Form Sc-40 - Unified Tax Credit For The Elderly - State Of Indiana
ADVERTISEMENT
1Unified Tax Credit for the Elderly
FORM
SC-40
Married Claimants
State Form 44404
R5 / 8-06
Must File Jointly
Do Not Write Above
Tax Year: 2006
You Must File This Form by July 2, 2007
Your Social Security Number
Your First Name, Middle Initial, Last Name
Spouse’s Social Security Number
Spouse’s First Name, Middle Initial, Last Name
Present Address (Number and street or rural route)
Taxpayer’s date of death
2006
m
m
d
d
City or Town
State Zip Code
Spouse’s date of death
2006
m
m
d
d
1. Your age as of December 31, 2006
Spouse’s age as of December 31, 2006
2. Were you a resident of Indiana for six months or more during 2006?
Yes
No
3. Was your spouse a resident of Indiana for six months or more during 2006?
Yes
No
Determine Your Income
Certain income, such as Social Security, veteran’s disability pensions and life insurance
proceeds, should not be entered on this form. Enter all other income received by you
and your spouse during the tax year. Complete all spaces. If you had no income from
any of the sources listed below, place a zero (-0-) in the space provided.
,
A. Wages, salaries, tips and commissions ...........................................
,
B. Dividend and interest income ..........................................................
,
C. Net gain or loss from rental income, business income, etc .............
,
D. Pensions or annuities
(Do not enter Social Security benefits) ................
,
E. Total income
(Add Lines A through D and enter the total here) ...................
00
F . Your Refund
(See chart on back to figure your refund) ...............................
Under penalty of perjury, I (we) have examined this return and to the best of my (our) knowledge and belief, it is
true, complete, and correct and that I am (we are) not required to file an Indiana income tax return.
I authorize the Department to discuss
my return with my preparer.
Your Signature
Date
I DO NOT authorize the Department to
discuss my return with my preparer.
Spouse’s Signature
Date
Paid Preparer’s Signature
Daytime Telephone Number
Paid Preparer’s Identification Number
AA
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial