200 1 366 927 1 120 24 200 24 300 1 375 934 1 127 24 300 24 400 1 383 941 1 134 24 400 24 500 1 392 948 1 141 24 500 24 600 1 400 955 1 148 24 600 24 700 1 409 962 1 155 24 700 24 800 1 417 969 1 162 24 800 24 900 1 426 976 1 169 24 900 25 000 1 434 983 1 176 24 000 30 000 24 54 000 60 000 48 24 25 26 TAX CREDITS (From Maine Schedule A line 21 ) NONRESIDENT CREDIT (For part year residents nonresidents and Safe Harbor residents only ) From Schedule NR line 9 or NRH line 11 (You MUST attach a copy of your federal return and/or TDY papers ) NET TAX (Subtract lines 24 and 25 from line 23 ) (Nonresidents see instructions ) 24 25 26 00 00 00 25 000 25 000 25 100 1 443 990 1 183 25 100 25 200 1 451 997 1 190 25 200 25 300 1 460 1 004 1 197 25 300 25 400 1 468 1 011 1 204 25 400 25 500 1 477 1 018 1 211 25 500 25 600 1 485 1 025 1 218 25 600 25 700 1 494 1 032 1 225 25 700 25 800 1 502 1 039 1 232 25 800 25 900 1 511 1 046 1 239 25 900 26 000 1 519 1 053 1 246 26 000 26 000 26 100 1 528 1 060 1 253 26 100 26 200 1 536 1 067 1 260 26 200 26 300 1 545 1 074 1 267 26 300 26 400 1 553 1 081 1 274 26 400 26 500 1 562 1 088 1 281 26 500 26 600 1 570 1 095 1 288 26 600 26 700 1 579 1 102 1 295 26 700 26 800 1 587 1 109 1 302 26 800 26 900 1 596 1 116 1 309 26 900 27 000 1 604 1 123 1 316 27 000 27 000 27 100 1 613 1 130 1 323 27 100 27 200 1 621 1 137 1 330 27 200 27 300 1 630 1 144 1 337 27 300 27 400 1 638 1 151 1 344 27 400 27 500 1 647 1 158 1 351 27 500 27 600 1 655 1 165 1 358 27 600 27 700 1 664 1 172 1 365 27 700 27 800 1 672 1 179 1 372 27 800 27 900 1 681 1 186 1 379 27 900 28 000 1 689 1 193 1 386 27 TAX PAYMENTS a Maine Income Tax Withheld (Enclose W 2 1099 and 1099ME forms) b 2012 Estimated Tax Payments and 2011 Credit Carried Forward and Extension payment (Include any REAL ESTATE WITHHOLDING Tax Payments ) REFUNDABLE TAX CREDITS Enclose applicable worksheet with your return c Rehabilitation of historic properties after 2007 (worksheet line 6) 27a 27b 27c 00 00 00 28 000 28 000 28 100 1 698 1 200 1 393 28 100 28 200 1 706 1 207 1 400 28 200 28 300 1 715 1 214 1 407 28 300 28 400 1 723 1 221 1 414 28 400 28 500 1 732 1 228 1 421 28 500 28 600 1 740 1 235 1 428 28 600 28 700 1 749 1 242 1 435 28 700 28 800 1 757 1 249 1 442 28 800 28 900 1 766 1 256 1 449 28 900 29 000 1 774 1 263 1 456 29 000 29 000 29 100 1 783 1 270 1 463 29 100 29 200 1 791 1 277 1 470 29 200 29 300 1 800 1 284 1 477 29 300 29 400 1 808 1 291 1 484 29 400 29 500 1 817 1 298 1 491 29 500 29 600 1 825 1 305 1 498 29 600 29 700 1 834 1 312 1 505 29 700 29 800 1 842 1 319 1 512 29 800 29 900 1 851 1 326 1 519 29 900 30 000 1 859 1 333 1 526 2a Column A multiply line 2 by line 1b column A Column B multiply line 2 by line 1b column B 2a 3 000 3 000 3 100 61 61 61 3 100 3 200 63 63 63 3 200 3 300 65 65 65 3 300 3 400 67 67 67 3 400 3 500 69 69 69 3 500 3 600 71 71 71 3 600 3 700 73 73 73 3 700 3 800 75 75 75 3 800 3 900 77 77 77 3 900 4 000 79 79 79 3 4 5 6 7 FILING STATUS (Check one) Single Married ling joint return (Even if only one had income) Married ling separate return Enter spouse s social security number and full name above Head of household (With qualifying person) Qualifying widow(er) with dependent child ( Year spouse died ) Composite Return (Pass through Entities ONLY) RESIDENCY STATUS (Check one) 8 Resident 8a Safe Harbor Resident 9 Part Year Resident 10 Nonresident 11 Nonresident Alien Check here if you are ling Schedule NRH 12 CHECK IF: You Spouse were was 65 or over 12a 12c Blind 12b 12d 3 Bone Marrow Screening Fund $5 3 FEDERAL INCOME ADJUSTMENTS NON MAINE SOURCE ONLY: Multiply amount on federal Form 1040 line 36 or Form 1040A line 20 by the percentage listed on line 2 Enter result here 3 Net Modi cation (Subtract line 2l from line 1i enter here and on 1040ME page 1 line 15) (If negative enter a minus sign in the box to the left of the number) 3 00 3 Percentage of income taxed by other jurisdiction (divide line 2 by line 1 if line 2 is greater than 30 000 30 000 30 100 1 868 1 340 1 533 30 100 30 200 1 876 1 347 1 540 30 200 30 300 1 885 1 354 1 547 30 300 30 400 1 893 1 361 1 554 30 400 30 500 1 902 1 368 1 561 30 500 30 600 1 910 1 375 1 568 30 600 30 700 1 919 1 382 1 577 30 700 30 800 1 927 1 389 1 585 30 800 30 900 1 936 1 396 1 594 30 900 31 000 1 944 1 403 1 602 31 000 31 000 31 100 1 953 1 410 1 611 31 100 31 200 1 961 1 417 1 619 31 200 31 300 1 970 1 424 1 628 31 300 31 400 1 978 1 431 1 636 31 400 31 500 1 987 1 438 1 645 31 500 31 600 1 995 1 445 1 653 31 600 31 700 2 004 1 452 1 662 31 700 31 800 2 012 1 459 1 670 31 800 31 900 2 021 1 466 1 679 31 900 32 000 2 029 1 473 1 687 31 CHARITABLE CONTRIBUTIONS and PARK PASSES (From Maine Schedule CP line 12 ) 31 00 32 000 32 000 32 100 2 038 1 480 1 696 32 100 32 200 2 046 1 487 1 704 32 200 32 300 2 055 1 494 1 713 32 300 32 400 2 063 1 501 1 721 32 400 32 500 2 072 1 508 1 730 32 500 32 600 2 080 1 515 1 738 32 600 32 700 2 089 1 522 1 747 32 700 32 800 2 097 1 529 1 755 32 800 32 900 2 106 1 536 1 764 32 900 33 000 2 114 1 543 1 772 32 NET OVERPAYMENT (Line 28 minus lines 30 30a and 31 ) NOTE: If total of lines 30 30a and 31 is greater than line 28 enter as amount due on line 34a below 32 00 33 000 33 000 33 100 2 123 1 550 1 781 33 100 33 200 2 131 1 557 1 789 33 200 33 300 2 140 1 564 1 798 33 300 33 400 2 148 1 571 1 806 33 400 33 500 2 157 1 578 1 815 33 500 33 600 2 165 1 585 1 823 33 600 33 700 2 174 1 592 1 832 33 700 33 800 2 182 1 599 1 840 33 800 33 900 2 191 1 606 1 849 33 900 34 000 2 199 1 613 1 857 33 Amount to be CREDITED to 2013 estimated tax 33a 33d Account Number* 33e Type of Account: Checking Savings NextGen 34 000 34 000 34 100 2 208 1 620 1 866 34 100 34 200 2 216 1 627 1 874 34 200 34 300 2 225 1 634 1 883 34 300 34 400 2 233 1 641 1 891 34 400 34 500 2 242 1 648 1 900 34 500 34 600 2 250 1 655 1 908 34 600 34 700 2 259 1 662 1 917 34 700 34 800 2 267 1 669 1 925 34 800 34 900 2 276 1 676 1 934 34 900 35 000 2 284 1 683 1 942 34 a TAX DUE (Add lines 29 30 30a and 31) NOTE: If total of lines 30 30a and 31 is greater than line 28 enter the difference as an amount due on this line 34a 35 000 35 100 2 293 1 690 1 951 42 000 42 100 2 888 2 201 2 546 35 100 35 200 2 301 1 697 1 959 42 100 42 200 2 896 2 209 2 554 35 200 35 300 2 310 1 704 1 968 42 200 42 300 2 905 2 218 2 563 35 300 35 400 2 318 1 711 1 976 42 300 42 400 2 913 2 226 2 571 35 400 35 500 2 327 1 718 1 985 42 400 42 500 2 922 2 235 2 580 35 500 35 600 2 335 1 725 1 993 42 500 42 600 2 930 2 243 2 588 35 600 35 700 2 344 1 732 2 002 42 600 42 700 2 939 2 252 2 597 35 700 35 800 2 352 1 739 2 010 42 700 42 800 2 947 2 260 2 605 35 800 35 900 2 361 1 746 2 019 42 800 42 900 2 956 2 269 2 614 35 900 36 000 2 369 1 753 2 027 42 900 43 000 2 964 2 277 2 622 35 000 42 000 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 www maine gov/revenue 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 36 000 36 100 2 378 1 760 2 036 43 000 43 100 2 973 2 286 2 631 36 100 36 200 2 386 1 767 2 044 43 100 43 200 2 981 2 294 2 639 36 200 36 300 2 395 1 774 2 053 43 200 43 300 2 990 2 303 2 648 36 300 36 400 2 403 1 781 2 061 43 300 43 400 2 998 2 311 2 656 36 400 36 500 2 412 1 788 2 070 43 400 43 500 3 007 2 320 2 665 36 500 36 600 2 420 1 795 2 078 43 500 43 600 3 015 2 328 2 673 36 600 36 700 2 429 1 802 2 087 43 600 43 700 3 024 2 337 2 682 36 700 36 800 2 437 1 809 2 095 43 700 43 800 3 032 2 345 2 690 36 800 36 900 2 446 1 816 2 104 43 800 43 900 3 041 2 354 2 699 36 900 37 000 2 454 1 823 2 112 43 900 44 000 3 049 2 362 2 707 36 000 43 000 37 000 37 100 2 463 1 830 2 121 44 000 44 100 3 058 2 371 2 716 37 100 37 200 2 471 1 837 2 129 44 100 44 200 3 066 2 379 2 724 37 200 37 300 2 480 1 844 2 138 44 200 44 300 3 075 2 388 2 733 37 300 37 400 2 488 1 851 2 146 44 300 44 400 3 083 2 396 2 741 37 400 37 500 2 497 1 858 2 155 44 400 44 500 3 092 2 405 2 750 37 500 37 600 2 505 1 865 2 163 44 500 44 600 3 100 2 413 2 758 37 600 37 700 2 514 1 872 2 172 44 600 44 700 3 109 2 422 2 767 37 700 37 800 2 522 1 879 2 180 44 700 44 800 3 117 2 430 2 775 37 800 37 900 2 531 1 886 2 189 44 800 44 900 3 126 2 439 2 784 37 900 38 000 2 539 1 893 2 197 44 900 45 000 3 134 2 447 2 792 37 000 44 000 38 000 38 100 2 548 1 900 2 206 45 000 45 100 3 143 2 456 2 801 38 100 38 200 2 556 1 907 2 214 45 100 45 200 3 151 2 464 2 809 38 200 38 300 2 565 1 914 2 223 45 200 45 300 3 160 2 473 2 818 38 300 38 400 2 573 1 921 2 231 45 300 45 400 3 168 2 481 2 826 38 400 38 500 2 582 1 928 2 240 45 400 45 500 3 177 2 490 2 835 38 500 38 600 2 590 1 935 2 248 45 500 45 600 3 185 2 498 2 843 38 600 38 700 2 599 1 942 2 257 45 600 45 700 3 194 2 507 2 852 38 700 38 800 2 607 1 949 2 265 45 700 45 800 3 202 2 515 2 860 38 800 38 900 2 616 1 956 2 274 45 800 45 900 3 211 2 524 2 869 38 900 39 000 2 624 1 963 2 282 45 900 46 000 3 219 2 532 2 877 38 000 45 000 39 000 39 100 2 633 1 970 2 291 46 000 46 100 3 228 2 541 2 886 