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 
Select only one:     <> Nonresident                  <> Filing as both a nonresident and<> Fill in if name/address has changed since 2013
                              <> Part-year resident                part-year resident (see instructions)<> Fill in if noncustodial parent
                                                                       <> Nonresident composite return (see inst.)<> Fill in if filing Schedule TDS (see instructions)
1  
FILING STATUS
(select one only)
<> Single  
   <> Married filing joint return (both must sign return) 
   <> 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     PART YEAR RESIDENTS ONLY    
      Dates as Massachusetts resident: From [MM] [DD] [YYYY]    To [MM] [DD] [YYYY]   
      Total days as Massachusetts resident ÷ 365 = 2 
  Whole-dollar method only
3     TOTAL INCOME from U.S. 1040, line 22; 1040A, line 15; 1040EZ, line 4; 1040NR, line 23;  
       or 1040NR-EZ, line 7. If married filing separately, see instructions.3 [X] If showing a loss, mark X in box  .00
4     EXEMPTIONS 
      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      4a     .00
      b. Number of dependents (Do not include yourself or your spouse.)
     You must enclose Schedule DI  pdf format of Schedule DI
.
Enter number× $1,000 = 4b.00
      Age 65 or over before 2015:<> You     <> Spouse Enter number× $   700 = 4c.00
      d. Blindness :<> You     <> SpouseEnter number× $2,200 = 4d.00
       e.1. Medical/Dental  (From U.S Schedule A, line 4)  .00           2. Adoption (See instructions)  .001 + 2 = 4e.00
      f. TOTAL EXEMPTIONS. Add lines 2a through 2e. Enter here and on line 184f.00

       INCOME
      Nonresidents report in lines 5 through 11 Massachusetts source income only. Use line 13 if appropriate. Part-year residents report in
      lines 5 through 11 income earned and/or received while a resident. Do not use lines 13 or 14. If filing both as a nonresident and part-year
      resident, be sure to complete and enclose Schedule R/NR, Resident/Nonresident Worksheet pdf format of Schedule R/NR
, before proceeding any further.
5      Wages, salaries, tips and other employee compensation (from all Forms W-2)5  .00
6      Taxable pensions and annuities (government) (see instructions)
      Taxable pensions and annuities (non-government) (see instructions)
6  .00
7      a.  _ _ _, _ _ _, _ _ _ .00                    – b.  _ _ _.00 (Not less than 0)
           Massachusetts bank interest                 Exemption amount.
      Exemption: if married filing jointly, subtract $200 from line 7a; otherwise subtract $100 and enter result (not less than “0”).
a – b = 7  .00
  If showing a loss, mark X in box  
8      Business/profession or farm income/loss (enclose Massachusetts Schedule C  pdf format of Schedule C
or U.S. Schedule F)8 [X].00
9      If you are reporting rental, royalty, REMIC, partnership, S corporation, trust income/loss , see instructions9 [X].00
10      a.  Unemployment compensation See instructions10a.00
       b.  Massachusetts state lottery winnings 10b.00
11      Other income (alimony, taxable IRA/Keogh distribution, winnings, fees) from Schedule X, line 5
      (enclose Schedule X pdf format of Schedules X/Y
note less than "0")        
11.00
12      TOTAL 5.2% INCOME Add lines 5 through 11. (Be sure to subtract any loss(es) in lines 8 or 9)12.00

13


 
       NONRESIDENT APPORTIONMENT WORKSHEET . You cannot apportion Massachusetts wages as shown on Form W-2. Do not use this work-
       sheet if you know the exact amount of your Massachusetts source income . Use only when income from employment/business is earned both
       inside and outside Massachusetts and the exact Massachusetts amount is not known.
       Basis:  <> working days  <> miles  <> sales  <> other:______________________________________
       a. Working days (or other basis) outside Massachusetts13a.00
       b. Working days (or other basis) inside Massachusetts13b.00
       c. Total working days. Add line 13a and line 13b13c.00
       d. Nonworking days (holidays, weekends, etc.).13d.00
       e. Massachusetts ratio. Divide line 13b by line 13c13e 
       f. Total income being apportioned (you cannot apportion Mass. wages as shown on Form W-2)13f.00
       g. Massachusetts income. Multiply line 13e by line 13f. Enter here and in appropriate lines on  
           pages 1 and 2.13g.00

