Form 24 - Idaho Grocery Credit Refund - 2016
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18734
2016
State Use Only
IDAHO GROCERY CREDIT REFUND
24
F
O
You or Your Spouse Must Be Age 65 or Older
R
EFO00086
M
07-15-2016
Your first name and initial
Last name
Your Social Security number
Deceased on
___/___/___
If a joint return, spouse's first name and initial
Last name
Spouse's Social Security number
Deceased on
___/___/___
Current mailing address
City, State, and ZIP Code
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. Enter 0 if your only income is from
1
Social Security benefits and/or Veterans Administration disability benefits ......
2. FILING STATUS
Enter the amount for your filing status.
.
Married filing joint: one 65 or older $21,950; both 65 or older $23,200 ...................
.
2
Single: 65 or older $11,900.......................................................................................
3. Compare lines 1 and 2.
.
If line 1 is equal to or larger than line 2, you can't use this form. You must file Form 40 to receive your
.
grocery credit.
If line 1 is less than line 2, continue.
B. REFUND CLAIMED
YOURSELF
SPOUSE
1. Enter the date of birth ..............................................................
Month
Day
Year
Month
Day
Year
2. Check the boxes that apply.
.
.
Under age 65 .......................................................... $100 per person
.
.
Age 65 or older ....................................................... $120 per person
.
3. If you're donating your grocery credit to the Cooperative Welfare Fund,
check here and the $0 total refund claimed box. This donation is irrevocable.
$0
$120
$220
$240
.
4. Total refund claimed (Check one box) .............................................................
.
Check if final deposit destination is outside of the U.S.
.
5. DIRECT DEPOSIT. See instructions.
.
.
Checking
.
Type of
Account No.
Routing No.
Account:
Savings
C. SIGNATURE(S) REQUIRED
If you or your spouse are unable to sign, your
If anyone other than the surviving spouse signs on
behalf of a deceased person, IRS Form 1310 must
representative must write "unable to sign" in
the signature space(s) and enter his or her
be completed and included.
name, address, and relationship.
Your signature
Phone number
Date
.
X
Spouse's signature (if a joint return, BOTH MUST SIGN)
.
X
{"^!¦}
MAIL TO:
Idaho State Tax Commission
PO Box 56
Boise, ID 83756-0056
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Parent category: Financial