39 100 39 200 2 641 1 977 2 299 46 100 46 200 3 236 2 549 2 894 39 200 39 300 2 650 1 984 2 308 46 200 46 300 3 245 2 558 2 903 39 300 39 400 2 658 1 991 2 316 46 300 46 400 3 253 2 566 2 911 39 400 39 500 2 667 1 998 2 325 46 400 46 500 3 262 2 575 2 920 39 500 39 600 2 675 2 005 2 333 46 500 46 600 3 270 2 583 2 928 39 600 39 700 2 684 2 012 2 342 46 600 46 700 3 279 2 592 2 937 39 700 39 800 2 692 2 019 2 350 46 700 46 800 3 287 2 600 2 945 39 800 39 900 2 701 2 026 2 359 46 800 46 900 3 296 2 609 2 954 39 900 40 000 2 709 2 033 2 367 46 900 47 000 3 304 2 617 2 962 39 000 46 000 4 000 4 000 4 100 81 81 81 4 100 4 200 83 83 83 4 200 4 300 85 85 85 4 300 4 400 87 87 87 4 400 4 500 89 89 89 4 500 4 600 91 91 91 4 600 4 700 93 93 93 4 700 4 800 95 95 95 4 800 4 900 97 97 97 4 900 5 000 99 99 99 4 Companion Animal Sterilization Fund $5 4 FEDERAL ADJUSTED GROSS INCOME NON MAINE SOURCE ONLY: Subtract line 3 from 4 Limitation of Credit: 4 Total itemized deductions from federal Form 1040 Schedule A line 29 4 00 4:30 p m 40 000 40 100 2 718 2 040 2 376 47 000 47 100 3 313 2 626 2 971 40 100 40 200 2 726 2 047 2 384 47 100 47 200 3 321 2 634 2 979 40 200 40 300 2 735 2 054 2 393 47 200 47 300 3 330 2 643 2 988 40 300 40 400 2 743 2 061 2 401 47 300 47 400 3 338 2 651 2 996 40 400 40 500 2 752 2 068 2 410 47 400 47 500 3 347 2 660 3 005 40 500 40 600 2 760 2 075 2 418 47 500 47 600 3 355 2 668 3 013 40 600 40 700 2 769 2 082 2 427 47 600 47 700 3 364 2 677 3 022 40 700 40 800 2 777 2 090 2 435 47 700 47 800 3 372 2 685 3 030 40 800 40 900 2 786 2 099 2 444 47 800 47 900 3 381 2 694 3 039 40 900 41 000 2 794 2 107 2 452 47 900 48 000 3 389 2 702 3 047 40 000 47 000 41 000 41 100 2 803 2 116 2 461 48 000 48 100 3 398 2 711 3 056 41 100 41 200 2 811 2 124 2 469 48 100 48 200 3 406 2 719 3 064 41 200 41 300 2 820 2 133 2 478 48 200 48 300 3 415 2 728 3 073 41 300 41 400 2 828 2 141 2 486 48 300 48 400 3 423 2 736 3 081 41 400 41 500 2 837 2 150 2 495 48 400 48 500 3 432 2 745 3 090 41 500 41 600 2 845 2 158 2 503 48 500 48 600 3 440 2 753 3 098 41 600 41 700 2 854 2 167 2 512 48 600 48 700 3 449 2 762 3 107 41 700 41 800 2 862 2 175 2 520 48 700 48 800 3 457 2 770 3 115 41 800 41 900 2 871 2 184 2 529 48 800 48 900 3 466 2 779 3 124 41 900 42 000 2 879 2 192 2 537 48 900 49 000 3 474 2 787 3 132 41 000 48 000 49 000 49 000 49 100 3 483 2 796 3 141 49 100 49 200 3 491 2 804 3 149 49 200 49 300 3 500 2 813 3 158 49 300 49 400 3 508 2 821 3 166 49 400 49 500 3 517 2 830 3 175 49 500 49 600 3 525 2 838 3 183 49 600 49 700 3 534 2 847 3 192 49 700 49 800 3 542 2 855 3 200 49 800 49 900 3 551 2 864 3 209 49 900 50 000 3 559 2 872 3 217 5 000 5 000 5 100 101 101 101 5 100 5 200 104 103 103 5 200 5 300 109 105 105 5 300 5 400 113 107 107 5 400 5 500 118 109 109 5 500 5 600 122 111 111 5 600 5 700 127 113 113 5 700 5 800 131 115 115 5 800 5 900 136 117 117 5 900 6 000 140 119 119 5 6 a Income taxes imposed by this state or any other taxing jurisdiction or general sales taxes included in line 4 above from federal Form 1040 Schedule A line 5 5a b Deductible costs included in line 4 above incurred in the production of Maine exempt income 5b c Amounts included in line 4 that are also being claimed for the Family Development Account Credit on Maine Schedule A line 18 5c d Amount included in line 4 attributable to income from an ownership interest in a pass through entity nancial institution 5d Deductible costs of producing income exempt from federal income tax but taxable by Maine 6 00 00 00 00 00 5 Allowable Credit line 4a or 4b whichever is less Enter here and on Maine Schedule A line 7 5 5 CHILD CARE CREDIT Enter amount from line 6 of the Child Care Credit Worksheet on page 14 Enclose the worksheet with your return *5 5 Maine Military Family Relief Fund $5 50 000 50 000 50 100 3 568 2 881 3 226 50 100 50 200 3 576 2 889 3 234 50 200 50 300 3 585 2 898 3 243 50 300 50 400 3 593 2 906 3 251 50 400 50 500 3 602 2 915 3 260 50 500 50 600 3 610 2 923 3 268 50 600 50 700 3 619 2 932 3 277 50 700 50 800 3 627 2 940 3 285 50 800 50 900 3 636 2 949 3 294 50 900 51 000 3 644 2 957 3 302 51 000 51 000 51 100 3 653 2 966 3 311 51 100 51 200 3 661 2 974 3 319 51 200 51 300 3 670 2 983 3 328 51 300 51 400 3 678 2 991 3 336 51 400 51 500 3 687 3 000 3 345 51 500 51 600 3 695 3 008 3 353 51 600 51 700 3 704 3 017 3 362 51 700 51 800 3 712 3 025 3 370 51 800 51 900 3 721 3 034 3 379 51 900 52 000 3 729 3 042 3 387 52 000 52 000 52 100 3 738 3 051 3 396 52 100 52 200 3 746 3 059 3 404 52 200 52 300 3 755 3 068 3 413 52 300 52 400 3 763 3 076 3 421 52 400 52 500 3 772 3 085 3 430 52 500 52 600 3 780 3 093 3 438 52 600 52 700 3 789 3 102 3 447 52 700 52 800 3 797 3 110 3 455 52 800 52 900 3 806 3 119 3 464 52 900 53 000 3 814 3 127 3 472 53 000 53 000 53 100 3 823 3 136 3 481 53 100 53 200 3 831 3 144 3 489 53 200 53 300 3 840 3 153 3 498 53 300 53 400 3 848 3 161 3 506 53 400 53 500 3 857 3 170 3 515 53 500 53 600 3 865 3 178 3 523 53 600 53 700 3 874 3 187 3 532 53 700 53 800 3 882 3 195 3 540 53 800 53 900 3 891 3 204 3 549 53 900 54 000 3 899 3 212 3 557 54 000 54 000 54 100 3 908 3 221 3 566 54 100 54 200 3 916 3 229 3 574 54 200 54 300 3 925 3 238 3 583 54 300 54 400 3 933 3 246 3 591 54 400 54 500 3 942 3 255 3 600 54 500 54 600 3 950 3 263 3 608 54 600 54 700 3 959 3 272 3 617 54 700 54 800 3 967 3 280 3 625 54 800 54 900 3 976 3 289 3 634 54 900 55 000 3 984 3 297 3 642 55 000 6 000 6 000 12 000 10 36 000 42 000 34 6 000 6 100 145 121 121 6 100 6 200 149 123 123 6 200 6 300 154 125 125 6 300 6 400 158 127 127 6 400 6 500 163 129 129 6 500 6 600 167 131 131 6 600 6 700 172 133 133 6 700 6 800 176 135 135 6 800 6 900 181 137 137 6 900 7 000 185 139 139 6 EARNED INCOME TAX CREDIT Enter amount from federal Form 1040 line 64a or federal Form 1040A line 38a or federal Form 1040EZ line 8a $ 6 I became a Maine resident on (Enter Date) 6 6 Maine Veterans Memorial Cemetery 6 NON MAINE ADJUSTED GROSS INCOME: Add or if negative subtract line 5c to or from line 4 7 000 14 000 7 000 7 100 190 141 141 14 000 14 100 602 377 441 7 100 7 200 194 143 143 14 100 14 200 609 382 446 7 200 7 300 199 145 145 14 200 14 300 616 386 450 7 300 7 400 203 147 147 14 300 14 400 623 391 455 7 400 7 500 208 149 149 14 400 14 500 630 395 459 7 500 7 600 212 151 151 14 500 14 600 637 400 464 7 600 7 700 217 153 153 14 600 14 700 644 404 468 7 700 7 800 221 155 158 14 700 14 800 651 409 473 7 800 7 900 226 157 162 14 800 14 900 658 413 477 7 900 8 000 230 159 167 14 900 15 000 665 418 482 7 CREDIT FOR INCOME TAX PAID TO OTHER JURISDICTIONS Enter the amount from line 5 from the worksheet for the Credit for Income Tax Paid to Other Jurisdictions available at 7 7 I moved from Maine and became a nonresident (I established a legal residence in another state) (Enter date of move) 7 7 Line 4 minus lines 5a b c and d plus line 6 Enter result here and on 1040ME page 1 line 17 7 00 7 Maine Asthma & Lung Disease 7 RATIO OF MAINE ADJUSTED GROSS INCOME: Divide amount on line 6 by amount from Form 1040ME line 16 (If less than 0 enter 0 0000 If greater than 100 enter 1 0000 ) 8 000 15 000 8 000 8 100 235 161 171 15 000 15 100 672 422 486 8 100 8 200 239 163 176 15 100 15 200 679 427 491 8 200 8 300 244 165 180 15 200 15 300 686 431 497 8 300 8 400 248 167 185 15 300 15 400 693 436 504 8 400 8 500 253 169 189 15 400 15 500 700 440 511 8 500 8 600 257 171 194 15 500 15 600 707 445 518 8 600 8 700 262 173 198 15 600 15 700 714 449 525 8 700 8 800 266 175 203 15 700 15 800 721 454 532 8 800 8 900 271 177 207 15 800 15 900 728 458 539 8 900 9 000 275 179 212 15 900 16 000 735 463 546 8 During period of nonresidency have you: 8 Maine Public Library Fund $5 8 MAINE SEED CAPITAL CREDIT (Enclose worksheet see instructions) 8 8 TAX SUBTOTAL: Enter from Form 1040ME line 20 minus line 22 minus Maine Schedule A lines 4 and 6 806 The income considered taxed by the other jurisdiction is income after deductions that is analogous to Maine adjusted gross income (federal adjusted gross income plus or minus income modi cations) 9 000 16 000 9 000 9 100 280 181 216 16 000 16 100 742 467 553 9 100 9 200 284 183 221 16 100 16 200 749 472 560 9 200 9 300 289 185 225 16 200 16 300 756 476 567 9 300 9 400 293 187 230 16 300 16 400 763 481 574 9 400 9 500 298 189 234 16 400 16 500 770 485 581 9 500 9 600 302 191 239 16 500 16 600 777 490 588 9 600 9 700 307 193 243 16 600 16 700 784 494 595 9 700 9 800 311 195 248 16 700 16 800 791 499 602 9 800 9 900 316 197 252 16 800 16 900 798 503 609 9 900 10 000 320 199 257 16 900 17 000 805 508 616 9 CREDIT FOR EDUCATIONAL OPPORTUNITY (Enclose worksheet see instructions) 9 9 NONRESIDENT CREDIT: Multiply amount on line 8 by line 7 Enter result here and on Form 1040ME line 25 9 TOTAL CONTRIBUTIONS (Add lines 1 through 8) 9 a Additions Specify a Form 1040ME page 1 line 20 $ multiplied by on line 3 4a A part year resident is subject to Maine income tax on all income