14
 
      NONRESIDENT DEDUCTION and EXEMPTION RATIO . Nonresident taxpayers must complete this item to determine the ratio for apportioning
      the deductions in lines 16 and 17; certain Schedule Y deductions (see instructions); the exemptions in line 22a; and the EIC in line 45.
       a. Total 5.2% income (from line 12). Not less than “0”14a.00
       b. Interest income (smaller of line 7a or line 7b).14b.00
       c. Total capital gain income, if any (total of Schedule B, Part 1, line 7; Schedule B, Part 2, line 13;  
       Schedule D, line 13. Not less than “0.”)14c.00
       d. Total income this return. Add lines 14a, b and c14d.00
       e. Non-Massachusetts source income. Not less than “0.” See instructions.14e.00
       f. Total income. Add line 14d and line 14e. See instructions14f.00
       g. Deduction and exemption ratio. Divide line 14d by line 14f14g 

      DEDUCTIONS.  Amounts entered in line(s) 15a and/or 15b must be related to Massachusetts income reported on this return.
15     a. Amount you paid to Social Security, Medicare, Railroad, U.S. or Mass. retirement  Not more than $2,000.  
         (Medicare premiums deducted from your Soc. Sec. or retirement payments are not deductible.)15a.00
      b. Amount your spouse paid to Social Security, Medicare, Railroad, U.S. or Mass. retirement  Not more than $2,000.  
         (Medicare premiums deducted from your Soc. Sec. or retirement payments are not deductible.)15b.00
16      Child under age 13, or disabled dependent/spouse care expenses (from worksheet)16.00
17
 
      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, 2014 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 =____________ Nonresidents multiply result by line 14g ; part-year residents multiply result by line 2 17.00
18      Rental deduction Total rental deduction cannot exceed $3,000 ($1,500 if married filing separately). See instructions  
       Total rent paid in 2014: a.    _ _ _, _ _ _ .00 ÷ 2 =18.00
       Nonresidents, during 2014 did you have a family home or any other dwelling outside Massachusetts to which you generally or customarily
       returned or intend to return in the future? <> Yes  <> No.  If Yes, you do not qualify for this deduction.
19      Other deductions from Schedule Y, line 17 (enclose Schedule Y pdf format of Schedules X/Y
)19.00
20      TOTAL DEDUCTIONS. Add lines 11 through 1520.00

21      5.2% INCOME AFTER DEDUCTIONS. Subtract line 20 from line 12. Not less than "0"21.00
22      Exemption amount                                 
      (from line 4f)          a. _ _ _,_ _ _.00            Nonresidents multiply result by line 14g ; part-year residents multiply result by line 2

22

.00
23      5.2% INCOME AFTER EXEMPTIONS. Subtract line 22 from line 21. Not less than "0"  
       If line 21 is less than line 22, see instructions23.00
24      INTEREST AND DIVIDEND INCOME from Schedule B, line 38. Not less than "0"  
       (enclose Schedule B  pdf format of Schedule B
)24.00
25      TOTAL TAXABLE 5.2% INCOME. Add line 23 and line 2425.00

26       TAX ON 5.2% INCOME (from tax table, page 37 pdf format of Form 1 Instructions
). If line 24 is more than $24,000 multiply by .052.  
        Note: if choosing optional 5.85% tax rate , multiply line 25 and the amount in Schedule D,         
         line 21 by .0585. See instructions; fill in oval. <> 26 .00
27       12% INCOME from Schedule B, line 39. Not less than "0" (enclose Schedule B  pdf format of Schedule B
):  
        a. _ _, _ _ _, _ _ _ .00 x .12 = 27 .00
28       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
<> 28 .00
        If  excess exemptions were used in calculating lines 24, 27 or 28, fill in oval, (see instructions) <>  
29        Credit recapture amounts (enclose Schedule H-2  pdf format of Schedule H-2
). See instructions.  
        <> BC <> EOA <> LIH <> HR 29  .00
30        Additional tax on installment sale (see instructions) 30

