Form 1040ME-Schd-1 Fillable income modifications / pension income deduction worksheet
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Pension benefi ts that do not qualify are those received from an $ 6 000 00 (5 Enter amount from federal Schedule A line 4) (and multiply by percentage on line 4 above) (Do not enter non Maine source income on line 2k) (If negative enter a minus sign in the box to the left of the number) 3 00 (Name(s) as shown on Form 1040ME) (Other (See instructions) List the type and amount of income items included (Attach) (Qualified Pension Plans including qualified 401 SIMPLE plans) (See instructions) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (undefined) (undefined) (undefined) (undefined) (undefined) (undefined) (undefined) (undefined) (undefined) (undefined) (undefined) 6000 *1202203*2012SCHEDULE 1 *Eligible pension income does not include benefits earned byanother person except in the case of a surviving spouse Onlythe individual that earned the benefit from prior employment mayclaim the pension income for the deduction However a widowedspouse receiving survivor s benefits under an eligible pension *Use this column only if filing married joint return and only if spouse separately earned an eligible pension 1 ADDITIONS to federal adjusted gross income 2 Enter amount from federal Schedule A line 1 $ 2 Maximum allowable deduction 2 SUBTRACTIONS from federal adjusted gross income 2012 WORKSHEET for Maine Schedule 1 line 2f 2012 Worksheet for Pension Income Deduction Schedule 1 Line 2d 3 Enter amount of long term care premiums included in line 2 above $ 3 Net Modification (Subtract line 2l from line 1i enter here and on 1040ME page 1 line 15) 3 Total social security and railroad retirement benefits you received whether taxable or not 3 4 Divide line 3 by line 2 4 Subtract line 3 from line 2 (if zero or less enter zero) 5 Enter the smaller of line 1 or line 4 here 6 Enter amount of long term care insurance premiums included on federal Form 1040 line 29 $ 6 Total eligible military pension income included in your federal adjusted gross income 6 7 Add line 5 and line 6 7 Subtract line 5 and line 6 from line 1 Enter result here and on Schedule 1 line 2f $ 8 Enter the smaller of line 2 or line 7 here and the total for both spouses on Schedule 1 line 2d 8 a Income from municipal and state bonds other than Maine 1a a U S Government Bond interest included in federal adjusted gross income (See instructions) 2a accounts) simplified employee pension plan benefits from an adjusted gross income (from federal Form 1040A line 12b or federal Form 1040 line 16b) (Do not and 403 (Employee annuities) Deductible pension income also Attachment Attachment b State Income Tax Refund (Only if included in federal adjusted gross income) 2b benefits received whether taxable or not Bonds included in federal adjusted gross income (See instructions) 2e Bonus Depreciation Add back (See instructions) 1e c Social Security and Railroad Retirement Benefits included in federal adjusted gross d Pension Income Deduction (Complete and attach the worksheet on back) 2d Deductible pension income includes state federal and military deductions 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 Domestic Production Activities Deduction Add back (See instructions) 1d during 2012 which have been previously taxed by the state 2g e Interest from Maine Municipal General Obligation Private Activity and Airport Authority employees under Internal Revenue Code (IRC) sections 401(a) Enclose this Worksheet and copies of your 1099 form(s) with your Form 1040ME Enclose with your Form 1040ME Enter amount from federal Schedule A line 4 $ and multiply by percentage on line 4 above $ Enter total amount of long term care insurance premiums paid during 2012: $ established and maintained by an employer for the benefit of its exceed $6 000 f Premiums for Long Term Care Insurance (Do not include health insurance premiums on this line) federal Form 1040 line 58) Also disability benefits reported as federal Form 4972 and distributions subject to the additional 10% federal tax on early distributions (see federal Form 5329 Part 1 or Fiduciary Adjustment additions only (Attach a copy of your federal Schedule K 1) 1g For individuals claiming a deduction for long term care insurance premiums Complete this worksheet only if you claim Maine itemized For more information visit www maine gov/revenue/forms For more information visit www maine gov/revenue/forms *1202203*2012SCHEDULE 1 FORM 1040ME g Maine Public Employees Retirement System Pick Up Contributions paid to the taxpayer government/tax exempt organizations/eligible deferred compensation gross income Except for military pension benefits the $6 000 cap h Contributions to Qualified Tuition Programs 529 Plans (See instructions) 2h i Fiduciary Adjustment subtractions only (Attach a copy of your federal Schedule K 1) 2i i Total additions (Add lines 1a through 1h) 1i if applicable may not be included in the deductible pension amount include social security or railroad retirement benefits received or pension benefits received from an includes benefits received under IRC section 457(b) (state and local income (See instructions) 2c INCOME MODIFICATIONS individual retirement account (including SIMPLE individual retirement individual retirement account simplified employee pension plan an ineligible deferred compensation ineligible deferred compensation plan under IRC section 457(f) j Bonus Depreciation and Section 179 Recapture (See instructions) 2j k Other List (See instructions) 2k l Total Subtractions (Add lines 2a through 2k) 2l Maine Capital Investment Credit Bonus Depreciation Add back 1f Maine Public Employees Retirement System Contributions 1c must be reduced by any social security and railroad retirement Name(s) as shown on Form 1040ME Name(s) as shown on Form 1040ME Your Social Security Number Net Operating Loss Recovery Adjustment (Attach a schedule showing your calculation) 1b NOTE: Enter eligible non military pension benefits on line 1 and eligible military pension benefits on line 6 NOTE: If you itemize deductions or are self employed complete and attach the worksheet on back 2f of eligible pension income* that is included in your federal adjusted Other (See instructions) List the type and amount of income items included (Attach over the life of the recipient and the recipient s designated benefi ciary pension benefits as well as retirement benefits received from plans plan may claim that amount for purposes of this deduction but plan under IRC 457(f) lump sum distributions included on federal Form 4972 distributions subject plans) except that pension income from 457(b) plans received prior refunds of excess contributions lump sum distributions included on SCHEDULE 1 INCOME MODIFICATIONS For Form 1040ME line 15 See instructions on pages 3 and 4 Sequence No 2 Sequence No 3 supporting documentation) 1h Taxpayer Spouse* the total pension deduction for the surviving spouse may not to age 55 that is not part of a series of equal periodic payments made to the additional 10% federal tax on early distributions or refunds of excess contributions) Total eligible non military pension income (both Maine and non Maine sources) included in your federal wages on your federal income tax return do not qualify You and your spouse (if married) may each deduct up to $6 000 Your Social Security Number