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3 NEAR FINAL DRAFT 8/1/24 3
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2024 Schedule M1LS, Tax on Lump-Sum Distribution
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9 YOUR FIRST NAME, INITXXXXXXXX YOUR LAST NAMEXXXXXXXXXXXX 999999999 9
10 Your First Name and Initial Last Name Social Security Number 10
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12 Round amounts to the 12
13 You must complete federal Form 4972 before you can complete this schedule. nearest whole dollar. 13
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15 1 Portion of your lump-sum distribution that is eligible for averaging (from line 19 of federal Form 4972) . . . . . . . . . . . 1 12345678 15
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17 2 If you completed Schedule M1R, see instructions. If you did not complete Schedule M1R, enter 0 . . . . . . . . . . . . . . . 2 12345678 17
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19 3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 12345678 19
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21 4 Multiply line 3 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 12345678 21
22 5 From the tax table in the Form M1 instructions, find the tax for the amount 22
23 on line 4 above using the column in the table for single persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 12345678 23
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25 6 Multiply line 5 by 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 12345678 25
26 If you did not complete lines 20 through 22 of federal Form 4972, skip lines 7 through 10 below, 26
27 and enter the amount from line 6 on line 11 of this schedule. 27
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29 7 Amount from line 22 of federal Form 4972 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 12345678 29
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31 8 Multiply line 7 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 12345678 31
32 9 From the tax table in the Form M1 instructions, find the tax for the amount 32
33 on line 8 above using the column for single persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 12345678 33
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35 10 Multiply line 9 by 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 12345678 35
36 11 Tax on the ordinary income portion of your lump-sum distribution (subtract line 10 from line 6). 36
37 If you shared the lump-sum distribution with other recipients, see instructions. 37
38 Enter the result here and on line 14 of Form M1. Check the box for Schedule M1LS on line 14 of Form M1. 38
39 Estates and trusts: Include this amount on line 12 of Form M2 and check the box for Schedule M1LS . . . . . . . . . . . . 11 12345678 39
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41 You must include this schedule and a copy of your federal Form 4972 when you file Form M1. 41
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