File by Mail Instructions for your 2020 Federal Tax Return

Important: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
Timothy Carter
2 Avalon Dr
Quincy, MA 02169-2463
|
Balance | Your federal tax return (Form 1040) shows you are due a refund of
Due/ | $1,200.00.
Refund |
|
______________________________________________________________________________________
|
What You | Your tax return - The official return for mailing is included in
Need to | this printout. Remember to sign and date the return.
Mail |
| Mail your return to:
| Department of the Treasury
| Internal Revenue Service
| Kansas City, MO 64999-0002
|
| Deadline: Postmarked by Thursday, April 15, 2021
|
| Note: Your state return may be due on a different date. Please
| review your state filing instructions.
|
| Don't forget correct postage on the envelope.
|
______________________________________________________________________________________
|
What You | Keep these instructions and a copy of your return for your records.
Need to | If you did not print one before closing TurboTax, go back to the
Keep | program and select File tab, then select the Print for Your Records
| category.
|
______________________________________________________________________________________
|
2020 | Adjusted Gross Income $ 0.00
Federal | Taxable Income $ 0.00
Tax | Total Tax $ 0.00
Return | Total Payments/Credits $ 1,200.00
Summary | Amount to be Refunded $ 1,200.00
| Effective Tax Rate 0.00%
|
______________________________________________________________________________________
|
Changed | You can still file electronically. Just go back to TurboTax, select
Your Mind | the File tab, then select the E-file category. We'll walk you
About | through the process. Once you file, we will let you know if your
e-filing? | return is accepted (or rejected) by the Internal Revenue Service.
|
______________________________________________________________________________________

Page 1 of 1
 1040 U.S. Individual Income Tax Return 2020 (99)
Form Department of the Treasury—Internal Revenue Service

OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying
one box.
person is a child but not your dependent a
Your first name and middle initial Last name Your social security number
Timothy Carter 367-84-6274
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
2 Avalon Dr Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
Quincy MA 021692463 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

At any time during 2020, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency? Yes No

Standard Someone can claim: You as a dependent Your spouse as a dependent

Deduction Spouse itemizes on a separate return or you were a dual-status alien

Age/Blindness You: Were born before January 2, 1956 Are blind Spouse: Was born before January 2, 1956 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4)  if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here a
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . 1
Attach 2a Tax-exempt interest . . . 2a 2b
b Taxable interest . . . . .
Sch. B if
3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
required.
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Standard 6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
Deduction for— a
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . 7
• Single or
Married filing 8 Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . 8
separately, a
$12,400 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . 9
• Married filing 10 Adjustments to income:
jointly or
Qualifying a From Schedule 1, line 22 . . . . . . . . . . . . . . 10a
widow(er),
$24,800
b Charitable contributions if you take the standard deduction. See instructions 10b
• Head of c Add lines 10a and 10b. These are your total adjustments to income . . . . . . . . a 10c
household, a
$18,650 11 Subtract line 10c from line 9. This is your adjusted gross income . . . . . . . . . 11
• If you checked 12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 12,400.
any box under
Standard 13 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . . . . . . 13
Deduction,
see instructions.
14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 12,400.
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . 15 0.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2020)
Form 1040 (2020) Page 2
16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 0.
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 0.
19 Child tax credit or credit for other dependents . . . . . . . . . . . . . . . . 19
20 Amount from Schedule 3, line 7 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 0.
23 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . 23 0.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . a 24 0.
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d
• If you have a 26 2020 estimated tax payments and amount applied from 2019 return . . . . . . . . . . 26
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . No. . 27
attach Sch. EIC.
• If you have 28 Additional child tax credit. Attach Schedule 8812 . . . . . . . 28
nontaxable 29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
combat pay,
see instructions. 30 Recovery rebate credit. See instructions . . . . . . . . . . 30 1,200.
31 Amount from Schedule 3, line 13 . . . . . . . . . . . . 31
32 Add lines 27 through 31. These are your total other payments and refundable credits . . . a 32 1,200.
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . a 33 1,200.
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 1,200.
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . a 35a 1,200.
Direct deposit? ab Routing number X X X X X X X X X a c Type: Checking Savings
See instructions. a
d Account number X X X X X X X X X X X X X X X X X
36 Amount of line 34 you want applied to your 2021 estimated tax . . a 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe now . . . . . . . . . . a 37
You Owe Note: Schedule H and Schedule SE filers, line 37 may not represent all of the taxes you owe for
For details on 2020. See Schedule 3, line 12e, and its instructions for details.
how to pay, see
instructions. 38 Estimated tax penalty (see instructions) . . . . . . . . . a 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . a Yes. Complete below. No
Designee’s Phone Personal identification
name a no. a number (PIN) a
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
F

Joint return? Courier (see inst.) a

See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.) a
Phone no. Email address
Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer Firm’s name a Self-Prepared Phone no.
Use Only Firm’s address a Firm’s EIN a

Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 01/03/21 Intuit.cg.cfp.sp Form 1040 (2020)
File by Mail Instructions for your 2020 Massachusetts Amended Tax Return
Important: Your taxes are not finished until all required steps are completed.

Timothy Carter
2 Avalon Dr
Quincy, MA 02169-2463
|
Balance | Your Massachusetts state amended tax return shows you owe a balance
Due/ | due of $6,230.00.
Refund |
| You are paying by check.
|
______________________________________________________________________________________
|
What You | Your amended tax return - Form 1. Remember to sign and date the
Need to | return.
Mail |
| Your payment - Mail a check or money order for $6,230.00, payable
| to "Commonwealth of Massachusetts". Write your Social Security number
| and "2020 Form 1" on the check. Mail the return and check together.
|
| Be sure to attach the state copy of Form(s) W-2, W-2G, and any Form
| 1099 to your return.
|
| Mail your return, attachments and payment to:
| Massachusetts Department of Revenue
| P.O. Box 7003
| Boston, MA 02204-7003
|
| Don't forget correct postage on the envelope.
|
______________________________________________________________________________________
|
What You | Keep these instructions and a copy of your return for your records.
Need to | If you did not print one before closing TurboTax, go back to the
Keep | program and select File tab, then select the Print for Your Records
| category.
|
______________________________________________________________________________________
|
2020 | Payment Due $ 6,230.00
Massachusetts |
Tax |
Return |
Summary |
|
______________________________________________________________________________________
|
Special | Your printed state tax forms may have special formatting on them,
Formatting | such as bar codes or other symbols. This is to enable fast
| processing. Don't worry, these forms have been approved by your
| taxing authority and are acceptable for printing and mailing.
|
______________________________________________________________________________________

Page 1 of 1
 DO NOT FILE

IF YOU ARE MAILING THE FORM PV WITH THE PAYMENT BY ITSELF, MAIL IT WITH THE PAYMENT TO:
MASSACHUSETTS DEPARTMENT OF REVENUE

FORM NOT FINAL

PO BOX 7062
BOSTON, MA 02204

 DETACH HERE 
REV 11/23/20 INTUIT.CG.CFP.SP
9 Form PV
2020
Massachusetts Income Tax Payment Voucher
Payment for period end date (mm/dd/yyyy) Tax type Voucher type ID type Vendor code
12/31/2020 053 14 005 1555
Name of taxpayer Social Security number Amount enclosed
TIMOTHY CARTER 367846274 $ 6,230.00
Name of taxpayer’s spouse Social Security number of taxpayer’s spouse

Street address City/Town State Zip

2 AVALON DR QUINCY MA 02169-2463
Phone E-mail Fill in if name/address changed since 2019
609-619-5097 [email protected]
Pay online at mass.gov/masstaxconnect. Or, return this voucher with check or money order payable to: Commonwealth of Massachusetts.
Mail to: Massachusetts Department of Revenue, PO Box 7062, Boston, MA 02204.

DO NOT FILE
00100367846274 123120 0000000000 053 140051555 00006230007
 2019 Form 1
MA20001011555
DO NOT FILE
Massachusetts Resident Income Tax Return
FOR FULL YEAR RESIDENTS ONLY
For the year January 1–December 31, 2019 or other taxable

Year beginning Ending

TIMOTHY CARTER 367846274

2 AVALON DR QUINCY MA 021692463

Fill in if: Original return X Amended return Amended return due to federal change Apt. no.
State Election Campaign Fund: $1 You $1 Spouse TOTAL 0
Fill in if veteran of U.S. armed forces who served in Operations Enduring Freedom, Iraqi Freedom, Noble Eagle
or Sinai Peninsula You Spouse
Taxpayer deceased You Spouse
Fill in if under age 18 You Spouse
a. Total federal income 0 Name/address changed since 2018
b. Federal adjusted gross income 0 X Fill in if noncustodial parent
1. Filing status (select one only): X Single Fill in if filing Schedule TDS
Married filing jointly

FORM NOT FINAL

Married filing separate return
Head of household You are a custodial parent who has released claim to exemption for child(ren)
2. Exemptions
a. Personal exemptions 2a 4400 C
b. Number of dependents. (Do not include yourself or your spouse.) Enter number × $1,000 = 2b 0
c. Age 65 or over before 2020 You + Spouse = × $700 = 2c 0
d. Blindness You + Spouse = × $2,200 = 2d 0
e. Medical/dental 2e 0
f. Adoption 2f 0
g. Total exemptions. Add lines 2a through 2f. Enter here and on line 18 2g 4400
SIGN HERE. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.
Your signature Date Spouse’s signature Date

[email protected] 609-619-5097
PRIVACY ACT NOTICE AVAILABLE UPON REQUEST

DO NOT FILE
01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
 2019 Form 1, pg. 2
MA20001021555
DO NOT FILE
Massachusetts Resident Income Tax Return
367846274

3. Wages, salaries, tips 3 0

4. Taxable pensions and annuities 4 0
5. Mass. bank interest: a. 0 – b. exemption 0 = 5 0
6a. Business/profession income/loss 6a 0
6b. Farming income/loss 6b 0
7. Rental, royalty and REMIC, partnership, S corp., trust income/loss 7 0
8a. Unemployment 8a 0
8b. Mass. lottery winnings 8b 0
9. Other income from Schedule X, line 5 9 0
10. TOTAL 5.05% INCOME 10 0
11a. Amount paid to Soc. Sec. Medicare, R.R., U.S. or Mass. Retirement 11a 0
11b. Amount your spouse paid to Soc. Sec., Medicare, R.R., U.S. or Mass. Retirement 11b 0
12. Child under age 13, or disabled dependent/spouse care expenses 12 0
13. Number of dependent member(s) of household under age 12, or dependents age 65 or over (not you or your spouse) as of
12/31/19, or disabled dependent(s)

FORM NOT FINAL

Not more than two. a. × $3,600 = 13 0
14. Rental deduction. a. 2572 ÷ 2 = 14 1286
15. Other deductions from Schedule Y, line 19 15 0
16. Total deductions. Add lines 11 through 15 16 1286
C
17. 5.05% INCOME AFTER DEDUCTIONS. Subtract line 16 from line 10. Not less than “0” 17 0
18. Exemption amount 18 4400
19. 5.05% INCOME AFTER EXEMPTIONS. Subtract line 18 from line 17. Not less than “0” 19 0
20. INTEREST AND DIVIDEND INCOME 20 0
21. TOTAL TAXABLE 5.05% INCOME. Add lines 19 and 20 21 0

BE SURE TO INCLUDE THIS PAGE WITH FORM 1, PAGE 1

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01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
 2019 Form 1, pg. 3
MA20001031555
DO NOT FILE
Massachusetts Resident Income Tax Return
367846274

22. TAX ON 5.05% INCOME. Note: If choosing the optional 5.85% tax rate, fill in and multiply line 21 and the
amount in Schedule D, line 21 by .0585 22 0
23. 12% INCOME. Not less than “0.” a. 0 × .12 = 23 0
24. TAX ON LONG-TERM CAPITAL GAINS. Not less than “0.” Fill in if filing Schedule D-IS 24 20
Fill in if any excess exemptions were used in calculating lines 20, 23 or 24
25. Credit recapture amount (from Credit Recapture Schedule) 25 0
26. Additional tax on installment sale 26 0
27. If you qualify for No Tax Status, fill in and enter “0” on line 28 X
28. TOTAL INCOME TAX. Add lines 22 through 26 28 0
29. Limited Income Credit 29 0
30. Income tax due to another state or jurisdiction 30 0
31. Other credits from Credit Manager Schedule 31 0
32. INCOME TAX AFTER CREDITS. Subtract the total of lines 29 through 31 from line 28. Not less than “0” 32 0
33. Voluntary Contributions

FORM NOT FINAL

a. Endangered Wildlife Conservation 33a 10
b. Organ Transplant Fund 33b 0
c. Massachusetts Public Health HIV and Hepatitis Fund 33c 10
d. Massachusetts U.S. Olympic Fund 33d 0
C
e. Massachusetts Military Family Relief Fund 33e 10
f. Homeless Animal Prevention and Care 33f 0
Total. Add lines 33a through 33f 33 30
34. Use tax due on Internet, mail order and other out-of-state purchases 34 0
35. Health care penalty a. You 0 + b. Spouse 0 35 0
36. Amended return only. Overpayment from original return 36 6200
37. INCOME TAX AFTER CREDITS PLUS CONTRIBUTIONS AND USE TAX. Add lines 32 through 36 37 6230

DO NOT FILE
01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
 2019 Form 1, pg. 4
MA20001041555
DO NOT FILE
Massachusetts Resident Income Tax Return
367846274

38. Massachusetts income tax withheld 38 0

39. 2018 overpayment applied to your 2019 estimated tax 39 0
40. 2019 Massachusetts estimated tax payments 40 0
41. Payments made with extension 41 0
42. Amended return only. Payments made with original return. Not less than “0” 42 0
43. Earned Income Credit. a. Number of qualifying children b. Amount from U.S. return 0 .30 = 43 0
Note: You cannot claim the Earned Income Credit if your filing status is married filing separately unless you qualify
for an exception (see instructions). Fill in if you qualify for this exception
44. Senior Circuit Breaker Credit 44 0
45. Other Refundable Credits 45 0
46. Excess Paid Family Leave Withholding 46 0
47. TOTAL. Add lines 38 through 46 47 0
48. Overpayment. Subtract line 37 from line 47 48 0
49. Amount of overpayment you want applied to your 2020 estimated tax 49 0

FORM NOT FINAL

50. Refund. Subtract line 49 from line 48. Mail to Massachusetts DOR, PO Box 7000, Boston, MA 02204 50 0

Direct deposit of refund. Type of account checking

savings C
RTN # account #

51. Tax due. Pay online at www.mass.gov/dor/payonline. Mail to: Mass. DOR, PO Box 7003, Boston, MA 02204 51 6230
Interest 0 Penalty 0 M-2210 amt. 0 EX enclose
Form M-2210

Fill in if the Department of Revenue may discuss this return with the preparer shown here
I do not want preparer to file my return electronically (this may delay your refund) Paid preparer’s
Print paid preparer’s name Date Check if self-employed SSN/PTIN

Paid preparer’s signature Paid preparer’s phone Paid preparer’s EIN

SELF PREPARED
BE SURE TO INCLUDE THIS PAGE WITH FORM 1, PAGE 1

DO NOT FILE
01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
2020 Schedule CMS
MA20647011555
DO NOT FILE
TIMOTHY CARTER 367846274 0 0

Section 1. Non-refundable credits

1a. 1b. NON- 1c. 1d. 1e. 1f. 1g.

CREDIT TYPE EXPIRING PERIOD END DATE CERTIFICATE NUMBER CREDIT AVAILABLE CREDIT TAKEN THIS YEAR CREDIT SHARED THIS YEAR

SLRWND 12312020 195 0 0

SEPTIC 12312020 0 0 0

FORM NOT FINAL

1h. Total. Enter total amount of credit(s) taken this year here and where indicated above 0
C

DO NOT FILE
01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
MA20647021555
367846274 DO NOT FILE
2020 Schedule CMS, pg. 2

Section 2. Refundable credits

2a. 2b. 2c. 2d. CREDIT AVAILABLE 2e. REDUCTION IN 2f. REFUNDABLE

CREDIT TYPE PERIOD END DATE CERTIFICATE NUMBER OR CERTIFICATE BALANCE BALANCE FOR REFUND CREDIT TAKEN

FORM NOT FINAL C

2g. Total. Enter total amount of credit(s) taken this year here and where indicated on page 1 0

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01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
 2020 Schedule CMS, pg. 3
MA20647031555
367846274 DO NOT FILE
Section 3. Non-refundable credits received from Massachusetts K-1 schedules
3a. FEDERAL ID NUMBER 3b. 3c. NON- 3d. 3e. 3f. 3g. 3h.

OF CREDIT SOURCE CREDIT TYPE EXPIRING PERIOD END DATE CERTIFICATE NUMBER CREDIT RECEIVED CREDIT TAKEN THIS YEAR CREDIT SHARED THIS YEAR

FORM NOT FINAL C

3i. Total. Enter total amount of credit(s) taken this year here and where indicated on page 1 0

DO NOT FILE
01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
 MA20647041555
367846274 DO NOT FILE
2020 Schedule CMS, pg. 4

Section 4. Refundable credits received from Massachusetts K-1 schedules

4a. FEDERAL ID NUMBER 4b. 4c. 4d. 4e. CREDIT AVAILABLE 4f. REDUCTION IN 4g.

