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- 1 4 70TPART I. ANSWER YES TO THE CONDITION THAT APPLIES
- 1 6 70T1. Filing single and over 65 [22]. 1 ==>
- 1 7 70T2. Filing single, under 65, and disabled [10]. 2 ==>
- 1 8 70T3. Joint and both over 65 [25]. 3 ==>
- 1 9 70T4. Joint, both under 65, but only one disabled .... 4 ==>
- 110 70T5. Joint, both under 65, and both disabled [08]. 5 ==>
- 111 70T6. Joint, one over 65, one under 65 disabled ..... 6 ==>
- 112 70T7. Joint, one over 65, one under 65 not disabled . 7 ==>
- 113 70T8. Married, separate returns, over 65 ............. 8 ==>
- 114 70T9. Married, separate returns, under 65, disabled... 9 ==>
- 116 70TPART II. DISABILITY STATEMENT
- 118 70TThis section must be filled in on the printed form and signed
- 119 70Tby you and your physician.
- 1 6670YN 1
- 1 7670YN 1
- 1 8670YN 1
- 1 9670YN 1
- 110670YN 1
- 111670YN 1
- 112670YN 1
- 113670YN 1
- 114670YN 1
- 2 4 71TPART III - CALCULATE CREDIT
- 2 6 70T10. Amount based on Part I [22]. 10 ==>C
- 2 7 70T11. Taxable disability income [19]. 11 ==>
- 2 8 70T12. Smaller of line 10 and line 11 [14]. 12 ==>C
- 2 9 70T13. Non-taxable pension and annuity income ...... 13 ==>
- 210 70T14. Amount from Form 1040, line 33 [14]. 14 ==>C
- 211 70T15. Amount based on Part I [22]. 15 ==>C
- 212 70T16. Subtract line 15 from line 14 [15]. 16 ==>C
- 213 70T17. Divide line 16 by 2 [25]. 17 ==>C
- 214 70T18. Add line 13 and line 17 [21]. 18 ==>C
- 215 70T19. Subtract line 18 from line 12 [15]. 19 ==>C
- 216 70T20. Percentage to figure credit [17]. 20 ==>C[07] x 15%
- 217 70T21. Credit [38]. 21 ==>C
- 2 6670$Y10
- 2 7670$N101411
- 2 8670$Y10
- 2 9670$N101413
- 210670$Y10
- 211670$Y10
- 212670$Y10
- 213670$Y10
- 214670$Y10
- 215670$Y10
- 217670$Y10