received while a resident of Maine plus any income derived from Maine sources during the period of nonresidence A nonresident or Safe Harbor resident is subject to Maine income tax on taxable income derived from sources within Maine For a description of Maine source income see Maine Revenue Services Rule 806 available at www maine gov/revenue (select Laws and Rules) or the Instructional Pamphlets for Schedule NR or NRH at www maine gov/revenue (select forms) A part year resident may claim a credit for tax paid to another jurisdiction on income earned during the period of Maine residency only (excluding period of Safe Harbor residency) Enter on line 1 your Maine adjusted income while a Maine resident (excluding period of Safe Harbor residency) Enter on line 2 the portion of line 1 that was taxed by the other jurisdiction Compute line 4a on the basis of the Maine tax relating to the Maine adjusted gross income shown on line 1 Enter on line 4b the income tax paid to the other jurisdiction relating to the income shown on line 2 Part year residents who qualify for both the credit for tax paid to another jurisdiction and the nonresident credit follow the special instructions included in the Instructional Pamphlet for Credit for Income Tax Paid to Other Jurisdictions available at www maine gov/revenue/forms Account enter the following RTN: 043000261 33d Bank Account or NextGen Account Number can be up to 17 characters (both numbers and letters) Omit hyphens spaces and special symbols Enter the number from left to right and leave any unused boxes blank NOTE: For a NextGen Account enter the account owner s 9 digit social security number Add line 3 column A and line 3 column B 4 4a FOR THOSE FILING SCHEDULE NR OR SCHEDULE NRH: You must prorate your child care credit For those ling Schedule NR multiply line 4 by the Maine source income ratio (1 0000 minus Schedule NR line 7) For those ling Schedule NRH multiply line 4 by the rate representing your portion of Maine adjusted gross Add line 5 and line 6 7 Add lines 1 through 14 Additional Maine Standard Deduction for Age and/or Blindness: additional Maine tax equal to 7 5% of the federal tax NOTE: Distributions ZONE CREDITS If your business produced a movie or other type ofof Maine Public Employees Retirement System contributions previously media production or if you expanded your business in Maine you maytaxed by Maine are not subject to this special tax address etc start on the left; dollar amounts start from the right adjusted gross income (from federal Form 1040A line 12b or federal Form 1040 line 16b) (Do not ADJUSTMENTS TO TAX Alimony received ALLOWABLE CREDITS Amount on line 19 or line 20 whichever is less Enter here and on FORM 1040ME line 24 21 AMOUNTS ENTERED ON WRONG LINE and federal Schedule A line 4 is greater than zero or you are self employed and federal Form 1040 line 29 is greater than zero and over 3 988 3 302 3 647 plus plus plus 8 5% of 8 5% of 8 5% of excess excess excess over over over 55 000 55 000 55 000 and to see the worksheets visit www maine gov/revenue/forms (select 10 years an individual taxpayer is allowed a credit of up to $200 forWorksheets for Tax Credits) or call (207) 626 8475 Except for lines 4 the costs of a forest management and harvest plan for a parcel ofand 6 you must complete and attach a tax credit worksheet for each tax more than 10 acres To claim the credit you must complete the Forest And Your Filing And Your Filing And Your Filing Any voluntary charitable contribution you make on lines 1 8 above may qualify for a charitable contributions deduction on your 2013 federal and Maine income tax returns if you itemize deductions Assistance: (207) 626 8475 Weekdays 8:00 a m 5:00 p m At But Married Filing At But Married Filing At But Married Filing Married Filing At Least Less Than At Least Less Than Attachment Attachment Sequence No 4 Attended or sent your children (if any) to a Maine school 8e b Income taxes paid to other jurisdiction on income shown on line 2 (not the amount withheld) 4b b Net Operating Loss Recovery Adjustment (Attach a schedule showing your calculation) 1b b Subtractions Specify b Underpayment Penalty (Attach Form 2210ME ) bene ts as well as retirement bene ts received from plans established and maintained by an employer for the bene t of its employees under Box A Box B Box C Box A From Worksheet B line 15 column A Box B From Worksheet B line 15 column B plus column E Box C From Worksheet B line 15 column D minus column E Business income/loss c Maine Public Employees Retirement System Contributions 1c c TOTAL AMOUNT DUE (Add lines 34a and 34b ) (Pay in full with return ) 34c Calculate Your Tax and Credits Calculate Your Taxable Income 15 INCOME MODIFICATIONS (From Schedule 1 line 3 ) 15 16 MAINE ADJUSTED GROSS INCOME (Line 14 plus or minus line 15) 16 17 DEDUCTION Standard (See instructions on page 2) 17 Itemized (From Maine Schedule 2 line 7 ) 18 EXEMPTION Multiply the number of exemptions on line 13 by $2 850 (See instructions ) 18 00 00 00 00 Capital gain/loss Check here if this refund 33c Routing Number* Check here if you checked the box on Form 2210 line 17 City State ZIP Code Collection problems and payment plans: (207) 621 4300 Column B expenses paid for quality child care services included on line 1 1a Complete Maine Schedule 1 to calculate your entry for this line COMPLETE THIS SECTION ONLY IF YOU HAVE FEDERAL INCOME ADJUSTMENTS COMPLETE THIS SECTION ONLY IF YOU HAVE INCOME MODIFICATIONS (Form 1040ME line 15) 5 INCOME MODIFICATIONS NON MAINE SOURCE ONLY: contributions See your Maine W 2 form credit claimed Management Planning Credit worksheet for your records Credit for Rehabilitation of Historic CREDIT FOR THE ELDERLY Enter amount from federal Form 1040 line 53 related to credit for the elderly or federal Form 1040A line 30 $ d Child care credit (Child Care Credit worksheet line 5 ) 27d 00 d Domestic Production Activities Deduction Add back (See instructions) 1d Date of birth 1b Deductible pension income includes state federal and military pension federal Form 4972 and distributions subject to the additional 10% federal tax on early distributions (see federal Form 5329 Part 1 or deduction is the greater of $950 or earned income plus $300 (up to deduction on federal Form 1040 line 35 DEPENDENTS claimed on another person s return: the standard Designee s name Phone no Personal identi cation #: Did you ever apply for a Homestead or Veterans property tax exemption? 5b distributions from a private venture capital fund of the refundable portion of the credit received by the fund pursuant to 36 M R S A 5216 B to the extent included in federal adjusted gross income Divide line 3 by line 2 DO NOT FILE SCHEDULE NR IF: All your income is taxable by Maine or if your federal ling status is Married ling joint and you elect to le Single on the Maine return (use Schedule NRH available at www maine gov/revenue/forms or by calling 624 7894) You do not have to complete Schedule NR if you qualify for the low income tax credit (see instructions for Form 1040ME line 22) DO NOT SEND PHOTOCOPIES OF RETURNS Domicile: Domicile is the place an individual establishes as his or her permanent home and includes the place to which he or she intends to return after any period of absence A number of factors associated with residency are relevant in the evaluation of a claimed domicile A domicile once established continues until a new xed and permanent home is acquired To change domicile a taxpayer must exhibit actions consistent with a change No change of domicile results from moving to a new location if the intent is to remain only for a limited time even if it is for a relatively long duration e Bonus Depreciation Add back (See instructions) 1e e TOTAL (Add lines 27a b c and d ) 27e 00 early distribution from a quali ed retirement plan you are subject to an Electronic ling and payment services Enclose Schedule NR and Worksheets A and B (and Worksheet C if used) with your Maine return Form 1040ME Include a COMPLETE copy of your federal tax return including all schedules and worksheets Enclose W 2 forms from other states or temporary duty (TDY) papers to support your entry in Box C Enclose with your Form 1040ME Enclose with your Form 1040ME You must also attach a copy of the income tax return led with the other jurisdiction Enter a negative amount with a minus sign in the box immediately to the left of the number Part year residents Nonresidents and SafeHarbor residents see Schedule NR or NRH Enter amount from federal Form 1040 line 48 or 1040A line 29 2 $ Enter amount from federal Schedule A line 1 $ Enter amount from federal Schedule A line 4 $ and multiply by percentage on line 4 above $ Enter amount of long term care insurance premiums included on federal Form 1040 line 29 $ Enter amount of long term care premiums included in line 2 above $ enter date of death Enter line 4 (or line 4a for those ling Schedule NR or