00000000: 00 06 20 20 20 20 20 20 20 20 20 20 20 20 20 20 |.. |
00000010: 20 20 20 20 20 20 20 20 20 0D 0A 70 41 52 54 20 | ..pART |
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00000040: 0D 0A 0D 0A 66 49 4C 49 4E 47 20 20 20 20 20 20 |....fILING |
00000050: 20 61 4E 44 20 42 59 20 54 48 45 20 45 4E 44 20 | aND BY THE END |
00000060: 4F 46 20 38 37 0D 0A 73 54 41 54 55 53 0D 0A 0D |OF 87..sTATUS...|
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00000080: 55 20 57 45 52 45 20 36 35 20 4F 52 20 4F 56 45 |U WERE 65 OR OVE|
00000090: 52 0D 0A 4F 52 0D 0A 68 45 41 44 20 4F 46 20 20 |R..OR..hEAD OF |
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000000B0: 45 52 20 36 35 20 41 4E 44 0D 0A 68 4F 55 53 45 |ER 65 AND..hOUSE|
000000C0: 48 4F 4C 44 20 20 20 20 79 4F 55 20 52 45 54 49 |HOLD yOU RETI|
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000000E0: 0D 0A 4F 52 20 20 20 20 20 20 20 20 20 20 20 41 |..OR A|
000000F0: 4E 44 20 54 4F 54 41 4C 20 44 49 53 41 42 49 4C |ND TOTAL DISABIL|
00000100: 49 54 59 0D 0A 71 55 41 4C 49 46 59 49 4E 47 20 |ITY..qUALIFYING |
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00000140: 20 20 20 20 20 20 20 20 20 20 20 20 20 4F 52 20 | OR |
00000150: 4F 56 45 52 0D 0A 66 49 4C 49 4E 47 0D 0A 6A 4F |OVER..fILING..jO|
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00000180: 45 52 20 0D 0A 20 20 20 20 20 20 20 20 20 20 20 |ER .. |
00000190: 20 20 36 35 20 42 55 54 20 4F 4E 4C 59 20 4F 4E | 65 BUT ONLY ON|
000001A0: 45 20 52 45 54 49 52 45 44 0D 0A 20 20 20 20 20 |E RETIRED.. |
000001B0: 20 20 20 20 20 20 20 20 4F 4E 20 50 45 52 4D 41 | ON PERMA|
000001C0: 4E 45 4E 54 20 41 4E 44 20 54 4F 54 41 4C 0D 0A |NENT AND TOTAL..|
000001D0: 20 20 20 20 20 20 20 20 20 20 20 20 20 44 49 53 | DIS|
000001E0: 41 42 49 4C 49 54 59 0D 0A 0D 0A 20 20 20 20 20 |ABILITY.... |
000001F0: 20 20 20 20 20 20 35 20 62 4F 54 48 20 53 50 4F | 5 bOTH SPO|
00000200: 55 53 45 53 20 57 45 52 45 20 55 4E 44 45 52 0D |USES WERE UNDER.|
00000210: 0A 20 20 20 20 20 20 20 20 20 20 20 20 20 36 35 |. 65|
00000220: 20 41 4E 44 20 42 4F 54 48 20 52 45 54 49 52 45 | AND BOTH RETIRE|
00000230: 44 20 4F 4E 20 0D 0A 20 20 20 20 20 20 20 20 20 |D ON .. |
00000240: 20 20 20 20 50 45 52 4D 20 26 20 54 4F 54 20 44 | PERM & TOT D|
00000250: 49 53 41 42 49 4C 49 54 59 0D 0A 0D 0A 20 20 20 |ISABILITY.... |
00000260: 20 20 20 20 20 20 20 20 36 20 6F 4E 45 20 53 50 | 6 oNE SP|
00000270: 4F 55 53 45 20 57 41 53 20 36 35 20 4F 52 20 4F |OUSE WAS 65 OR O|
00000280: 56 45 52 0D 0A 20 20 20 20 20 20 20 20 20 20 20 |VER.. |
00000290: 20 20 26 20 54 48 45 20 4F 54 48 45 52 20 57 41 | & THE OTHER WA|
