Worksheet A/worksheet B (Form 1040me) - Residency Information Worksheet For Part-Year Residents/nonresidents/"Safe Harbor" Residents/income Allocation Worksheet For Part-Year Residents/nonresidents/"Safe Harbor" Residents
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2Name(s) as shown on Form 1040ME
Your Social Security Number
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WORKSHEET A - Residency Information Worksheet
Attachment
12
Sequence No.
for Part-year Residents/Nonresidents/“Safe Harbor” Residents
Enclose with your Form 1040ME
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 fi ling a Maine return for the fi rst time, and 3) former Maine residents who are fi ling as nonresidents or
“Safe Harbor” residents for the fi rst time. Failure to enclose a completed Worksheet A with your 1040ME may delay processing of your return.
Yourself
Spouse
1. NAME ........................................................................................................................................... 1. ________________ ________________
a. Social security number ........................................................................................................... 1a. ________________ ________________
b. Date of birth ............................................................................................................................ 1b. ________________ ________________
c. Occupation.............................................................................................................................. 1c. ________________ ________________
During 2015: Unless otherwise indicated, enter “Yes” or “No” on each line.
2. I was domiciled in (Enter state(s)) ................................................................................................ 2. ________________ ________________
3. I was in the military and stationed in (Enter state or country) ...................................................... 3. ________________ ________________
a. My designated state of legal residence was (Enter state) ...................................................... 3a. ________________ ________________
4. The number of days I spent in Maine (for any purpose) was ....................................................... 4. ________________ ________________
5. I own(ed) a home/real property in Maine .................................................................................... 5. ________________ ________________
a. If yes, in what municipality was the property located? ............................................................ 5a. ________________ ________________
b. Did you ever apply for a Homestead or Veterans property tax exemption? ........................... 5b. ________________ ________________
c. Have you disposed of the property? ....................................................................................... 5c. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
6. I became a Maine resident on (Enter Date) ................................................................................. 6. ________________ ________________
a. Enter state of prior residence.................................................................................................. 6a. ________________ ________________
b. Registered to vote in Maine .................................................................................................... 6b. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
c. Purchased a home in Maine ................................................................................................... 6c. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
d. Obtained a driver’s license in Maine ....................................................................................... 6d. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
e. Registered an auto or other vehicle in Maine ......................................................................... 6e. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
7. I moved from Maine and became a nonresident (I established a legal residence in
another state) (Enter date of move) ............................................................................................. 7. ________________ ________________
a. Enter new state of residence .................................................................................................. 7a. ________________ ________________
b. Registered to vote in my new state of residence .................................................................... 7b. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
c. Purchased a home in my new state of residence ................................................................... 7c. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
d. Obtained a driver’s license in my new state of residence ....................................................... 7d. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
e. Registered an auto or other vehicle in my new state of residence ......................................... 7e. ________________ ________________
If yes, when? (Yourself:_____________________ Spouse: ____________________ )
f. If married, did your spouse and dependent children (if any) move to your new
state of residence? ................................................................................................................. 7f. ________________ ________________
8. During period of nonresidency, have you:
a. Performed any work or services in Maine............................................................................... 8a. ________________ ________________
If yes, list employer. (Yourself: ___________________ Spouse: _________________ )
b. Registered an auto or other vehicle in Maine ......................................................................... 8b. ________________ ________________
c. Renewed a Maine driver’s license .......................................................................................... 8c. ________________ ________________
d. Voted in Maine, in person or by absentee ballot ..................................................................... 8d. ________________ ________________
e. Attended or sent your children (if any) to a Maine school....................................................... 8e. ________________ ________________
f. Purchased a Maine resident hunting or fi shing license .......................................................... 8f. ________________ ________________
g. Listed Maine as your legal residence for any purpose ........................................................... 8g. ________________ ________________
h. Obtained or renewed any Maine trade or professional licenses or union memberships ........ 8h. ________________ ________________
9. 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)? _________________________________________________
_______________________________________________________________________________________________________________
10. If you answered “no” to question 7(f) please explain the circumstances (Attach a separate sheet if necessary): ________________________
_______________________________________________________________________________________________________________
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