Looking for a Illinois Tax Forms And Templates? Download it for free!

Marital status

•

if your spouse died in 2003, but was

living with you during 2002**.

Check only one of the marital status boxes on

**If your spouse was living with you during 2002,

Line 7.

but died in 2003, you must provide a copy of the

Single, widow(er), or divorced

death certificate.

•

if you are single, or

•

if your spouse was deceased before

Married, but not living together

January 1, 2003*, or

•

if you were permanently separated from

•

if you were divorced before

your spouse during 2002, or

January 1, 2003.

•

if you or your spouse were living in a

*If your spouse was living with you during 2002,

nursing, retirement, or shelter care home

you must include his or her income in Step 3.

in 2002.

Married and living together

Tell us if you are male or female

•

if you were married and living with

Check the box that applies to you.

your spouse during 2002, or

Step 2:

Tell us about your spouse (husband or wife).

If your spouse is disabled and younger than 65

Complete Step 2 only if you checked Marital

years of age,

status 2, “Married and living together” on Line 7.

Otherwise, if you do not have a spouse, if your

you must send us proof of your

spouse is deceased, or if you are not living in the

spouse’s disability — see Page 17.

same household as your spouse, skip to Step 3.

Do not send us any payment with your

Spouse’s Social Security number

Form IL-1363.

Write your spouse’s (husband’s or wife’s) Social

12b Check the “Yes” box if your spouse is

Security number. Your spouse must have his or

a U.S. citizen.

her own Social Security number. It cannot be the

Complete Line 12b only if your spouse is 65 years

same as yours.

of age or older or will become 65 years of age

10 Spouse’s name

during 2003. If yes, check the “Yes” bo x.

Print your spouse’s first name, middle initial, and

12c If your spouse is not a U.S. citizen,

last name.

determine which box to check.

11 Spouse’s birth date

Complete Line 12c only if your spouse is 65 years

of age or older or will become 65 years of age

Write the month, day, and year of your spouse’s

during 2003.

birth.

Check Box 1 if your spouse is not a U.S. citizen

If this is the first time your spouse is applying,

and is one of the following:

you must send us proof of your

• lawful permanent resident who has lived in

spouse’s age — see Page 17.

the U.S. for at least five years

• refugee

12a Check the box if your spouse wants

• asylee

prescription coverage or the

• parolee

SeniorCare rebate

• his or her deportation is being withheld

If your spouse wants to apply for Pharmaceutical

• not a citizen but a U.S. veteran

Assistance or SeniorCare (prescription coverage

If you check Box 1 for your spouse,

or the insurance rebate), check the box on

you must send us proof of your

Line 12a. (To be eligible for prescription coverage,

spouse’s immigration status — see

your spouse must meet the requirements listed on

Page 17.

Page 2, “Who should apply?”.)

Check Box 2 if your spouse is not a U.S. citizen

and does not qualify to check Box 1.

Avoid a delay

Apply by March 31

IL-1363 instructions (R-12/02)

Instructions And Benefits Information For Form Il-1363 - Illinois Department Of Revenue - 2002 Page 11

Related Articles

Related forms

Related Categories