State Election Campaign Fund (this contribution will not change your tax or reduce your refund)<> $1 You<> $1 Spouse if filing jointly  
Total
$__
Fill in if veteran of U.S. armed forces who served in Operation Enduring Freedom, Iraqi Freedom or Noble Eagle<> You<> Spouse 
If taxpayer(s) is deceased, fill in appropriate oval(s)<> Primary <> Spouse 
Under age 18 (see instructions)<> You <> Spouse 
 <> Fill in if name/address has changed since 2012
 <> Fill in if noncustodial parent
 <> Fill in if Filing Schedule TDS (see instructions)
 
1  FILING STATUS<> Single   
   (select one only)<> Married filing joint (both must sign)
    <> Married filing separate return (enter spouse's Social Security number in the appropriate space above)
    <> Head of household
     (see instructions)
<> You are a custodial parent who has released claim to exemption
     for child(ren)     
 
2  EXEMPTIONS     Whole-dollar method only
         
   a.  Personal exemptions . If single or married filing separately, enter $4,400. If head of household, enter $6,800.
     If married filing jointly, enter $8,800....................................................  
2 

.00
   b.  Number of dependents (Do not include yourself or your spouse.)         Enter number _ _ x $1,000 =         
     You must enclose Schedule DI
2b .00
   c.  Age 65 or older before 2013 :        <> You  <> Spouse                         Enter number   _ _ x $700 =         2c  .00
   d.  Blindness :                                  <> You  <> Spouse                        Enter number _ _ x $2,200 =         2d  .00
   e.  1. Medical/Dental     _ _ _, _ _ _.00                                                    2. Adoption    _ _ _, _ _ _ .00 
                                   From U.S. Schedule A, line 4                                                    See instructions
1+2
= e
  .00
   f.   TOTAL EXEMPTIONS. Add lines 2a through 2e. Enter here on line 18  2f  .00

INCOME

3      Wages, salaries, tips and other employee compensation (from all Forms W-2)3  .00
4      Taxable pensions and annuities (government) (see instructions)
      Taxable pensions and annuities (non-government) (see instructions)
4  .00
5      a.  _ _ _, _ _ _, _ _ _ .00                    – b.  _ _ _.00
           Massachusetts bank interest                 Exemption amount   
a – b
= 5
  .00
       Exemption: if married filing jointly, subtract $200 from Total; otherwise subtract $100 & enter result. Not less than "0."  
6      Business/profession or farm income/loss (enclose Massachusetts Schedule C pdf format of Schedule C
or U.S. Schedule F)6.00
7      If you are reporting rental, royalty, REMIC, partnership, S corporation, trust income/loss , see instructions7.00
8      a.  Unemployment compensation See instructions8a.00
       b.  Massachusetts state lottery winnings 8b 
9      Other income (alimony , taxable IRA/Keogh distribution , winnings, fees) from Sch X, Line 5
      (enclose Schedule X pdf format of Schedules X, Y
; note less than "0")        
9.00
10      TOTAL 5.25% INCOME Add lines 3 through 9.  (Be sure to subtract any loss(es) in lines 6 or 7)10.00

DEDUCTIONS

11     a. Amount you paid to Social Security, Medicare, Railroad., U.S. or Mass. retirement Not more than $2,000 per person.  
         (Medicare premiums deducted from your Soc. Sec. or retirement payments are not deductible.)11a.00
      b. Schedules B and D Excess Exemptions Not more than $2,000 per person.  
         (Medicare premiums deducted from your Soc. Sec. or retirement payments are not deductible.)11b.00
12      Child under age 13, or disabled dependent/spouse care expenses (from worksheet)12.00
13        Number of dependent member(s) of household under age 12, or dependents age 65 or over (not you or your spouse) as of December 31, 2013       or disabled dependent(s) (only if single, head of house or married filing joint return and not claiming line 12)  
       Not more than two: a. _x $3,600 =13.00
14      Rental deduction Total rental deduction cannot exceed $3,000 ($1,500 if married filing separately). See instructions  
       Total rent paid in 2013: a.    _ _ _, _ _ _ .00 ÷ 2 =14.00
15      Other deductions from Schedule Y, line 17 (enclose Schedule Y pdf format of Schedules X, Y
)15.00
16      TOTAL DEDUCTIONS. Add lines 11 through 1516.00

17      5.25% INCOME AFTER DEDUCTIONS. Subtract line 16 from line 10. Not less than "0"17.00
18      Total exemption amount (from line 2, item f)18.00
19      5.25% INCOME AFTER EXEMPTIONS. Subtract line 18 from line 17. Not less than "0"  
       If line 17 is less than line 18, see instructions19.00
20      INTEREST AND DIVIDEND INCOME from Schedule B, line 38. Not less than "0"  
       (enclose Schedule B pdf format of Schedule B
)20.00
21      TOTAL TAXABLE 5.25% INCOME. Add line 19 and line 2021.00

