Form 24 - Idaho Grocery Credit Refund - 2005
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1F
2005
24
IDAHO GROCERY CREDIT REFUND
O
R
TC2401
M
5-12-05
Your first name and initial
Last name
Your Social Security Number
-
-
Spouse's Security Number
If a joint return, spouse's first name and initial Last name
-
-
Mailing address
Taxpayer
deceased
in 2005
City, State and Zip Code
Spouse
deceased
in 2005
A. INCOME
1. Enter your gross income. Include wages, salaries, tips, interest, dividends,
self-employment income before expenses, farm income before expenses,
rental income before expenses, and pensions. Do NOT include Social
1
Security benefits or Veterans Administration disability benefits. .....................................
2. Enter the amount for your filing status from the filing status chart.
2
See instructions. ...............................................................................................................
3. Compare lines 1 and 2.
If line 1 is equal to or larger than line 2, you cannot use this form. You
must file an income tax return, Form 40.
If line 1 is less than line 2, continue.
YOURSELF
SPOUSE
B. REFUND CLAIMED
/
/
/
/
1. Enter the date of birth. ................................................................................
month
day
year
month
day
year
2. Check the boxes that apply.
Age 65 or older ............................................................................... $35 per person
Age 62, 63 or 64 ............................................................................. $20 per person
Blind and under age 62 .................................................................. $20 per person
Disabled veteran under age 62 ...................................................... $20 per person
If you or your spouse have not filed this form before, provide
a photocopy of the Veterans Administration document that
establishes the disability.
$20
$35
$40
$55
$70
3. Total refund claimed (Check one box). ......................................................
C. SIGNATURE(S) REQUIRED
If anyone other than the surviving spouse signs on
If you or your spouse are unable to sign, your
representative must write "unable to sign" in
behalf of a deceased person, IRS Form 1310 must
the signature space(s) and enter his or her
be completed and attached.
name, address and relationship.
Your Signature
Date
Spouse's signature (if a joint return, BOTH MUST SIGN)
Phone Number
4890
MAIL TO: Idaho State Tax Commission, PO Box 56, Boise, ID 83756-0056
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Parent category: Financial