OF CREDIT SOURCE CREDIT TYPE PERIOD END DATE CERTIFICATE NUMBER OR CERTIFICATE BALANCE BALANCE FOR REFUND REFUNDABLE CREDIT TAKEN

FORM NOT FINAL C

4h. Total. Enter total amount of credit(s) taken this year here and where indicated on page 1 0

DO NOT FILE
01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
 2019 Schedule D
MA20012011555
DO NOT FILE
Long-Term Capital Gains and Losses
Excluding Collectibles

Part 1. Long-Term Capital Gains and Losses, Excluding Collectibles

1. Enter amounts from U.S. Schedule D, lines 8a and 8b, col. h 1 0
2. Enter amounts from U.S. Schedule D, line 9, col. h 2 0
3. Enter amounts from U.S. Schedule D, line 10, col. h 3 0
4. Enter amounts from U.S. Schedule D, line 11, col. h 4 0
5. Enter amounts from U.S. Schedule D, line 12, col. h 5 0
6. Enter amounts from U.S. Schedule D, line 13, col. h 6 0
7. Massachusetts long-term capital gains and losses included in U.S. Form 4797, Part II 7 0
8. Carryover losses from prior years 8 0
9. Combine lines 1 through 8 9 0
10a. Massachusetts adjustments 10a -400
10b. Part-year/Nonresidents only 10b 0
10c. Combine lines 10a and 10b 10c -400

FORM NOT FINAL

11. Massachusetts capital gains and losses 11 400
12. Long-term gains on collectibles and pre-1996 installment sales 12 0
13. Subtotal 13 400
14. Capital losses applied against capital gains 14 0
C
15. Subtotal 15 400
16. Long-term capital losses applied against interest and dividends 16 0
17. Subtotal 17 400
18. Allowable deductions from your trade or business 18 0
19. Subtotal 19 400
20. Excess exemptions 20 0
21. Taxable long-term capital gains 21 400
22. Tax on long-term capital gains 22 20
23. Massachusetts available losses for carryover 23 0

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01/11/2021 06:27 PM REV 11/23/20 INTUIT.CG.CFP.SP
 2019 Schedule EC
MA20SWC011555
Solar and Wind Energy Credit

TIMOTHY CARTER 367846274

2 AVALON DR QUINCY MA 021692463
Costs of renewable solar and/or wind energy source property
Note: This credit can only be taken once for the principal residence indicated above. Do not include repair or maintenance costs.
1. Cost of renewable solar and/or wind energy property installed in your principal Massachusetts residence in  1 1300
2. Enter any U.S. HUD grant or rebate for such expenditures 2 0
3. Net 2019 expenditures. Subtract line 2 from line 1 3 1300
4. Enter 15% of line 3 4 195
5a. Maximum allowable credit for principal residence 5a 1000
5b. Total prior years credit taken by taxpayer for this principal residence 5b 0
5c. Subtract line 5b from line 5a. Not less than “0” 5c 1000
6. 2019 Massachusetts Energy Credit. Enter line 4 or line 5c, whichever is less 6 195
7a. Enter 2016 unused Massachusetts Energy Credit (from 2018 Schedule EC, line 11, col. c) 7a 0
7b. Enter 2017 unused Massachusetts Energy Credit (from 2018 Schedule EC, line 11, col. c) 7b 0
7c. Enter 2018 unused Massachusetts Energy Credit (from 2018 Schedule EC, line 11, col. c) 7c 0
8. Massachusetts Energy Credit available this year. Add lines 6, 7a, 7b and 7c 8 195
Computation of Energy Credit allowable on return
9. Tax from return (see instructions) 9 0
10. Massachusetts Energy Credit allowable this year. Not more than $1,000. You must enclose Sch. EC with your return 10 0
Unused Massachusetts Energy Credit Carryover
11. a. Unused credits from prior years b. Portion used
Year and current year credit this year c. Unused credit available

2017 (2018 Sch. EC, line 12, col. c) 0 0 0 2020

2018 (2018 Sch. EC, line 12, col. c) 0 0 0 2020–2021
2019 (2019 Sch. EC, line 6) 195 0 195 2020–2022
12. Totals 195 0 195

