Form Ma Nrcr – Fill Out and Use This PDF

Forcalendaryear2012ortaxableperiodbeginning

2012andending

Name of pass-through entity

Federal Identification number

3

3

Address

City/Town

State

Zip

Name of filing agent

Name/address change since last year?

Is entity filing Schedule TDS?

Number of members included on return

Yes

No

Yes

No

Is this composite return being filed on behalf of one or more upper-tier entities?

This composite return is being filed by a:

Yes

No. If Yes, enter the total number of upper-tier entities represented:

Partnership

S corporation

Summary Information. The following lines represent summary amounts for all participants.

1

. . . . . . . . .Rent, royalty, REMIC, partnership, S corporation, trust income/loss (from Schedule E Reconciliation, line 58)

. . . 1

2

. . . . . . .Massachusetts state lottery winnings

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 2

3

. . . . .Other income (from Schedule X, line 5)

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 3

4

. . . . . . . . . . . . . . . . . . .Massachusetts bank interest (from Schedule B, line 5)

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 4

5a

. . . . . . . . . . . . . . . . . . .Add lines 1 through 4

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 5a

5b

. . . . . . . . . . . . . . . . . . . . . . . . .Enter amount from line 5a but not less than “0”

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 5b

6

. . . . . . . . . . . . . . . . . .Interest and dividend income (from Schedule B, line 38)

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 6

7

. . . . . . . . . . . . . . . . . . . . . . . . .Total 5.25% taxable income. Add lines 5b and 6

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 7

8

. . . . . . . . . . . . . . . . . . . . . . . . .Tax on 5.25% income. Multiply line 7 by tax rate

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 8

9

. . . .12% income (from Schedule B, line 39)

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 9

10

. .Tax on 12% income. Multiply line 9 by .12

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 10

11

. . . . . . . . . . . . . . . . .Tax on long-term capital gains (from Schedule D, line 22)

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 11

12

. . . . . . . . . . . . . . . . . . . . . . . . . .Credit recapture amount (from Schedule H-2)

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 12

13

. . . . . . . . .Additional tax on installment sales

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 13

14

. . . . . . . . . . . . . . . . . . . . . . . .Total income tax. Add lines 8 and 10 through 13

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 14

15

. . . . . . . . . . .Overpayment from prior year applied to this year’s estimated tax

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 15

16

. . . .Massachusetts estimated tax payments

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 16

17

. . . . . . . . . . .Payments made with extension

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 17

18

. . . .Total payments. Add lines 15 through 17

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 18

19

.Overpayment. If line 14 is smaller than line 18, subtract line 14 from line 18. If line 14 is larger than line 18, go to line 22

. . 19

20

. . . . . . . . . . . . . .Amount of overpayment applied to next year’s estimated tax

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 20

21

. . . . . .Refund. Subtract line 20 from line 19

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 21

22

. . . . . .Tax due. Subtract line 18 from line 14

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 22

23

. . . . . . . . .Interest

. . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 23

24

. . . . . . . . . . . . . . . .Late file/payment penalty

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 24

25

M-2210 penalty

.Exception

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 25

26

. .Total balance due. Add lines 22 through 25

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . 26

Paid preparer’s phone

Paid preparer’s EIN

Paid preparer’s signature

Date

Self-employed?

Yes

No