  .00

31        If you qualify for No Tax Status, fill in oval and enter "0" on line 32. Complete Schedule NTS-L-NR/PY and enclose   
        Schedule NTS-L-NR/PY pdf format of Schedule NTS-L-NR/PY
<>  
32       TOTAL INCOME TAX. Add lines 26 through 3032.00

       CREDITS
33      Limited Income Credit Complete Schedule NTS-L-NR/PY and enclose Schedule NTS-L-NR/PY  pdf format of Schedule NTS-L-NR/PY
33.00
34      Credits from Schedule Z , line 10 (enclose Schedule Z pdf format of Schedules Z/RF
)34.00
35      Credits from Schedule Z, line 13 (part-year residents only; enclose Schedule Z pdf format of Schedules Z/RF
).35 
36      INCOME TAX AFTER CREDITS. Subtract total of lines 33 through 35 from line 32. Not less than "0"36.00
37      Voluntary fund contributions :  
        a. Endangered Wild life Conservation37a _, _ _ _.00                     d. Massachusetts U.S. Olympic                     37d.00
        b. Organ Transplant37b _, _ _ _.00                     e. Mass. Military Family Relief37e.00
        c. Massachusetts AIDS37c _, _ _ _.00                      f. Homeless Animal Prevention And Care37f.00
         Total. Add lines 37a through 37f37 .00
38        Use tax due on Internet, mail order and other out-of-state purchases (from worksheet ).38.00
39       Health Care penalty for certain part-year residents. Not less than “0”(from worksheet; be sure to enclose Schedule HC  pdf format of Schedule HC
)  
        a. You _, _ _ _ .00          +b. Spouse _, _ _ _.00            – c Federal healthcare penalty  _, _ _ _.00   a + b – c = 34     39.00
40       INCOME TAX AFTER CREDITS, CONTRIBUTIONS, USE TAX and HC PENALTY. Add lines 36-39...40.00

41      Massachusetts income tax withheld (enclose all Massachusetts Forms W-2, W-2G, 2-G, PWH-WA, LOA and certain 1099s ,  
       if applicable)41 .00
42      2013 overpayment applied to your 2014 estimated tax (from 2013 Form 1-NR/PY, line 50; do not enter 2013 refund)  
       42 .00
43       2014 Massachusetts estimated tax payments (do not include amount in line 42)43 .00
44        Payments made with extension 44  .00
45      Earned Income Credit   ( Nonresidents multiply result by line 14g ; part-year residents multiply result by line 2 )  
        a. Number of qualifying children ___    Amount from U.S. return _, _ _ _.00 x .1545  .00
46      Senior Circuit Breaker Credit (part-year residents only; enclose Schedule CB  pdf format of Schedule CB
)46  .00
47       Other refundable credits from Schedule RF, line 4 (enclose Schedule RF pdf format of Schedules Z/RF
)47  .00
48       TOTAL. Add lines 41 through 4748  .00

49
 
      OVERPAYMENT. If line 40 is smaller than line 48, subtract line 40 from line 48. if line 40 is larger
      
than line 48, go to line 52. If line 40 and line 48 are equal, enter "0" in line 51
49   .00
50      Amount of overpayment you want APPLIED to your 2015 ESTIMATED TAX50.00
51      THIS IS YOUR REFUND. Subtract line 50 from line 49.  
       Mail to: Massachusetts DOR, PO Box 7000, Boston, MA 0220451.00
       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  
52      TAX DUE. Subtract line 48 from line 40. Pay online at www.gov/dor/payonline, or use  
        Form PV pdf format of Form PV 2014
52.00
       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  
                                                                                                                  <> Exception: Enclose Form M-2210  pdf format of Form M-2210