Schedule NRH) or $500 whichever is less Enter this amount on Form 1040ME line 27d 5 Enter line totals below: Enter new state of residence 7a Enter state of prior residence 6a Enter the smaller of line 1 or line 4 here 5 Enter the smaller of line 2 or line 7 here and the total for both spouses on Schedule 1 line 2d 8 Enter total amount of long term care insurance premiums paid during 2012: $ ERRORS THAT DELAY PROCESSING OF RETURNS: Every day 24 Hours Expenses Expenses EZ PAY at www maine gov/revenue or ENCLOSE CHECK payable to: Treasurer State of Maine DO NOT SEND CASH f Maine Capital Investment Credit Bonus Depreciation Add back 1f federal Form 1040 line 58) Also disability bene ts reported as Internal Revenue Code (IRC) sections 401(a) (Quali ed Pension Federal income tax information and forms: Call the Internal Revenue Service at (800) 829 1040 or visit www irs gov FEDERAL MAINE NON MAINE federal return (Form 1040EZ line 4 or 1040A line 21 or 1040 line 37) Line 15 You must complete this line if you have income that is taxable by the state but not by the federal government (additions) or income that is taxable by the federal government but not by the state (subtractions) Filing Jointly* Filing Jointly* Filing Jointly* House Than Filing Jointly* FILING STATUS AND NUMBER OF EXEMPTIONS INCOMPLETE W 2 FORMS ARE NOT ENCLOSED WITH THE RETURN ERRORS IN CALCULATION Find the amount of Maine income tax as if you were a full year Maine resident To do this complete Form 1040ME lines 1 through 24 Use your total federal adjusted gross income on line 14 For additional answers to frequently asked questions (faqs) visit www maine gov/revenue/faqs/homepage shtml For additional information on determining Maine residency or if you are inthe military see the Maine Revenue Services Guidance to ResidencyStatus and Guidance to Residency Safe Harbors brochures at www maine gov/revenue/forms or call the forms line at (207) 624 7894 for investments in or contributions to public shery infrastructure For more information on Maine income modi cations visit www maine gov/revenue/forms For more information on Maine tax additions and tax credits visit www maine gov/revenue/forms For more information see www maine gov/revenue For more information visit www maine gov/revenue/forms for Part year Residents/Nonresidents/ Safe Harbor Residents For tax period Form 1040ME FORM 1040ME Form 1040ME due date: Tuesday April 16 2013 forms or call the forms line at (207) 624 7894 Line 26 Subtract lines 24 and 25 from line 23 Nonresidents and Safe Harbor Residents only: show negative amounts with a minus sign in the box to the left of the number A negative amount represents unused business credits claimed on Schedule A that may be carried over See instructions for Maine Schedule A Free internet access is available at most local libraries in Maine See your librarian for details about free internet access Full Year Resident: 1) Maine was my domicile for the entire year of 2012; or 2) I maintained a permanent place of abode in Maine for the entire year and spent a total of more than 183 days in Maine g Fiduciary Adjustment additions only (Attach a copy of your federal Schedule K 1) 1g GENERAL INSTRUCTIONS Gross Income Amount Gross Income Amount Have you disposed of the property? 5c If yes when? (Yourself: Spouse: ) Head Least Less Head Least Less Head Least Less HEAD OF HOUSEHOLD $8 700 hold Separately hold Home Phone Number House Separately House Separately House Separately I own(ed) a home/real property in Maine 5 i Total additions (Add lines 1a through 1h) 1i 00 I was domiciled in (Enter state(s)) 2 I was in the military and stationed in (Enter state or country) 3 If Line 19 Form If Line 19 Form If married did your spouse and dependent children (if any) move to your new state of residence? 7f If NOT requesting a refund mail to: Maine Revenue Services P O Box 1067 Augusta ME 04332 1067 If requesting a REFUND mail to: Maine Revenue Services P O Box 1066 Augusta ME 04332 1066 If spouse is deceased enter date of death If taxpayer is deceased If yes in what municipality was the property located? 5a If you answered no to question 7(f) please explain the circumstances (Attach a separate sheet if necessary): If you answered yes to question 5 but have not disposed of the property what use do you intend to make of it and how often (Attach a separate sheet if necessary)? IF YOU OVERPAID YOUR TAX ENTER THE AMOUNT YOU WANT TO BE REFUNDED ON LINE 33B SOCIAL SECURITY NUMBERS THAT ARE NOT CORRECT IF YOU WOULD LIKE YOUR REFUND SENT DIRECTLY TO YOUR BANK ACCOUNT ($10 000 or less) OR TO A NEXTGEN COLLEGE INVESTING PLAN ACCOUNT see the instructions on page 3 and ll in the lines below in black or blue ink Letters and numbers must be entered legibly include social security or railroad retirement bene ts received or pension bene ts received from an included on line 10 of federal Form 1040 Line 2c If included in federal adjusted gross income enter social security benefits issued by the U S Government and railroad retirement bene ts (tier 1 and tier 2) and unemployment and sickbene ts issued by the U S Railroad Retirement Board income (1 0000 minus Schedule NRH line 7 column C) 4a income (Schedule NRH line 7 column B) Then multiply the result by the Maine source income ratio of your Income Allocation Worksheet for Part Year Residents/Nonresidents/ Safe Harbor Residents INCOME SUBJECT TO MAINE INCOME TAX: Individual Income Tax Booklet individual retirement account simpli ed employee pension plan an ineligible deferred compensation Individuals who are considered to be residents of both Maine (excluding Safe Harbor residents) and another state for income tax purposes may qualify for a dual resident credit under 36 M R S A 5128 For more information see www maine gov/revenue/forms or call (207) 626 8475 Injured Spouse Check the box below your signature(s) if you are an innocent/injured spouse (see federal Form 8379 or Form 8857 and related instructions) For more information call (207) 624 9595 or email compliance tax@maine gov Instead of ling Schedule NR you may elect to le single on the Maine return using Schedule NRH if your ling status on your federal return is married ling jointly and your residency status is different from that of your spouse or both you and your spouse are nonresidents of Maine or Safe Harbor residents but only one of you has Maine source income The nonresident or Safe Harbor resident spouse with no Maine source income does not have to le a Maine return Do not use Schedule NRH if your ling status on your federal return is single head of household or married separate investments in child care facilities Line 1 ADDITIONS Also include the taxpayer s distributive share of addition modi cation items from partnerships S corporations and other pass through entities Line 1 Box C line 1 enter 1 0000) 3 Line 1 Enter your income from Worksheet B on line 1 List your total federal income in Box A In Box B list only your Maine source income List your non Maine source income in Box C Line 1 FOR MAINE RESIDENTS ONLY The Maine Clean Election Fund nances the election campaign of certi ed Maine Clean Election Act candidates Checking this box does not increase your tax or reduce your refund but reduces General Fund revenue by the same amount Line 10 MAINE CAPITAL INVESTMENT CREDIT If your business Line 14 Enter the federal adjusted gross income shown on your Line 14 MINIMUM TAX CREDIT If you paid minimum tax in previousfrom a retirement plan or are subject to the special federal tax on an years you may qualify for a minimum tax credit Line 17 Deduction If your ling status is nonresident alien you must use itemized deductions If you use the standard deduction on your federal return you must use the Maine standard deduction on your Maine return Line 18 Multiply the number of exemptions on line 13 by $2 850 and enter the result on this line Caution: If you led federal Form 1040EZ and checked one or both boxes on line 5 of that form and line F of the Worksheet for dependents who checked one or both boxes on line 5 is zero (see reverse side of federal Form 1040EZ) enter zero on line 18 of your Maine long form If you checked one or both boxes on federal Form 1040EZ line 5 and line F of the worksheet is $3 800 enter $2 850 on line 18 Line 1a Enter the income from municipal and state bonds otherthan Maine that is not included in your federal adjusted gross income (i e enter bond interest from City of New York but not Portland Maine) Line 1b Net Operating Loss Recovery Adjustment Enter on this line any amount of federal net operating loss carry forward that has been previously used to offset Maine addition modi cations For more information go to www maine gov/revenue/forms (select Income Tax Guidance Documents) Line 1c Enter 2012 Maine Public Employees Retirement System Line 1d Enter the amount claimed as a domestic production activities Line 1e BONUS DEPRECIATION ADD BACK: An