Schedule R (Form 1040a Or 1040) - Credit For The Elderly Or The Disabled - 2013

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Schedule R
OMB No. 1545-0074
Credit for the Elderly or the Disabled
(Form 1040A
1040A
2013
. . . . . . . . . .
or 1040)
1040
Complete and attach to Form 1040A or 1040.
R
Information about Schedule R and its separate instructions is at
Attachment
Department of the Treasury
16
Internal Revenue Service (99)
Sequence No.
Name(s) shown on Form 1040A or 1040
Your social security number
You may be able to take this credit and reduce your tax if by the end of 2013:
• You were age 65 or older
or
• You were under age 65, you retired on permanent and total disability, and
you received taxable disability income.
But you must also meet other tests. See instructions.
In most cases, the IRS can figure the credit for you. See instructions.
TIP
Part I
Check the Box for Your Filing Status and Age
If your filing status is:
And by the end of 2013:
Check only one box:
Single,
1
1 You were 65 or older . . . . . . . . . . . . . . . . . . . .
Head of household, or
Qualifying widow(er)
2
2 You were under 65 and you retired on permanent and total disability
. .
3
3 Both spouses were 65 or older . . . . . . . . . . . . . . . . .
4 Both spouses were under 65, but only one spouse retired on permanent and
4
total disability . . . . . . . . . . . . . . . . . . . . . . .
5 Both spouses were under 65, and both retired on permanent and total
Married filing
5
disability . . . . . . . . . . . . . . . . . . . . . . . . .
jointly
6 One spouse was 65 or older, and the other spouse was under 65 and retired
6
on permanent and total disability . . . . . . . . . . . . . . . .
7 One spouse was 65 or older, and the other spouse was under 65 and not
7
retired on permanent and total disability . . . . . . . . . . . . .
8
8 You were 65 or older and you lived apart from your spouse for all of 2013 .
Married filing
separately
9 You were under 65, you retired on permanent and total disability, and you
9
lived apart from your spouse for all of 2013 . . . . . . . . . . . .
Did you check
Yes
Skip Part II and complete Part III on the back.
box 1, 3, 7, or
No
Complete Parts II and III.
8?
Part II
Statement of Permanent and Total Disability
(Complete only if you checked box 2, 4, 5, 6, or 9 above.)
1 You filed a physician’s statement for this disability for 1983 or an earlier year, or you filed or got a
If:
statement for tax years after 1983 and your physician signed line B on the statement, and
2 Due to your continued disabled condition, you were unable to engage in any substantial gainful activity
in 2013, check this box
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
• If you checked this box, you do not have to get another statement for 2013.
• If you did not check this box, have your physician complete the statement in the instructions. You must
keep the statement for your records.
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 11359K
Schedule R (Form 1040A or 1040) 2013

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