Form SC-40 Fillable 2013 Unified Tax Credit for the Elderly
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Checking (4) Savings Elderly Credit If married you must file a joint return; You and/or your spouse must have been age 65 or older You and/or your spouse must have been an Indiana resident You and/or your spouse must not have been in prison 180 You are married and only one person is age 65 or older You are married both of you are age 65 or older and your You are single or widowed and your income on Line E is $1 000 $2 499 99 $50 00 $1 000 $2 999 99 $50 00 $1 000 $2 999 99 $90 00 $2 500 or Over You must fi le form $3 000 $3 499 99 $40 00 $3 000 $4 999 99 $80 00 $3 500 or Over You must fi le form $5 000 or Over You must fi le Form (2) Account Number (5) Place an "X" in the box if refund will go to an account outside the United States (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (City or Town) (Date) (Daytime Telephone Number) (Paid Preparer Address) (Paid Preparer City) (Paid Preparer Name) (Paid Preparer State) (Paid Preparer Zip Code) (Personal Representative s Name) (Personal Representative's Address) (Personal Representative's City) (Personal Representative's State) (Personal Representative's Zip Code) (Personal Representative'sTelephone) (Present address) (PTIN Number) (PTIN) Unchecked (R12 / 9 13) (Spouse s first name) (Spouse's Date Of Death) (Spouse's Initial) (Spouse's last name) (Spouse's SSN) (Spouse's SSN) (State) (Taxpayer Date Of Death) (text) (text) (text) (text) (Your first name) (Your initial) (Your last name) (Your SSN) (Your SSN) (Zip Code) *If your income is more than these amounts you will need to 0 $999 99 $100 00 0 $999 99 $100 00 0 $999 99 $140 00 1 Check box if you were age 65 or older by Dec 31 2013 16213111694 2 Were you a resident of Indiana for six months or more during 2013? Yes No 24100000000 3 Was your spouse a resident of Indiana for six months or more during 2013? Yes No 32 Do not use a deposit slip to verify the number because it 65 or Older 65 or Older A Wages salaries tips and commissions unemployment compensation etc about this tax return After your return is filed the Department accents and special symbols Enter the number from account outside the United States Address Amount is: Amount is: If Line E is: and claim the credit on one of those forms and that I am (we are) not required to file an Indiana income tax return and your income on Line E is less than $3 500*; or B Dividend and interest income based on your filing status and age This will give you your by Dec 31 2013; C Net gain or loss from rental income business income etc Certain income such as Social Security veteran s disability pensions and life insurance proceeds should not be entered on this form Check box if spouse was age 65 or older by Dec 31 2013 Check the appropriate box for the type of account to which City or Town Compare the Figure on Line E to the Chart Below: Enter Your Refund Amount on Line F compare the Line E amount to the amounts on the chart below Complete Lines A through E on the front of this form Then credit If you have not received your refund within 12 D Pensions or annuities (Do not enter Social Security benefits) days or more during 2013 Daytime Telephone Number Determine Your Income Direct deposit E Total income (Add Lines A through D and enter the total here) Enter all other income received by you and your spouse during the tax year Complete all spaces If you had no income from any of the file either Form IT 40 (if you are a full year resident) or Form File this form by June 30 2014 to be eligible for this for more than six months during 2013; and for the Elderly? FORM Unified Tax Credit for the Elderly G Direct Deposit (1) Routing Number have a surviving spouse the estate cannot claim the credit I authorize the Department to discuss my return with my If Line E is: If yes complete the information below If you complete this area you are authorizing the Department income on Line E is less than $5 000* Indiana Dept of Revenue Indianapolis IN 46206 6103 IT 40 or IT 40PNR IT 40 or IT 40PNR IT 40PNR (if you and/or your spouse are part year residents) left to right and leave any unused boxes blank line at (317) 233 4018 M M D D Mail by June 30 2014 Married with both persons Married with only one person may have internal codes as part of the actual routing number meet the following requirements: Note: If a spouse dies before this return is filed the surviving Note: If you are due a refund it will be paid to you (and your Note: If you lived in Lake County and paid property tax on number of the number beginning with 01 through 12 or 21 through on behalf of the deceased taxpayer or savings account P O Box 6103 paid preparer relative or friend etc ) concerning information Paid Preparer: Firm s Name (or yours if self employed) Personal Representative Information Personal Representative s Name (please print) personal representative Yes No Please mail your claim for refund to: Present address (number and street or rural route) property tax credit plus the Unified Tax Credit for the Elderly refund amount representative SC 40 Single or Widowed sources listed below place a zero ( 0 ) in the space provided Round all entries spouse can claim this credit by filing a joint return A copy of spouse if filing jointly) even if you designate a personal representative Spouse s first name Initial Last name Spouse s Social Security Number Spouse's Signature Date State State Form 44404 Married Claimants Must File Jointly State Zip Code + 4 Taxpayer s date of death Spouse's date of death Telephone The account number can be up to 17 digits Omit any hyphens the date of death However if a taxpayer dies and does not the death certificate must be attached to the tax return to verify The routing number is nine digits with the first two digits to be in contact with someone other than you (e g under $2 500*; or 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 weeks of filing you may call our automated information Who may use this form to claim the Unified Tax Credit will communicate primarily with your designated personal you are making your deposit and if the refund will go to an You may be able to claim a credit if you and/or your spouse You may file this form if you meet all the above requirements You may have your refund directly deposited in your checking You Must File This Form by June 30 2014 Your first name Initial Last name Your Refund Your Refund Your Refund (See chart on back to figure your refund) your residence file Form IT 40 to get both the residential Your Signature Date Your Social Security Number Zip/Postal code