addition modi cation is required equal to the net increase in depreciation resulting from bonus depreciation claimed on the federal return To calculate this addition modi cation the amount of the add back on line 1f must be subtracted from the basis of property placed in service in 2012 Then MACRS depreciation must be calculated on the remaining property basis The amount entered on this line equals the amount that the federal depreciation claimed less the amount on line 1f exceeds the recalculated MACRS depreciation If the recalculated MACRS depreciation is greater than the adjusted federal depreciation no addition modi cation is required on this line Enclose a copy of the federal Form 4562 along with the add back calculation with the return For more information and examples go to www maine gov/revenue/forms (select Income Tax Guidance Documents) Line 1f Enter on this line the bonus depreciation claimed on the federal return relating to property for which the Maine Capital Investment creditis claimed Line 1g Enter your share of a fiduciary adjustment (addition modi cations) relating to income from an estate or trust (36 M R S A 5122(3)) Attach a copy of your federal Schedule K 1 Line 1h Other Enter on this line: the amount of loss deductions and other expenses of a nancial institution subject to Maine franchise tax that are included in your federal adjusted gross income due to an ownership share in the nancial institution that is a partnership S corporation or entity disregarded as separate from its owner amounts deducted as a business or other expense for federal tax purposes that are included in the credit base for the high technology investment tax credit and the forest management planning credit the amount claimed as a deduction in determining federal adjusted gross income that is used to calculate the Maine Fishery Infrastructure Investment Tax Credit under 36 M R S A 5216 D quali ed tuition and other education expenses claimed on the federal return in accordance with section 222 of the Internal Revenue Code quali ed payments and tax bene ts from states or municipalities to re ghters and emergency medical responders that are excluded from federal gross income pursuant to Code section 139B List the source of each amount claimed in the space provided For more information go to www maine gov/revenue Line 2 Check if at least two thirds of your gross income for 2012 was from commercial farming or shing as de ned by the Internal Revenue Code Include your spouse s income in your calculation if you are ling a joint return line 2 column C 1 $ Line 2 RATIO OF INCOME Divide your total non Maine source income on line 1 Box C by your total federal income on line 1 Box A If this ratio is less than 0 enter 0 0000 If it is greater than 100 enter 1 0000 Line 2 SUBTRACTIONS NOTE: You may only subtract the itemslisted below on this schedule Do not subtract non Maine source income Also include the taxpayer s distributive share of subtraction modi cation items from partnerships S corporations and other pass through entities If you are a resident of Maine and have income taxed by another state see the worksheet for Credit for Income Tax Paid to Other Jurisdictions on page 12 Line 22 If your taxable income line 19 is $2 000 or less and neither you nor your spouse (if married) is claimed as a dependent on somebody else s return you are entitled to a low income credit equal to the income tax that would normally be due You are not required to le a return if you qualify for this credit However you must le a return to claim any refund due to you Line 25 NOTE: Schedule NRH is available at www maine gov/revenue/ Line 27a Enter the total amount of Maine income tax withheld Enclose (do not staple or tape) supporting W 2 1099 and 1099ME forms Unless the 1099 form is required as supporting documentation for another schedule or worksheet only send 1099 forms if there is State of Maine income tax withheld shown on them Line 27b Enter the total amount of Maine estimated tax paid during 2012 Also include on this line extension payments and amounts withheld in 2012 on the sale of real estate in Maine (enclose a copy of Form REW 1 to support your entry) Line 2a If included in federal adjusted gross income enter income from direct obligations of the U S Government such as Series EE and Series HH Savings bonds and U S Treasury bills and notes Line 2b Enter the amount of any state or local income tax refund Line 2d Enter the pension income deduction from the Worksheet on Line 2f Enter premiums for long term care insurance if the insurance policy on which the premiums are paid 1) meet the federal de nition for a long term care insurance contract (IRC 7702B(b)) (these are long term care premiums that generally qualify for federal itemized deductions) or 2) are certi ed by the Maine Bureau of Insurance Premiums claimed must be reduced by any premiums claimed as Maine itemized deductions and by any premiums included in the federal self employed health insurance deduction claimed on federal Form 1040 line 29 Line 2g Use this line only if you retired after 1988 and are receiving retirement bene ts from the Maine Public Employees RetirementSystem (MePERS) Subtract the amount in box 14 from the amount in box 2a on Form 1099 R issued by MePERS Also enter on this line MePERS rollover amounts previously taxed by the state whether or not included in federal adjusted gross income Line 2h Enter up to $250 per bene ciary of contributions made to a Maine or non Maine quali ed tuition program ( 529 college savingsplan ) only if your federal adjusted gross income is not more than $100 000 if single or married ling separately or $200 000 if married ling joint or head of household Line 2i Enter your share of a duciary adjustment (subtraction modi cations) relating to income from an estate or trust (36 M R S A 5122(3)) Attach a copy of your federal Schedule K 1 Line 2j Bonus depreciation/section 179 expense recapture amounts required to be added to income under 36 M R S A 5122(1)(N) 5122(1)(AA) 5122(1)(FF)(2) 5200 A(1)(N) or 5200 A(1)(Y)(2) may be recaptured over the life of the applicable asset For more information and examples visit www maine gov/revenue/forms (select Income Tax Guidance Documents) Line 2k Other subtractions Unless speci cally stated do not enter non Maine income on this line Enter ONLY items speci cally listed below Line 3 FEDERAL INCOME ADJUSTMENTS NON MAINE SOURCE ONLY Complete this section only if you have federal income adjustments on federal Form 1040 line 36 or federal Form 1040A line 20 Multiply your total federal income adjustments by the percentage listed on line 2 of Schedule NR Line 30 If you purchased items for use in Maine from retailers who did not collect the Maine sales tax (such as businesses in other states and many mail order and internet sellers) you may owe Maine use tax on those items The rate of tax for purchases in 2012 is 5% If you paid another state s sales or use tax on any purchase that amount may be credited against the Maine use tax due on that purchase If you do not know the exact amount of Maine use tax that you owe either multiply your Maine adjusted gross income from line 16 by 08% ( 0008) or use the table below NOTE: For items that cost $1 000 or more you must add the tax on those items to the percentage or table amount Use Tax on items that cost more than $5 000 must be reported on an individual use tax return by the 15th day of the month following its purchase For additional information visit www maine gov/revenue/salesuse/usetax/ usetax html or call (207) 624 9693 Line 30a If you collected $2 000 or less in sales tax on casual rentals of living quarters you may report the tax on this line Multiply the rentals received in 2012 not reported on any sales tax return by 7% Note: To report sales tax greater than $2 000 you must le a sales/use tax return to report all sales you owe to Maine Sales and use tax forms are available at www maine gov/revenue/salesuse/returnlink htm or call (207) 624 9693 Line 33b Refunds of $1 00 or more will be issued to you Lines 33c 33e To comply with banking rules you must check the box to the left of line 33d if your refund is going to an account outside the United States If you check the box we will mail you a paper check Except for NextGen Accounts the account to receive the direct deposit must be in your name If you are married the account can be in either name or in both your names Note that some banks will not allow a joint refund to be deposited into an individual account Refunds directed to a NextGen Account are subject to the terms and conditions of the Program Description Participation Agreement and any Supplement(s) Line 34b Underpayment Penalty If line 26 less the sum of lines 27a 27d and REW amounts included in line 27b is $1 000 or more use Form 2210ME to see if you owe an underpayment of estimated tax penalty Form 2210ME is available at www maine gov/revenue/forms or call (207)624 7894 Line 34c Total Amount Due Do not send cash If you owe less than $1 00 do not pay it Remit your payment using Maine EZ Pay at www maine gov/revenue or enclose (do not staple or tape) a check or money order payable to Treasurer State of Maine with your return Include your complete name address and telephone number on your check or money order Line 4 FEDERAL ADJUSTED GROSS INCOME NON MAINE SOURCE ONLY Subtract line 3 from line 1 Box C Line 4 Total Itemized Deductions Federal Form 1040 Enter your total itemized deductions as shown on federal Schedule A line 29 Line 4b is the income tax assessed by the other jurisdiction minus any tax credits (except withholding and estimated tax payments) Line 5 MODIFICATIONS NON MAINE SOURCE ONLY Use this section only if you have income modi cations entered on Form 1040ME line 15 Enter your modi cations to income from non Maine sources For details on these modi cations see the instructions for Schedule 1 on pages 3 and 4 Do not include taxable refunds of state and local taxes Prorate the pension deduction (Form 1040ME Schedule 1 line 2d) and the subtraction for premiums for Long Term Care Insurance (Form 1040ME Schedule 1 line 2f) based on the percentage of quali ed pension income received or premiums paid as a nonresident or a Safe Harbor resident Line 5a Income Taxes Imposed by this State or any other taxing Jurisdiction or General Sales Taxes included in Line 4 Enter the total of state and local income taxes or sales taxes included in line 4 Line 5b Deductible costs included in Line 4 incurred in the production of Maine exempt income Enter any interest or other expense items attributable to income not taxable under Maine law Line 6 Deductible costs of producing income exempt from federal income tax but taxable by Maine Enter any interest or other expense items attributable to income taxable under Maine law but exempt from federal income tax Enter only amounts not included on line 4 Line 6 NON MAINE ADJUSTED GROSS INCOME Add or subtract your total modi cations line 5c to or from line 4 Line 7 RATIO OF MAINE ADJUSTED GROSS INCOME Divide the amount of your non Maine adjusted gross income line 6 by your total Maine adjusted gross income from Form 1040ME line 16 If this ratio is less than 0 enter 0 0000 If it is greater than 100 enter 1 0000 Line 8 MAINE SEED CAPITAL CREDIT If you invested in a quali ed Line 18 OTHER TAX CREDITS Enter the sum of the following credits Maine business of which you are not a principal owner you may qualify List the name of each credit claimed in the space provided: Biofuel for a credit through the Finance Authority of Maine Production Tax Credit for DEP certi ed production of non fossil fuels Line 9 CREDIT FOR EDUCATIONAL OPPORTUNITY Graduates of Family Development Account Credit for contributions to the FAME Maine colleges (or employers of quali ed graduates) may qualify for a authorized fund Jobs and Investment Tax Credit for creation of 100 credit based on certain loan repayments made in 2012 jobs and investment of $5 million Maine Fishery Infrastructure Credit Line 8 TAX SUBTOTAL Enter your tax subtotal This is from Form 1040ME line 20 minus line 22 minus Maine Schedule A lines 4 and 6 Line 9 NONRESIDENT CREDIT Multiply the amount on line 8 by the percentage on line 7 This is your Nonresident Credit Enter the result here and on Form 1040ME line 25 Lines 1 and 2 RETIREMENT PLAN DISTRIBUTIONS / EARLY Lines 13 HIGH TECH CREDIT If your business invested in computer DISTRIBUTION FROM QUALIFIED RETIREMENT PLANS If you equipment used in high tech activity you may qualify for this credit choose to compute a separate federal tax on a lump sum distribution Lines 11 and 12 RESEARCH CREDITS Enter on these lines any Lines 15 & 16 MEDIA PRODUCTION / PINE TREE DEVELOPMENT Lines 3 7 Use the ling status from your federal income tax return If you led a married joint federal return and one spouse is a part yearresident nonresident or Safe Harbor resident see the Guidance to Residency Status brochure at www maine gov/revenue/forms for more information If you are ling married ling separately be sure to include your spouse s name and social security number For pass through entities only: check the red box below line 7 if this is a composite ling A composite return may be led by a pass through entity on behalf of nonresident owners You must complete and enclose Schedule 1040C ME and Maine Schedules K 1 with your composite return For more information on composite ling and forms visit www maine gov/revenue Lines 8 11 See General Instructions above to determine your residency status If you check line 8a 9 10 or 11 enclose a copy of your federal tax return Listed Maine as your legal residence for any purpose 8g M R S A 6232(1 A) to the extent included in federal adjusted gross income interest income and capital gains from the sale of bonds issued relative to the Maine Waste Management & Recycling Program to the extent included in federal adjusted gross income Mailing Address (PO Box number street and apt no) Maine Adjusted Use Tax Maine Adjusted Use Tax Maine Credit Column A multiply line 2a column A by 25% ( 25) Column B multiply line 2a column B by 50% ( 50) 3 Maine FastFile MAINE INCOME TAX Form 1040ME line 23 20 MAINE REVENUE SERVICES 24 STATE HOUSE STATION AUGUSTA ME 04333 0024 MAINE STANDARD DEDUCTION AMOUNTS: Maintenance Fund Married (whether ling jointly or separately) or a quali ed widow(er): multiply the number of boxes checked on lines 12a 12b 12c and 12d by $1 150 Add the result to the standard deduction for your ling status above MARRIED FILING JOINTLY OR QUALIFYING WIDOW(ER) $11 900 MARRIED FILING SEPARATELY $5 950 Maximum allowable deduction 2 MEDIA PRODUCTION CREDIT (Enclose worksheet see instructions) 15 must be reduced by any social security and railroad retirement ineligible deferred compensation plan under IRC section 457(f) bene ts received whether taxable or not refunds of excess contributions lump sum distributions included on Name(s) as shown on Form 1040ME Name(s) as shown on Form 1040ME Name(s) as shown on Form 1040ME Your Social Security Number Name(s) as shown on Form 1040ME Your Social Security Number net operating losses carried forward from previous tax years pursuant to 5122(2)(H) 5122(2)(P) 5122(2)(CC) or for individual owners of certain electing S corporations net operating losses carried forward pursuant to 5200 A(2)(H) or 5200 A(2)(L) For more information on Maine s treatment of NOL s go to www maine gov/ revenue/forms (select Income Tax Guidance Documents) Also enter on this line to the extent included in federal adjusted gross income military compensation received by a nonresident servicemember to the extent not included in the pension deduction on line 2d military annuity payments made to a survivor of a deceased member of the military as a result of service in the active or reserve components of the U S armed services under a survivor bene t plan or reserve component survivor bene t plan in accordance with 10 USC Chapter 73 recovery amounts included on federal Form 1040 line 21 related to items previously deducted on your federal return but not on your Maine return in an earlier year such as real estate taxes discharge of indebtedness amounts included in federal adjusted gross income deferred for federal tax purposes but not Maine tax purposes during 2009 or 2010 the amount of loan payments made by employers included in federal adjusted gross income of individuals quali ed for the opportunity Maine credit the amount of the reduction in your salaries and wages expense deduction directly related to claiming the federal Work Opportunity Credit or Empowerment Zone Credit reported on federal Form 5884 line 2 or federal Form 8844 line 2 (owners of pass through entities enter your share of the amount from line 3 of these forms to the extent not included on line 2) Note: do not enter wage amounts from Form 8844 related to the federal Renewal Community credit settlement payments received by Holocaust victims that are included in federal adjusted gross income account proceeds from a Family Development Account administered by FAME earnings from shing operations contributed to a capital construction fund the amount of military retirement bene ts not included in the pension income deduction on line 2d received by certain licensed dentists who practice an average of 20 hours or more per week in Maine and accept patients who receive MaineCare bene ts income from investments in the Northern Maine Transmission Corporation up to $750 of property tax bene ts provided by municipalities to senior citizens pursuant to 36 Nonresident individuals including individuals who were nonresidents for only part of the year and Safe Harbor resident individuals who have Maine source income may owe a Maine income tax See page 2 for residency information MILITARY SERVICEMEMBER SPOUSE: The income of a military spouse for the