REV 11/23/20 INTUIT.CG.CFP.SP

 2019 Schedule HC
MA20029011555
DO NOT FILE
Schedule HC, Health Care Information, must be completed by all
full-year residents and certain part-year residents (see instructions).
Note: Schedule HC must be enclosed with your Form 1 or Form
1-NR/PY. Failure to do so will delay the processing of your return.
TIMOTHY CARTER 367846274

1a. Date of birth 07181972 1b. Spouse’s date of birth 1c. Family size 1
2. Federal adjusted gross income 2 0
3. Indicate the time period that you were enrolled in a Minimum Creditable Coverage (MCC) health insurance plan(s). The Form MA 1099-HC from your insurer
will indicate whether your insurance met MCC requirements. Note: MassHealth, Medicare, and health coverage for U.S. Military, including Veterans
Administration and Tri-Care, meet the MCC requirements. If you did not receive a Form MA 1099-HC from your insurer, or you had insurance that did
not meet MCC requirements, see the special section on MCC requirements in the instructions.

See instructions if, during 2019, you turned 18, you 3a You: X Full-year MCC Part-year MCC No MCC/None
were a part-year resident or a taxpayer was deceased. 3b Spouse: Full-year MCC Part-year MCC No MCC/None
If you filled in the full-year or part-year MCC oval, go to line 4. If you filled in No MCC/None, go to line 6.

FORM NOT FINAL

4. Indicate the health insurance plan(s) that met the Minimum Creditable Coverage (MCC) requirements in which you were enrolled in 2019, as
shown on Form MA 1099-HC (check all that apply). If you did not receive this form, fill in line(s) 4f and/or 4g and see instructions. Fill in if you were
enrolled in private insurance and MassHealth or Commonwealth Care and enter your private insurance information in line(s) 4f and/or 4g and go
to line 5.
4a. Private insurance, including ConnectorCare (completes line(s) 4f and/or 4g below) You Spouse
C

4b. MassHealth. Fill in and go to line 5 X You Spouse

4c. Medicare (including a replacement or supplemental plan). Fill in and go to line 5 You Spouse
4d. U.S. Military (including Veterans Administration and Tri-Care). Fill in and go to line 5 You Spouse
4e. Other program (enter the program name(s) only in lines 4f and/or 4g below). Note: Health Safety Net You Spouse
is not considered insurance or minimum creditable coverage.

4f. Your Health Insurance. Complete if you answered line(s) 4a or 4e and go to line 5. Fill in if you were not issued Form MA 1099-HC.

4g. Spouse’s Health Insurance. Complete if you answered line(s) 4a or 4e and go to line 5. Fill in if you were not issued Form MA 1099-HC.

5. If you had health insurance that met MCC requirements for the full-year, including private insurance, MassHealth, Commonwealth Care or ConnectorCare,
you are not subject to a penalty. Skip the remainder of this schedule and continue completing your tax return. Otherwise, go to line 6.

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If you had Medicare (including a replacement or supplemental plan), U.S. Military (including Veterans Administration and Tri-Care), or other government
insurance at any point during 2019, you are not subject to a penalty. Skip the remainder of this schedule and continue completing your tax return. Other-
wise, go to line 6.

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 367846274
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2019 Schedule HC, pg. 2
MA20029021555

Uninsured for All or Part of 2019

6. Was your income in 2019 at or below 150% of the federal poverty level? 6 Yes No
If you answer Yes, you are not subject to a penalty in 2019. Skip the remainder of this schedule and complete your tax return. If you answer No and you were enrolled
in a health insurance plan that met the MCC requirements for part, but not all, of 2019, go to line 7. If you answer No and you had no insurance or you were enrolled in
a plan that did not meet the MCC requirements during the period that the mandate applied, go to line 8a.
7. Complete this section only if you, and/or your spouse if married filing jointly, were enrolled in a health insurance plan(s) that met the Minimum Creditable
Coverage (MCC) requirements for part, but not all of 2019. Fill in below the months that met the MCC requirements, as shown on Form MA 1099-HC. If you
did not receive this form, fill in the months you were covered by a plan that met the MCC requirements at least 15 days or more. If, during 2019, you turned
18, you were a part-year resident or a taxpayer was deceased, fill in the oval(s) below for the month(s) that met the MCC requirements during the period
that the mandate applied. See instructions.
You may only fill in the month(s) you had health insurance that met MCC requirements. If you had health insurance, but it did not meet MCC requirements,
you must skip this section and go to line 8a.

