Sc 40 Form – Fill Out and Use This PDF

Your fi rst name	Initial	Last name
Spouse’s fi rst name	Initial	Last name

Your Social Security Number

Spouse’s Social Security Number

Present address (number and street or rural route)

City or Town	State	Zip/Postal code

Taxpayer’s date of death

2013

M M D D

Spouse's date of death

2013

M M D D

Note: If you lived in Lake County and paid property tax on your residence, file Form IT-40 to get both the residential property tax credit plus the Unified Tax Credit for the Elderly.

Who may use this form to claim the Unifi ed Tax Credit for the Elderly?

You may be able to claim a credit if you and/or your spouse meet the following requirements:

•You and/or your spouse must have been age 65 or older by Dec. 31, 2013;

•If married, you must file a joint return;

•You and/or your spouse must have been an Indiana resident for more than six months during 2013; and

•You and/or your spouse must not have been in prison 180 days or more during 2013.

You may file this form if you meet all the above requirements,

and

•You are single or widowed and your income on Line E is under $2,500*; or

•You are married, and only one person is age 65 or older, and your income on Line E is less than $3,500*; or

•You are married, both of you are age 65 or older, and your income on Line E is less than $5,000*.

Complete Lines A through E on the front of this form. Then, compare the Line E amount to the amounts on the chart below based on your filing status and age. This will give you your refund amount.

*If your income is more than these amounts, you will need to file either Form IT-40 (if you are a full-year resident), or Form IT-40PNR (if you and/or your spouse are part-year residents), and claim the credit on one of those forms.

Note: If a spouse dies before this return is filed, the surviving spouse can claim this credit by filing a joint return. A copy of the death certificate must be attached to the tax return to verify the date of death. However, if a taxpayer dies and does not have a surviving spouse, the estate cannot claim the credit on behalf of the deceased taxpayer.

Direct deposit

You may have your refund directly deposited in your checking or savings account.

The routing number is nine digits, with the first two digits of the number beginning with 01 through 12 or 21 through

32.Do not use a deposit slip to verify the number because it may have internal codes as part of the actual routing number.

The account number can be up to 17 digits. Omit any hy- phens, accents and special symbols. Enter the number from left to right and leave any unused boxes blank.

Check the appropriate box for the type of account to which you are making your deposit, and if the refund will go to an account outside the United States.

Personal Representative Information

If you complete this area, you are authorizing the Depart- ment to be in contact with someone other than you (e.g. paid preparer, relative or friend, etc.) concerning information about this tax return. After your return is filed, the Department will communicate primarily with your designated personal representative.

Note: If you are due a refund, it will be paid to you (and your spouse, if filing jointly) even if you designate a personal rep- resentative.

File this form by June 30, 2014, to be eligible for this credit. If you have not received your refund within 12 weeks of filing, you may call our automated information line at (317) 233-4018.

Please mail your claim for refund to:

Elderly Credit

Indiana Dept. of Revenue

P.O. Box 6103

Indianapolis, IN 46206-6103

Mail by June 30, 2014