performance of services in Maine will not be treated as Maine source income subject to Maine income taxation if the military spouse is not a resident or domiciliary of Maine the military spouse is located in Maine solely to be with the servicemember the servicemember is located in Maine in compliance with military orders and the servicemember and the spouse have the same state of residency or domicile The Maine tax is determined by rst calculating a tax amount as if the part year resident nonresident or Safe Harbor resident were a Maine resident for the entire year and then reducing that amount by a nonresident credit The Maine tax is calculated on the basis of the nonresident s or Safe Harbor resident s entire federal adjusted gross income and the Maine income modi cations itemized or standard deduction personal exemption amount and credits The nonresident credit is based on the amount of non Maine source income The nonresident credit is calculated on Schedule NR or Schedule NRH and entered on Form 1040ME line 25 NOTE: Nonresident minimum taxability thresholds: A nonresident individual working in Maine as an employee is not required to pay a Maine tax or le a Maine return on income from personal services unless that individual works in Maine for more than 12 days and earns or derives income from all Maine sources totaling more than $3 000 Up to 24 days performing certain personal services such as training and site inspections are not counted against the 12 day threshold Also generally a nonresident individual present in Maine for business for no more than 12 days and earning no more than $3 000 from business activity in Maine is not required to pay a Maine tax or le a Maine income tax return on that income For more information see Maine Revenue Services Rule 806 and 36 M R S A 5142(8 B) and 5220(2) available on the MRS web site at www maine gov/revenue (select Laws and Rules) Nonresident: I was not a resident or part year resident in 2012 but I do have Maine source income Follow the federal ling requirements for ling status number of exemptions federal adjusted gross income and itemized deductions File Form 1040ME and Schedule NR or NRH Note: Form 1040ME is designed to comply with optical scanning NOTE: If married ling separately the additional deduction amounts for your spouse apply only if you can claim an exemption for him/her NOTE: If you le Schedule NRH multiply the joint amount (for both you and your spouse) of Schedule A lines 4 and 6 by the percentage listed on Schedule NRH Column B line 7 Enter the result on the appropriate line of Schedule A Also see the note below if you are ling as a nonresident or Safe Harbor resident individual NOTE: Nonresidents/Part year residents/ Safe Harbor residents: prior tax years NOTE: If the federal research credit is extended Enter on Schedule A lines 1 and 2 the amounts that relate to Maine to quali ed expenses paid or incurred after 2011 Maine Revenue source income only Do not include amounts based on pension income Services will post the 2012 Maine research credit worksheets tootherwise exempt from state taxation by federal law (Public Law 104 95) its web site NOTE: See instructions at www maine/gov/revenue/forms on how to use Worksheet B line 15 entries to complete line 1 of Schedule NR or Schedule NRH NOTE: Tax rate schedules are available at www maine gov/ revenue/forms/1040/2012 htm Note: You may photocopy this page if you need additional worksheets Obtained a driver s license in Maine 6d If yes when? (Yourself: Spouse: ) Obtained a driver s license in my new state of residence 7d If yes when? (Yourself: Spouse: ) Obtained or renewed any Maine trade or professional licenses or union memberships 8h of Least Less of Than of Than of Than on pages 19 20 or compute your tax using the tax rate 00 Ordinary dividends Other gains/losses Other income (Including lump sum distributions but excluding state income tax refunds) outside the United page 10 line 8 Include copies of your 1099 forms to verify the subtraction Line 2e If included in federal adjusted gross income enter interest from Maine municipal general obligation & private activity bondsand bonds issued by a Maine airport authority PART YEAR RESIDENT NONRESIDENT AND SAFE HARBOR RESIDENT INSTRUCTIONS Part Year Resident: I was domiciled in Maine for part of the year and was not a full year resident as de ned in (2) above File Form 1040ME and Schedule NR or NRH Part year residents Nonresidents and Safe Harbor residents must complete this worksheet before completing Schedule NR or Schedule NRH Payment Plan Check the box below your signature(s) if you are requesting a payment plan Your rst payment should be submitted with your return and you should continue to make payments until Maine Revenue Services contacts you For more information call (207) 621 4300 or email compliance tax@maine gov Performed any work or services in Maine 8a If yes list employer (Yourself: Spouse: ) PINE TREE DEVELOPMENT ZONE CREDIT Enter the amount from the Credit Application Worksheet (Enclose worksheet see instructions) 16 plan under IRC 457(f) lump sum distributions included on federal Form 4972 distributions subject Print or type your name(s) and mailing address in the spaces provided Social security number(s): You must enter your social security number(s) in the spaces provided Printed Under Appropriation 010 18F 0002 07 projects Employer credits for payment of employee expenses (long placed depreciable property in service in Maine during tax year 2012 term care insurance day care expenses dependent health bene ts)you may qualify for this credit Purchased a home in Maine 6c If yes when? (Yourself: Spouse: ) Purchased a home in my new state of residence 7c If yes when? (Yourself: Spouse: ) Purchased a Maine resident hunting or shing license 8f qualify for one of these credits certi ed through the Department of Quality Child Care Program Column A Column B Name & Certi cate Number: Regular Quality (do not enter the Child Care Program s federal ID number) Child Care Child Care REFUND or TAX DUE Registered an auto or other vehicle in Maine 6e If yes when? (Yourself: Spouse: ) Registered an auto or other vehicle in Maine 8b Registered an auto or other vehicle in my new state of residence 7e If yes when? (Yourself: Spouse: ) Registered to vote in Maine 6b If yes when? (Yourself: Spouse: ) Registered to vote in my new state of residence 7b If yes when? (Yourself: Spouse: ) Renewed a Maine driver s license 8c Rental real estate royalties partnerships S corporations and trusts etc requirements only original forms and schedules may be submitted requirements The spaces outlined in red must be completed carefully Research Fund Resident Nonresident or Part Year Resident Residents (excluding Safe Harbor residents) may claim a credit against Maine income tax for income tax paid to another jurisdiction if all the following conditions are met: (1) the other jurisdiction is another state a political subdivision thereof the District of Columbia Canadian Province or any political subdivision of a foreign country that is analogous to a state of the United States; (2) the tax paid to the other jurisdiction is directly related to the income received during the tax year covered by this return (tax payments made to other taxing jurisdictions for prior year tax liabilities cannot be considered when computing this credit); and (3) the income taxed by the other jurisdiction is derived from sources in that jurisdiction Income sourced to another state must be determined in the same way that a Maine nonresident calculates Maine source income for purposes of Schedule NR or Schedule NRH For a description of Maine source income see 36 M R S A 5142 and Maine Rule Round down to the next lower dollar any amount less than 50 cents Round SCHEDULE 1 INCOME MODIFICATIONS See page 9 SCHEDULE A SCHEDULE NR INSTRUCTIONS Schedule NRH is available at www maine gov/revenue/forms or call SECTION 1 TAX ADDITIONS: SECTION 2 TAX CREDITS: Economic and Community Development Tax Credit Worksheets Required For more information on all tax credits Line 17 FOREST MANAGEMENT PLANNING CREDIT Once every See instructions on page 14 Enclose with your Form 1040ME See instructions on pages 2 and 3 Print neatly in blue or black ink only Sequence No 8 Sequence No 9 WORKSHEET B SHOULD I FILE SCHEDULE NR OR SCHEDULE NRH? SINGLE $5 950 Single or Married Single or Married Single or Married Head At But Single or Married Social security number 1a Special instructions for taxpayers who claim credit for income tax paid to more than one other jurisdiction: The credit for each jurisdiction must be computed separately Use a separate worksheet for each jurisdiction Print the name of the other jurisdiction in the space provided on line 2 Add the line 5 results together and enter the total on Maine Schedule A line 7 Attach a copy of the income tax return led with the other jurisdiction SPECIFIC INSTRUCTIONS