22       TAX ON 5.25 INCOME pdf format of Form 1 Instructions
(from tax table, p. 31). If line 21 is more than $24,000 multiply by .0525.  
        Note: if choosing optional 5.85% tax rate , multiply line 21 and the amount in Schedule D, line 21 by .0585.  
        See instructions; fill in oval. <> 22 .00
23       12% INCOME from Schedule B, line 39. Not less than "0" (enclose Schedule B pdf format of Schedule B
):  
        a. _ _, _ _ _, _ _ _ .00 x .12 = 23 .00
24       TAX ON LONG-TERM CAPITAL GAINS  (from Schedule D, line 22). Not less than "0." Enclose Schedule D pdf format of Schedule D
  
        If filing Sched. D-IS, Installment Sales, fill in oval and enclose Schedule D-IS pdf format of Schedule D-IS
<> 24 .00
        If  excess exemptions were used in calculating lines 20, 23 or 24, fill in oval, (see instructions) <>  
25        Credit recapture amounts (enclose Schedule H-2 pdf format of Schedule H-2
). See instructions.  
        <> BC <> EOA <> LIH <> HR 25  .00
26       Additional tax on installment sale (see instructions) 26

  .00

27        If you qualify for No Tax Status, fill in oval and enter "0" on line 28 (from worksheet ) <>    
28       TOTAL INCOME TAX. Add lines 22 through 2628.00

CREDITS

29      Limited Income Credit (from worksheet)29.00
30      Other credits from Schedule Z , line 14 (enclose Schedule Z pdf format of Schedule Z/RF
)30.00
31      INCOME TAX AFTER CREDITS. Subtract total of lines 29 and 30 from line 28. Not less than "0"31.00
32      Voluntary fund contributions :  
        a. Endangered Wild life Conservation32a _, _ _ _.00                     d. Massachusetts U.S. Olympic                     32d.00
        b. Organ Transplant32b _, _ _ _.00                     e. Mass. Military Family Relief32e.00
        c. Massachusetts AIDS32c _, _ _ _.00                      f. Homeless Animal prevention And Care32f.00
         Total. Add lines 32a through 32f32 .00
33       Use tax due on out-of-state purchases (from worksheet ). If no use tax due enter "0"33.00
34       Health Care penalty (from worksheet; be sure to enclose 2013 Schedule HC pdf format of 2013 Schedule HC
)  
        a. You _, _ _ _ .00          b. Spouse _, _ _ _.00 a + b =      34.00
35       INCOME TAX AFTER CREDITS, CONTRIBUTIONS, USE TAX and HC PENALTY. Add lines 31-34...3535.00

36      Massachusetts income tax withheld (enclose all Massachusetts Forms W-2, W-2G, 2-G,  
       PWH-WA, LOA and certain 1099s, if applicable)36.00
37      2012 overpayment applied to your 2013 estimated tax (from 2012 form 1, line 45 or  
       Form 1-NR/PY, line 50; do not enter 2012 refund)37 .00
38      2013 Massachusetts estimated tax payments (do not include amount in line 37)38 .00
39       Payments made with extension 39  .00
40       Earned Income Credit  
        a. Number of qualifying children ___    Amount from U.S. return _, _ _ _.00 x .1540  .00
41      Senior Circuit Breaker Credit (enclose Schedule CB pdf format of Schedule CB
)41  .00
42       Other refundable credits from Schedule RF, line 4 (enclose Schedule RF pdf format of Schedule Z/RF
)42  .00
43       TOTAL. Add lines 36 through 4243  .00

44
 
      OVERPAYMENT. If line 35 is smaller than line 43, subtract line 35 from line 43. if line 35 is larger than line 43, go to line 47. If
      line 35 and line 43 are equal, enter "0" in line 46
44   .00
45      Amount of overpayment you want APPLIED to your 2014 ESTIMATED TAX45.00
46      THIS IS YOUR REFUND. Subtract line 45 from line 44.  
       Mail to: Massachusetts DOR, PO Box 7000, Boston, MA 0220446.00
       Direct Deposit Refund. See Instructions.              Type of account (you must select one) <> checking  <> savings  
       _ _ _ _ _ _ _ _ _                                                                                                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  
       Routing number (first two digits must be 01-12 or 21-32)                                        Account  number  
47      TAX DUE. Subtract line 43 from line 35. Pay online at www.gov/dor/payonline, or use  
        Form PV 2013 pdf format of Form PV 2013
47.00
       Pay in full. Write Social Security numbers(s) on lower left corner of check and be sure to sign check.  
       Make payable to Commonwealth of Massachusetts. Mail to: Massachusetts DOR, PO BOX 7003, Boston, MA 0224.  
       Add to total in line 47, if applicable;  
       Interest        .00                                      Penalty      .00                        M-2210 amount      .00 .00
                                                                                                                  <> Exception: Enclose Form M-2210 pdf format of Form M-2210