Massachusetts Department of Revenue 2022 Form 1 Massachusetts Resident Income Tax Return 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

/ / / / TAXPAYER’S E-MAIL ADDRESS TAXPAYER’S PHONE TAXPAYER’S FIRST NAME M.I. LAST NAME TAXPAYER’S SOCIAL SECURITY NUMBER

SPOUSE’S FIRST NAME M.I. LAST NAME SPOUSE’S SOCIAL SECURITY NUMBER

MAILING ADDRESS (no. & street; apt./suite/postal box). If you have a foreign address, also complete line below. CITY/TOWN

STATE ZIP FOREIGN PROVINCE/STATE/COUNTY

FOREIGN COUNTRY (OR COUNTRY CODE) FOREIGN POSTAL CODE Fill in if (see instructions):

Amended return Other jurisdiction change (enter date of change) M M D D Y Y Y Y

Federal amendment Amended return due to IRS BBA Partnership Audit State Election Campaign Fund (this contribution will not change your tax or reduce your refund) $1 Taxpayer $1 Spouse. . . . . . . . . . . . . . Total $ Fill in if veteran of U.S. armed services who served in Operation Enduring Freedom, Iraqi Freedom, Noble Eagle or Sinai Peninsula. . . . . . Taxpayer Spouse Fill in appropriate oval(s) if taxpayer(s) is deceased. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taxpayer Spouse Fill in if under age 18. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taxpayer Spouse Fill in if name has changed since 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taxpayer Spouse Fill in if noncustodial parent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fill in if filing the following schedule(s). See instructions: Schedule TDS Schedule FCI Fill in if at any time during 2022 you received (as a reward, award, or payment for property or services) or sold, exchanged, gifted, or otherwise disposed of a digital asset (or a financial interest in a digital asset). See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 IF A LOSS, MARK AN X IN BOX  IF A LOSS, MARK AN X IN BOX a Total federal income b Total federal adjusted gross income

(from U.S. Form 1040, line 9) 0 0 (from U.S. Form 1040, line 11) 0 0 1 FILING STATUS. Fill in one only.

Single Head of household (see instructions)

Married filing joint return (both must sign return) You are a custodial parent who has released claim to exemption for child(ren)

Married filing separate return (must enter spouse’s name and Social Security number in the appropriate areas above) 2 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a 0 0

b. Number of dependents (do not include yourself or your spouse). Enclose Schedule DI. . . . . . Total × $1,000 = 2b 0 0

c. Age 65 or over before 2023 You Spouse. . . . . . . . . . . . . . . . . . . . . . . . . Total

× $1,700 = 2c 0 0

d. Blindness You Spouse. . . . . . . . . . . . . . . . . . . . . . . . . Total × $2,200 = 2d 0 0

e. Medical/dental (from U.S. Schedule A, line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e 0 0

f. Adoption. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f 0 0

g. TOTAL EXEMPTIONS. Add lines 2a through 2f. Enter here and on line 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g 0 0 Be sure to enclose any forms or schedules (W-2, W-2G, 1099, 3K-1, SK-1, PWH or LOA) that show Massachusetts withholding. Fill out in black ink. For a faster refund, file your return elec­tronically at mass.gov/dor. You must also complete and enclose Schedule HC.

TAXPAYER’S FIRST NAME M.I. LAST NAME TAXPAYER’S SOCIAL SECURITY NUMBER

INCOME 3 Wages, salaries, tips and other employee compensation (from all Forms W-2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 0 0 4 Taxable pensions and annuities. Attach any Form(s) 1099-R with Massachusetts withholding. See instructions. . . . . . . . .4 0 0