FORM 1040ME Spouse s First Name MI Spouse s Last Name Spouse s Social Security Number Spouse* States Status is: Status is: Status is: STEP 1 Complete Worksheets A and B on pages 17 and 18 before completing Schedule NR STEP 2 Complete Form 1040ME lines 1 through 24 STEP 3 Complete Schedule NR to compute your Nonresident Credit Subtract line 3 from line 2 (if zero or less enter zero) 4 Subtract line 5 and line 6 from line 1 Enter result here and on Schedule 1 line 2f $ Subtract line 5 from line 4 or line 4a (for those ling Schedule NR or NRH) Enter here and on Schedule A line 5 6 Tax Payments/Refundable Credit Tax violations hot line: (207) 624 9600 Call this number or send an email to compliance tax@maine gov to report possible tax violations including failure to le tax returns failure to report all income and failure to register for tax ling Taxable amount of IRA distributions Taxable amount of pensions and annuities Taxable amount of social security bene ts Taxable interest TAXPAYER ASSISTANCE and FORMS The following individuals must complete Worksheet A: 1) All part year residents whether moving into or out of Maine during the tax year; 2) nonresidents and Safe Harbor residents who are ling a Maine return for the rst time and 3) former Maine residents who are ling as nonresidents or Safe Harbor residents for the rst time Failure to enclose a completed Worksheet A with your 1040ME may delay processing of your return The number of days I spent in Maine (for any purpose) was 4 the standard deduction amount shown above for your ling status) thereto (The NextGen Program is administered by the Finance Authority of Maine ) 33c Routing Number ( RTN ) must be 9 digits NOTE: For a NextGen THIRD PARTY DESIGNEE Complete this section if you would like to allow Maine Revenue Services to call or accept information from another person to discuss your 2012 Maine individual income tax return Choose any 5 digit PIN which will be used to ensure MRS employees only speak with the individual you have designated This authorization will automatically end on April 15 2014 Third Party Designee Do you want to allow another person to discuss this return with Maine Revenue Services? Yes (complete the following) No To determine your residency status for 2012 read the following To download or request forms or other information: Visit www maine gov/revenue/forms or call (207) 624 7894 to the additional 10% federal tax on early distributions or refunds of excess contributions) TOTAL ADDITIONS Add lines 1 and 2 Enter result here and on 1040ME page 1 line 21 3 Total eligible non military pension income (both Maine and non Maine sources) included in your federal Total social security and railroad retirement bene ts you received whether taxable or not 3 TTY (hearing impaired only): 711 Weekdays 8:00 a m Under penalties of perjury I declare that I have examined this return and accompanying schedules and statements and to the best of my knowledge andbelief they are true correct and complete Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge Unmarried (single or head of household): multiply the number of boxes checked on lines 12a and 12b by $1 450 Add the result to the standard deduction for your ling status above unused Maine research credit amounts carried forward to 2012 from Properties placed in service prior to 2008 up to the next higher dollar any amount 50 cents or more Due to scanning USE BLACK OR BLUE INK DO NOT USE RED INK BE SURE TO SIGN YOUR RETURN USE TAX TABLE Use Tax/Voluntary Contributions USE THE CORRECT COLUMN FROM THE TAX TABLE FOR YOUR FILING STATUS Visit www maine gov/revenue to learn the status of your refund and obtain the latest tax updates frequently asked questions (FAQs) electronic tax assistance download Maine tax forms and instructions pay your tax or email tax related questions Voted in Maine in person or by absentee ballot 8d wages on your federal income tax return do not qualify Plans including quali ed 401 SIMPLE plans) and 403 (Employee *Eligible pension income does not include bene ts earned by annuities) Deductible pension income also includes bene ts received another person except in the case of a surviving spouse Only under IRC section 457(b) (state and local government/tax exempt the individual that earned the bene t from prior employment mayorganizations/eligible deferred compensation plans) except that claim the pension income for the deduction However a widowedpension income from 457(b) plans received prior to age 55 that is spouse receiving survivor s bene ts under an eligible pension not part of a series of equal periodic payments made over the life of plan may claim that amount for purposes of this deduction but the recipient and the recipient s designated bene ciary if applicable the total pension deduction for the surviving spouse may not may not be included in the deductible pension amount exceed $6 000 NOTE: Enter eligible non military pension bene ts on line 1 and eligible military pension bene ts on line 6 Taxpayer Wages salaries tips other compensation** What is my Residence Status? WHO MUST FILE SCHEDULE NR? Part year resident nonresident and Safe Harbor resident individuals who are required to le a Maine return but have income not taxable by Maine and use the same ling status on the Maine return as used on the federal return See reverse side for instructions Who must le? A Maine income tax return must be led by April 16 2013 if you are a resident of Maine who is required to le a federal income tax return or if you are not required to le a federal return but do have income subject to Maine income tax resulting in a Maine income tax liability You do not have to le a Maine income tax return if you meet all of the following requirements: 1) your Maine taxable income is $2 000 or less AND 2) you claim yourself as an exemption on your return However you must le a return to claim any refund due to you Generally if you are a nonresident or a Safe Harbor resident who has income from Maine sources resulting in a Maine income tax liability you must le a Maine income tax return NOTE: Nonresident minimum taxability thresholds: A nonresident individual working in Maine as an employee is not required to pay Maine tax or le a Maine return on income from personal services unless that individual works in Maine for more than 12 days and earns or derives income from all Maine sources totaling more than $3 000 Up to 24 days performing certain personal services such as training and site inspections are not counted against the 12 day threshold Also generally a nonresident individual present in Maine for business for no more than 12 days and earning no more than $3 000 from business activity in Maine is not required to pay Maine tax or le a Maine income tax return on that income See 36 M R S A 5142(8 B) and Rule 806 WHO SHOULD FILE SCHEDULE CP? You only need to le Schedule CP if you want to make voluntary charitable contributions to any of the organizations listed below or if you choose to purchase a park pass for entry into Maine State Parks Otherwise do not le Schedule CP will go to an account within the outline area Letters must be in upper case only Name Work Phone Number WORKSHEET A Residency Information Worksheet x $35 10 x $70 11 x 05 *6 x 075 1 x 075 2 x 20 *4 You and your spouse (if married) may each deduct up to $6 000 Pension bene ts that do not qualify are those received from an of eligible pension income* that is included in your federal adjusted individual retirement account (including SIMPLE individual retirement gross income Except for military pension bene ts the $6 000 cap accounts) simpli ed employee pension plan bene ts from an YOU MUST ENCLOSE A COMPLETE COPY OF YOUR FEDERAL TAX RETURN including all schedules and worksheets Enclose copies of W 2 forms from other states or temporary duty (TDY) papers to support your entry in Box C You must le Schedule NR if you are a part year resident a nonresident or a Safe Harbor resident individual required to le a Maine return have income not taxable to Maine and are using the same ling status used on your federal return Your child care provider may be certi ed as a Quality Child Care Program facility by the Department of Health and Human Services (DHHS) Of ce of Child Care and Head Start If so enter your child care provider s Quality Child Care certi cate number or Step 4 Child Care Quality Rating System certi cate number in the space provided and enter your quality child care expenses in Column B Otherwise use only column A to calculate your child care credit For a list of certi ed quality child care providers go to Maine Revenue Services web site at www maine gov/revenue (select Income/Estate Tax) or call DHHS at (207) 624 7909 Monday through Friday Your First Name MI Your Last Name Your Social Security Number Your Social Security Number Your Social Security Number Your Tax is: Your Tax is: Your Tax is: Your Tax is: Yourself Spouse