000002A0: 53 20 55 4E 44 45 52 20 36 35 20 26 0D 0A 20 20 |S UNDER 65 &.. |
000002B0: 20 20 20 20 20 20 20 20 20 20 20 52 45 54 49 52 | RETIR|
000002C0: 45 44 20 4F 4E 20 50 45 52 4D 41 4E 45 4E 54 20 |ED ON PERMANENT |
000002D0: 41 4E 44 0D 0A 20 20 20 20 20 20 20 20 20 20 20 |AND.. |
000002E0: 20 20 54 4F 54 41 4C 20 44 49 53 41 42 49 4C 49 | TOTAL DISABILI|
000002F0: 54 59 0D 0A 0D 0A 20 20 20 20 20 20 20 20 20 20 |TY.... |
00000300: 20 37 20 6F 4E 45 20 53 50 4F 55 53 45 20 57 41 | 7 oNE SPOUSE WA|
00000310: 53 20 36 35 20 4F 52 20 4F 56 45 52 0D 0A 20 20 |S 65 OR OVER.. |
00000320: 20 20 20 20 20 20 20 20 20 20 20 26 20 54 48 45 | & THE|
00000330: 20 4F 54 48 45 52 20 57 41 53 20 55 4E 44 45 52 | OTHER WAS UNDER|
00000340: 20 36 35 20 26 0D 0A 20 20 20 20 20 20 20 20 20 | 65 &.. |
00000350: 20 20 20 20 6E 6F 74 20 52 45 54 49 52 45 44 20 | not RETIRED |
00000360: 4F 4E 20 50 45 52 4D 41 4E 45 4E 54 20 26 0D 0A |ON PERMANENT &..|
00000370: 20 20 20 20 20 20 20 20 20 20 20 20 20 54 4F 54 | TOT|
00000380: 41 4C 20 44 49 53 41 42 49 4C 49 54 59 0D 0A 0D |AL DISABILITY...|
00000390: 0A 0D 0A 6D 41 52 52 49 45 44 20 20 20 20 38 20 |...mARRIED 8 |
000003A0: 79 4F 55 20 57 45 52 45 20 36 35 20 4F 52 20 4F |yOU WERE 65 OR O|
000003B0: 56 45 52 20 41 4E 44 0D 0A 66 49 4C 49 4E 47 20 |VER AND..fILING |
000003C0: 20 20 20 20 20 20 59 4F 55 20 44 49 44 20 4E 4F | YOU DID NO|
000003D0: 54 20 4C 49 56 45 20 57 49 54 48 20 59 4F 55 52 |T LIVE WITH YOUR|
000003E0: 0D 0A 73 45 50 41 52 41 54 45 4C 59 20 20 20 53 |..sEPARATELY S|
000003F0: 50 4F 55 53 45 20 49 4E 20 31 39 38 37 0D 0A 0D |POUSE IN 1987...|
00000400: 0A 20 20 20 20 20 20 20 20 20 20 20 39 20 79 4F |. 9 yO|
00000410: 55 20 57 45 52 45 20 55 4E 44 45 52 20 36 35 20 |U WERE UNDER 65 |
00000420: 26 20 59 4F 55 0D 0A 20 20 20 20 20 20 20 20 20 |& YOU.. |
00000430: 20 20 20 20 52 45 54 49 52 45 44 20 4F 4E 20 50 | RETIRED ON P|
00000440: 45 52 4D 2E 20 26 20 54 4F 54 41 4C 0D 0A 20 20 |ERM. & TOTAL.. |
00000450: 20 20 20 20 20 20 20 20 20 20 20 44 49 53 41 42 | DISAB|
00000460: 49 4C 49 54 59 20 41 4E 44 20 59 4F 55 20 44 49 |ILITY AND YOU DI|
00000470: 44 0D 0A 20 20 20 20 20 20 20 20 20 20 20 20 20 |D.. |
00000480: 4E 4F 54 20 4C 49 56 45 20 57 49 54 48 20 59 4F |NOT LIVE WITH YO|
00000490: 55 52 20 0D 0A 20 20 20 20 20 20 20 20 20 20 20 |UR .. |
000004A0: 20 20 53 50 4F 55 53 45 20 49 4E 20 31 39 38 37 | SPOUSE IN 1987|
000004B0: 0D 0A 0D 0A 70 41 52 54 20 32 20 69 66 0D 0A 20 |....pART 2 if.. |
000004C0: 20 20 20 31 20 79 4F 55 20 46 49 4C 45 44 20 41 | 1 yOU FILED A|
000004D0: 20 50 48 59 53 49 43 49 41 4E 27 53 20 53 54 41 | PHYSICIAN'S STA|
000004E0: 54 45 4D 45 4E 54 0D 0A 20 20 20 20 20 20 46 4F |TEMENT.. FO|
000004F0: 52 20 54 48 45 20 44 49 53 41 42 49 4C 49 54 59 |R THE DISABILITY|
00000500: 20 42 45 46 4F 52 45 20 31 39 38 33 20 4F 52 0D | BEFORE 1983 OR.|
00000510: 0A 20 20 20 20 20 20 59 4F 55 20 46 49 4C 45 44 |. YOU FILED|
00000520: 20 41 20 53 55 42 53 45 51 55 45 4E 54 20 53 54 | A SUBSEQUENT ST|
00000530: 41 54 45 4D 45 4E 54 0D 0A 20 20 20 20 20 20 26 |ATEMENT.. &|
00000540: 20 54 48 45 20 50 48 59 53 49 43 49 41 4E 20 43 | THE PHYSICIAN C|
00000550: 48 45 43 4B 45 44 20 42 4F 58 20 62 0D 0A 61 6E |HECKED BOX b..an|
00000560: 64 0D 0A 20 20 20 20 32 20 64 55 45 20 54 4F 20 |d.. 2 dUE TO |
00000570: 59 4F 55 52 20 44 49 53 41 42 4C 45 44 20 43 4F |YOUR DISABLED CO|
00000580: 4E 44 49 54 49 4F 4E 0D 0A 20 20 20 20 20 20 59 |NDITION.. Y|
00000590: 4F 55 20 57 45 52 45 20 55 4E 41 42 4C 45 20 54 |OU WERE UNABLE T|
000005A0: 4F 20 45 4E 47 41 47 45 20 49 4E 0D 0A 20 20 20 |O ENGAGE IN.. |
000005B0: 20 20 20 53 55 42 53 54 41 4E 54 49 41 4C 20 47 | SUBSTANTIAL G|
000005C0: 41 49 4E 46 55 4C 20 41 43 54 49 56 49 54 59 0D |AINFUL ACTIVITY.|
000005D0: 0A 74 68 65 6E 20 20 41 4E 53 57 45 52 20 79 65 |.then ANSWER ye|
000005E0: 73 0D 0A 0D 0A 70 41 52 54 20 33 20 66 69 67 75 |s....pART 3 figu|
000005F0: 72 65 20 61 6D 6F 75 6E 74 20 6F 66 20 79 6F 75 |re amount of you|
00000600: 72 20 63 72 65 64 69 74 0D 0A 0D 0A 31 30 20 20 |r credit....10 |
00000610: 62 41 53 45 20 41 4D 4F 55 4E 54 0D 0A 31 31 20 |bASE AMOUNT..11 |
00000620: 20 74 41 58 41 42 4C 45 20 44 49 53 41 42 49 4C | tAXABLE DISABIL|
00000630: 49 54 59 20 49 4E 43 4F 4D 45 0D 0A 31 32 20 20 |ITY INCOME..12 |
00000640: 6C 45 53 53 45 52 20 4F 46 20 54 48 45 20 54 57 |lESSER OF THE TW|
00000650: 4F 20 41 4D 4F 55 4E 54 53 0D 0A 31 33 20 20 70 |O AMOUNTS..13 p|
00000660: 45 4E 53 49 4F 4E 20 41 4E 4E 55 49 54 59 20 41 |ENSION ANNUITY A|
00000670: 4E 44 20 0D 0A 20 20 20 20 44 49 53 41 42 49 4C |ND .. DISABIL|
00000680: 49 54 59 20 49 4E 43 4F 4D 45 53 0D 0A 20 20 41 |ITY INCOMES.. A|
00000690: 20 6E 4F 4E 54 41 58 41 42 4C 45 20 50 41 52 54 | nONTAXABLE PART|
000006A0: 20 4F 46 20 53 4F 43 49 41 4C 20 0D 0A 20 20 20 | OF SOCIAL .. |
000006B0: 20 53 45 43 55 52 49 54 59 20 42 45 4E 45 46 49 | SECURITY BENEFI|
000006C0: 54 53 0D 0A 20 20 42 20 6E 4F 4E 54 41 58 41 42 |TS.. B nONTAXAB|
000006D0: 4C 45 20 50 41 52 54 20 4F 46 20 41 4E 59 20 0D |LE PART OF ANY .|
000006E0: 0A 20 20 20 20 4F 54 48 45 52 20 53 55 43 48 20 |. OTHER SUCH |
000006F0: 42 45 4E 45 46 49 54 53 0D 0A 20 20 43 20 74 4F |BENEFITS.. C tO|
