Form Sc-40 - Unified Tax Credit For The Elderly - 2008

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Unifi ed Tax Credit for the Elderly
FORM
Tax Year: 2008
SC-40
Married Claimants Must File Jointly
State Form 44404
(R7 / 9-08)
You Must File This Form by June 30, 2009
Y
Your Social Security Number
our fi rst name
Initial
Last name
Spouse’s fi rst name
Initial
Last name
Spouse’s Social Security Number
Present address (number and street or rural route)
Taxpayer’s date of death
Spouse's date of death
City or Town
State
Zip Code + 4
2008
2008
M
M
D
D
M
M
D
D
1.
Your age as of Dec. 31, 2008
Spouse’s age as of Dec. 31, 2008
2.
Were you a resident of Indiana for six months or more during 2008?
Yes
No
3.
Was your spouse a resident of Indiana for six months or more during 2008?
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. Do not include any federal economic stimulus payment you
may have received. 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 ....................................................................................
A
B.
Dividend and interest income ....................................................................................................
B
C.
Net gain or loss from rental income, business income, etc .......................................................
C
D.
Pensions or annuities (Do not enter Social Security benefi ts) ..............................................
D
Total income (Add Lines A through D and enter the total here) ...............................................
E
E.
Your Refund (See chart on back to fi gure your refund) ..........................................................
F
F.
00
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 fi le an Indiana income tax return.
__________________________________________
_________________________________________
Your Signature
Date
Spouse's Signature
Date
Daytime Telephone Number
A
Paid Preparer: Firm’s Name (or yours if self-employed)
I authorize the Department to discuss my return with my
personal representative
Yes
No
______________________________________________________
If yes, complete the information below.
H
Personal Representative’s Name (please print)
____________________________________________________
I
Federal I.D. Number
PTIN OR
Social Security Number
B
Telephone
J
number
C
Telephone
K
number
D
L
Address _____________________________________________
Address _______________________________________________
E
City ________________________________________________
M
City __________________________________________________
F
State _____________________
G
Zip Code + 4 ___________
N
State _______________________
O
Zip Code + 4 ___________
Signature __________________________
Date ______________

162081101

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