Massachusetts bank interest Exemption amount. If married filing jointly, enter $200; otherwise enter $100. 5 a. 0 0 b. 0 0 . . . . . . . . . . . . . . . . a – b (not less than 0) = 5 0 0 6 a. Business/profession income or loss. Enclose Schedule C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a 0 0

b. Farming income or loss. Enclose U.S. Schedule F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b 0 0 7 If you are reporting rental, royalty, REMIC, partnership, S corporation, or trust income or loss, see instructions . . . . 7 0 0 8 a. Unemployment compensation. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a 0 0

b. Massachusetts state lottery winnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b 0 0 9 Other income from Schedule X, line 7. Enclose Schedule X; not less than 0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 0 0 10 TOTAL 5.0% INCOME. Add lines 3 through 9. Be sure to subtract any losses in lines 6 or 7. . . . . . . . . . . . . . . . 10 0 0 DEDUCTIONS 11 a. Amount you paid to Social Security, Medicare, Railroad, U.S. or Massachusetts retirement. Not more than $2,000 . . . . . . . . . . . . 11a 0 0

b. Amount spouse paid to Social Security, Medicare, Railroad, U.S. or Massachusetts retirement. Not more than $2,000. . . . . . . . . 11b 0 0 12 Reserved for future use. See line 45 for new Child under age 13, or disabled dependent/spouse credit. . . . . . . . . . . . . . . . . . . . 12 13 Reserved for future use. See line 46 for new Dependent member(s) of household under age 12, or dependent(s). . . . . . . . . . . . . . . . 13 0 0 0 0 0 0 age 65 or over (not you or your spouse) as of December 31, 2022 credit 14 Rental deduction. (See instructions)

a. Enter the total qualified rent paid in 2022 in the box then divide by 2. . . . . . . . . . . . . . . . . . . 0 0 ÷ 2 = 14 0 0 15 Other deductions from Schedule Y, line 19. Enclose Schedule Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 0 0 16 TOTAL DEDUCTIONS. Add lines 11 through 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 0 0 17 5.0% INCOME AFTER DEDUCTIONS. Subtract line 16 from line 10. Not less than 0. . . . . . . . . . . . . . . . . . . . . . . 17 0 0 18 Total exemption amount (from line 2g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 0 0 19 5.0% INCOME AFTER EXEMPTIONS. Subtract line 18 from line 17. Not less than 0. If line 17 is less than line 18, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 0 0 20 INTEREST AND DIVIDEND INCOME (from Schedule B, line 38). Not less than 0. Enclose Schedule B. . . . . . . . 20 0 0 21 TOTAL TAXABLE 5.0% INCOME. Add lines 19 and 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 0 0 22 TAX ON 5.0% INCOME (from tax table). If line 21 is more than $24,000, multiply by .05. Note: If choosing the optional 5.85% tax rate, fill in oval and see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . 22 0 0 2022 FORM 1, PAGE 2

TAXPAYER’S FIRST NAME M.I. LAST NAME TAXPAYER’S SOCIAL SECURITY NUMBER 23 12% INCOME (from Schedule B, line 39). Not less than 0. Enclose Schedule B. a.

0 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . × .12 = 23 0 0 24 TAX ON LONG-TERM CAPITAL GAINS (from Schedule D, line 22). Not less than 0. Enclose Schedule D. If filing Schedule D-IS, Installment Sales, fill in oval and enclose Schedule D-IS . . . . . . . . . . . . . . . . . . . . . . . 24 0 0 If excess exemptions were used in calculating lines 20, 23 or 24, fill in oval and see instructions 25 Credit recapture amount. Enclose Schedule CRS. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 0 0 26 Additional tax on installment sales. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 0 0 27 If you qualify for No Tax Status, fill in oval and enter 0 in line 28 (from worksheet) 28 TOTAL INCOME TAX. Add lines 22 through 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 0 0 CREDITS 29 Limited Income Credit (from worksheet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 0 0 30 Income tax due to another state or jurisdiction (from worksheet). Not less than 0. Enclose Schedule OJC. . . . . . . . . 30 0 0 31 Other credits (from Schedule CMS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 0 0 32 INCOME TAX AFTER CREDITS. Subtract total of lines 29 through 31 from line 28. Not less than 0 . . . . . . . . . . . . 32 0 0 33 Voluntary fund contributions a. Endangered Wildlife Conservation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33a 0 0 b. Organ Transplant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33b 0 0 c. Massachusetts Public Health HIV and Hepatitis Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33c 0 0 d. Massachusetts U.S. Olympic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33d 0 0 e. Massachusetts Military Family Relief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33e 0 0 f. Homeless Animal Prevention And Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33f 0 0

Total. Add lines 33a through 33f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 0 0 34 Use tax due on Internet, mail order and other out-of-state purchases (from worksheet). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 0 0 35 Health Care penalty. Not less than 0 (from worksheet). Enclose Schedule HC. a. You

0 0 b. Spouse

0 0 Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a + b = 35 0 0 36 AMENDED RETURN ONLY. Overpayment from original return. Not less than 0. See instructions. . . . . . . . . . . . . . . 36 0 0 37 INCOME TAX AFTER CREDITS, CONTRIBUTIONS, USE TAX and HC PENALTY. Add lines 32 through 36. . . . . 37 0 0 MASSACHUSETTS WITHHOLDING, PAYMENTS AND REFUNDABLE CREDITS 38 a. Massachusetts income tax withheld from Form(s) W-2. . . . . . . . . . . . . . . . . . . 38a 0 0 b. Massachusetts income tax withheld from Form(s) 1099. . . . . . . . . . . . . . . . . . 38b 0 0 c. Massachusetts income tax withheld from other forms. See instructions. . . . . . . 38c 0 0 Total. Add lines 38a through 38c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 0 0 2022 FORM 1, PAGE 3

TAXPAYER’S FIRST NAME M.I. LAST NAME TAXPAYER’S SOCIAL SECURITY NUMBER

39 2021 overpayment applied to your 2022 estimated tax (from 2021 Form 1, line 51 or Form 1-NR/PY, line 55.) Do not enter 2021 refund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 0 0 40 2022 Massachusetts estimated tax payments. Do not include line 39 amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 0 0 41 Payments made with extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 0 0 42 AMENDED RETURN ONLY. Payments made with original return. Not less than 0. See instructions. . . . . . . . . . . . . 42 0 0 43 EARNED INCOME CREDIT.

a. Number of qualifying children

b. Amount from U.S. return 0 0 (See instructions) 43b × ____ = .43 0 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 oval if you qualify for this exception. 44 Senior Circuit Breaker Credit. Enclose Schedule CB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 0 0 45 Child under age 13, or disabled dependent/spouse credit (from worksheet). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 0 0 46 Dependent member(s) of household under age 12, or dependent(s)

age 65 or over (not you or your spouse) as of December 31, 2022 credit. a. Not more than two x _______(See instructions) = 46 0 0 47 Other refundable credits (from Schedule CMS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 0 0 48 TOTAL REFUNDABLE CREDITS. Add lines 43 through 47. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 0 0 49 Excess Paid Family Leave withholding. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 0 0 50 TOTAL. Add lines 38 through 42 and lines 48 and 49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 0 0 51 OVERPAYMENT. If line 37 is smaller than line 50, subtract line 37 from line 50. If line 37 is larger than line 50, go to line 54. If line 37 and line 50 are equal, enter 0 in line 53. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 0 0 52 Amount of overpayment you want APPLIED to your 2023 ESTIMATED TAX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 0 0 53 THIS IS YOUR REFUND. Subtract line 52 from line 51. Mail to: Massachusetts DOR, PO Box 7000, Boston, MA 02204. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 R E F U N D 0 0

Direct deposit of refund. See instructions. Type of account (select one): Checking Routing number (first two digits must be 01 to 12 or 21 to 32) Account number

Savings

54 TAX DUE. Subtract line 50 from line 37. Pay in full online at mass.gov/masstaxconnect. . . . . . . . . . . . . . . . . . 54 0 0

Or pay by mail. Make check payable to Commonwealth of Massachusetts. Write Social Security number(s) in memo section of check and be sure to sign check. Mail to: Massachusetts DOR, PO Box 7003, Boston, MA 02204.

These amounts will affect your refund or tax due: Exception. Enclose Form M-2210.

Interest 0 0 Penalty 0 0 M-2210 amount 0 0 PRINT PAID PREPARER’S NAME PAID PREPARER’S SSN or PTIN PAID PREPARER’S PHONE DATE

/ / ( ) PAID PREPARER’S SIGNATURE PAID PREPARER’S EIN Fill in if self-employed

DOR may discuss this return with the preparer

I do not want my preparer to file my return electronically BE SURE TO SIGN RETURN ON PAGE 1 AND ENCLOSE SCHEDULE HC (IF APPLICABLE). FOR PRIVACY ACT NOTICE, SEE INSTRUCTIONS. 2022 FORM 1, PAGE 4