2015 Indiana State Income Tax Return Electronic Filing Questionnaire (Page 2 of 2) in pdf

2015 Indiana State Income Tax Return Electronic Filing Questionnaire Page 2

-Are you a surviving spouse and received military retirement pay during 12/31/2015?

Yes_____

No_____

10. Were you a member of a military reserve component or the Indiana National Guard?

-If yes, answer the following questions:

-Were you deployed or mobilized for full service during 2015?

Yes_____

No_____

If yes, date mobilized ____________________

-Was your Indiana National Guard unit federalized during 2015?

Yes_____

No_____

If yes, date federalized ___________________

11.

Did you receive a Form 1099C for 2015?

Yes_____*

No_____

-If yes,

was it due to a discharge of indebtedness of your principal residence (mortgage forgiveness)?

Yes_____

No_____

Refund Information

12. If you are getting a refund would you like to have it Direct Deposited?

Yes_____*

No_____

-If yes, will any of your refund go to an account outside the United States?

Yes_____

No_____

Personal Representative for your 2015 Indiana Tax Return

(Person you are giving permission to the IDOR to speak to about your 2015 tax return.)

His/Her Name______________________________ His/Her Phone Number__________________

His/Her Mailing Address ___________________________________________________________

________________________________________________________________________________

2015 Indiana State Income Tax Return Electronic Filing Questionnaire Page 2