Months Covered By Health Insurance

You Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec.

FORM NOT FINAL

Spouse Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec.
If you had four or more consecutive months either with no insurance or insurance that did not meet the MCC requirements (four or more blank months in a row),
go to line 8a. Otherwise, a penalty does not apply to you in 2019. Skip the remainder of this schedule and complete your tax return.
C
Religious Exemption and Certificate of Exemption
8a. Religious exemption: Are you claiming an exemption from the requirement to purchase health insurance based 8a You Yes No
on your sincerely held religious beliefs that cause you to object to substantially all forms of treatment covered by
health insurance? Spouse Yes No
If you answer Yes, go to line 8b. If you answer No, go to line 9.
8b. If you are claiming a religious exemption in line 8a, did you receive medical health care during the 2019 tax year? 8b You Yes No
Spouse Yes No
If you answer No to line 8b, skip the remainder of this schedule and continue completing your tax return. If you answer Yes to line 8b, go to line 9.
9. Certificate of exemption: Have you obtained a Certificate of Exemption issued by the Massachusetts Health 9 You Yes No
Connector for the 2019 tax year? Spouse Yes No
If you answer Yes, enter the certificate number, skip the remainder of this schedule and continue completing your tax
return. If you answer No to line 9, go to line 10.

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2019 Schedule HC, pg. 3
MA20029031555

TIMOTHY CARTER 367846274

Affordability as Determined By State Guidelines
Note: This section will require the use of worksheets and tables found in the instructions. You must complete the worksheet(s) to determine if health insurance was
affordable to you during the 2019 tax year.
10. Did your employer offer affordable health insurance that met minimum creditable coverage requirements 10 You Yes No
as determined by completing the Schedule HC Worksheet for Line 10 in the instructions? Spouse Yes No
Fill in No if your employer did not offer health insurance that met minimum creditable coverage requirements, you were not eligible for health insurance offered by
your employer, you were self-employed or you were unemployed.
11. Were you eligible for government-subsidized health insurance as determined by completing the Schedule HC 11 You Yes No
Worksheet for Line 11 in the instructions? Spouse Yes No
If you answer No, go to line 12. If you answer Yes, go to the Health Care Penalty Worksheet in the instructions to calculate your penalty amount.
12. Were you able to purchase affordable private health insurance that met minimum creditable coverage requirements 12 You Yes No
as determined by completing the Schedule HC Worksheet for Line 12 in the instructions? Spouse Yes No
If you answer No, you are not subject to a penalty. Continue completing your tax return. If you answer Yes, go to the Health Care Penalty Worksheet in the

FORM NOT FINAL

instructions to calculate your penalty amount.

Complete Only If You Are Filing An Appeal

You must complete the Health Care Penalty Worksheet to determine your penalty amount before completing this section. C
You may have grounds to appeal if you were unable to obtain affordable insurance that meets the minimum creditable coverage requirements in 2019 due to a
hardship or other circumstances. The grounds for appeal are explained in more detail in the instructions. If you believe you have grounds for appealing the penalty,
fill in the field(s) below. The appeal will be heard by the Massachusetts Health Connector. By filling in the field below, you (or your spouse if married filing jointly) are
authorizing DOR to share information from your tax return, including this schedule, with the Massachusetts Health Connector for purposes of deciding your appeal.
You will receive a follow-up letter asking you to state your grounds for appeal in writing, and submit supporting documentation. Failure to respond to that
letter within the time specified in the letter will lead to dismissal of your appeal and will result in a future assessment of a penalty. Once your documentation
is received, it will be reviewed by the Massachusetts Health Connector and you may be required to attend a hearing on your case. You will be required to file your
claims under the pains and penalties of perjury.
Note: If you are filing an appeal, make sure you have calculated the penalty amount that you are appealing, but do not assess yourself or enter a penalty amount
on your Form 1 or Form 1-NR/PY. Also, do not include any hardship documentation with your original return. You will be required to submit substantiating hardship
documentation at a later date during the appeal process.

You I wish to appeal the penalty. I authorize DOR to share this tax return including this schedule with the Massachusetts Health Connector
for purposes of deciding this appeal.

Spouse I wish to appeal the penalty. I authorize DOR to share this tax return including this schedule with the Massachusetts Health Connector
for purposes of deciding this appeal.

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