00000700: 54 41 4C 0D 0A 31 34 20 20 61 4D 4F 55 4E 54 20 |TAL..14 aMOUNT |
00000710: 46 52 4F 4D 20 31 30 34 30 20 4C 49 4E 45 20 33 |FROM 1040 LINE 3|
00000720: 31 0D 0A 31 35 20 20 6D 41 58 49 4D 55 4D 20 41 |1..15 mAXIMUM A|
00000730: 4D 4F 55 4E 54 0D 0A 31 36 20 20 6C 49 4E 45 20 |MOUNT..16 lINE |
00000740: 31 35 20 46 52 4F 4D 20 31 34 0D 0A 31 37 20 20 |15 FROM 14..17 |
00000750: 64 49 56 49 44 45 20 4C 49 4E 45 20 31 36 20 42 |dIVIDE LINE 16 B|
00000760: 59 20 32 0D 0A 31 38 20 20 74 4F 54 41 4C 20 0D |Y 2..18 tOTAL .|
00000770: 0A 31 39 20 20 6C 49 4E 45 20 31 38 20 46 52 4F |.19 lINE 18 FRO|
00000780: 4D 20 31 32 0D 0A 32 30 20 20 25 20 54 4F 20 46 |M 12..20 % TO F|
00000790: 49 47 55 52 45 20 43 52 45 44 49 54 2D 31 35 25 |IGURE CREDIT-15%|
000007A0: 0D 0A 32 31 20 20 63 52 45 44 49 54 20 41 4D 4F |..21 cREDIT AMO|
000007B0: 55 4E 54 0D 0A 1A |UNT... |
.. ..PART 1 CHECK
LINE THAT APPLIES TO YOU....FILING
AND BY THE END OF 87..STATUS....SINGLE
1 YOU WERE 65 OR OVER..OR..HEAD OF
2 YOU WERE UNDER 65 AND..HOUSEHOLD
YOU RETIRED ON PERMANENT..OR A
ND TOTAL DISABILITY..QUALIFYING ..WIDOWE
R....MARRIED 3 BOTH SPOUSES WERE 65..
OR OVER..FILING..JOINTLY
4 BOTH SPOUSES WERE UNDER ..
65 BUT ONLY ONE RETIRED..
ON PERMANENT AND TOTAL.. DIS
ABILITY.... 5 BOTH SPOUSES WER
E UNDER.. 65 AND BOTH RETIRE
D ON .. PERM & TOT DISABILIT
Y.... 6 ONE SPOUSE WAS 65 OR O
VER.. & THE OTHER WAS UNDER
65 &.. RETIRED ON PERMANENT
AND.. TOTAL DISABILITY....
7 ONE SPOUSE WAS 65 OR OVER..
& THE OTHER WAS UNDER 65 &..
NOT RETIRED ON PERMANENT &..
TOTAL DISABILITY......MARRI
ED 8 YOU WERE 65 OR OVER AND..FILING
YOU DID NOT LIVE WITH YOUR..SEPARA
TELY SPOUSE IN 1987.... 9 YO
U WERE UNDER 65 & YOU.. RETI
RED ON PERM. & TOTAL.. DISAB
ILITY AND YOU DID.. NOT LIVE
WITH YOUR .. SPOUSE IN 1987
....PART 2 IF.. 1 YOU FILED A PHYSICI
AN'S STATEMENT.. FOR THE DISABILITY
BEFORE 1983 OR.. YOU FILED A SUBSE
QUENT STATEMENT.. & THE PHYSICIAN C
HECKED BOX B..AND.. 2 DUE TO YOUR DIS
ABLED CONDITION.. YOU WERE UNABLE T
O ENGAGE IN.. SUBSTANTIAL GAINFUL A
CTIVITY..THEN ANSWER YES....PART 3 FIGU
RE AMOUNT OF YOUR CREDIT....10 BASE AMO
UNT..11 TAXABLE DISABILITY INCOME..12
LESSER OF THE TWO AMOUNTS..13 PENSION A
NNUITY AND .. DISABILITY INCOMES.. A
NONTAXABLE PART OF SOCIAL .. SECURIT
Y BENEFITS.. B NONTAXABLE PART OF ANY .
. OTHER SUCH BENEFITS.. C TOTAL..14
AMOUNT FROM 1040 LINE 31..15 MAXIMUM A
MOUNT..16 LINE 15 FROM 14..17 DIVIDE L
INE 16 BY 2..18 TOTAL ..19 LINE 18 FRO
M 12..20 % TO FIGURE CREDIT-15%..21 CR
EDIT AMOUNT...
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