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Schedule R (Form 1040A or 1040) Department of the Treasury Internal Revenue Service (99) Credit for the Elderly or the Disabled a Complete and attach to Form 1040A or 1040. a Information about Schedule R and its separate instructions is at www.irs.gov/scheduler. 1040A . . . . . . . . . . 1040 R ` OMB No. 1545-0074 20 13 Attachment Sequence No. 16 Name(s) shown on Form 1040A or 1040 Your social security number You may be able to take this credit and reduce your tax if by the end of 2013: • You were age 65 or older or • You were under age 65, you retired on permanent and total disability, and you received taxable disability income. But you must also meet other tests. See instructions. TIP In most cases, the IRS can figure the credit for you. See instructions. Part I Check the Box for Your Filing Status and Age If your filing status is: And by the end of 2013: Check only one box: Single, Head of household, or Qualifying widow(er) 1 You were 65 or older .................... 1 2 You were under 65 and you retired on permanent and total disability . . 2 Married filing jointly 3 Both spouses were 65 or older ................. 3 Both spouses were under 65, but only one spouse retired on permanent and total disability ....................... 5 Both spouses were under 65, and both retired on permanent and total disability ......................... 5 6 One spouse was 65 or older, and the other spouse was under 65 and retired on permanent and total disability ................ 6 7 One spouse was 65 or older, and the other spouse was under 65 and not retired on permanent and total disability ............. 7 Married filing separately 8 You were 65 or older and you lived apart from your spouse for all of 2013 . 8 9 You were under 65, you retired on permanent and total disability, and you lived apart from your spouse for all of 2013 ............ 9 Did you check box 1, 3, 7, or 8? Yes a Skip Part II and complete Part III on the back. No a Complete Parts II and III. Part II Statement of Permanent and Total Disability (Complete only if you checked box 2, 4, 5, 6, or 9 above.) If: 1 You filed a physician’s statement for this disability for 1983 or an earlier year, or you filed or got a statement for tax years after 1983 and your physician signed line B on the statement, and 2 Due to your continued disabled condition, you were unable to engage in any substantial gainful activity in 2013, check this box ............................. a • If you checked this box, you do not have to get another statement for 2013. • If you did not check this box, have your physician complete the statement in the instructions. You must keep the statement for your records. For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11359K Schedule R (Form 1040A or 1040) 2013 3 4 4 ----------------Page (0) Break---------------- Schedule R (Form 1040A or 1040) 2013 Page 2 Part III Figure Your Credit 10 If you checked (in Part I): Enter: Box 1, 2, 4, or 7 ............ $5,000 Box 3, 5, or 6 ............. $7,500 Box 8 or 9 .............. $3,750 } .......... 10 Did you check box 2, 4, 5, 6, or 9 in Part I? Yes a You must complete line 11. No a Enter the amount from line 10 on line 12 and go to line 13. 11 If you checked (in Part I): • Box 6, add $5,000 to the taxable disability income of the spouse who was under age 65. Enter the total. • Box 2, 4, or 9, enter your taxable disability income. • Box 5, add your taxable disability income to your spouse’s taxable disability income. Enter the total. } ....... 11 TIP For more details on what to include on line 11, see Figure Your Credit in the instructions. 12 If you completed line 11, enter the smaller of line 10 or line 11. All others, enter the amount from line 10 ......................... 12 13 Enter the following pensions, annuities, or disability income that you (and your spouse if filing jointly) received in 2013. a Nontaxable part of social security benefits and nontaxable part of railroad retirement benefits treated as social security (see instructions) .................... 13a b Nontaxable veterans’ pensions and any other pension, annuity, or disability benefit that is excluded from income under any other provision of law (see instructions) .......... 13b c Add lines 13a and 13b. (Even though these income items are not taxable, they must be included here to figure your credit.) If you did not receive any of the types of nontaxable income listed on line 13a or 13b, enter -0- on line 13c ......... 13c 14 Enter the amount from Form 1040A, line 22, or Form 1040, line 38 ..... 14 15 If you checked (in Part I): Enter: Box 1 or 2 ...... $7,500 Box 3, 4, 5, 6, or 7 . . . $10,000 Box 8 or 9 ...... $5,000 } 15 16 Subtract line 15 from line 14. If zero or less, enter -0- ......... 16 17 Enter one-half of line 16 ............... 17 18 Add lines 13c and 17 ......................... 18 19 Subtract line 18 from line 12. If zero or less, stop; you cannot take the credit. Otherwise, go to line 20 ............................ 19 20 Multiply line 19 by 15% (.15) ....................... 20 21 Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions . 21 22 Credit for the elderly or the disabled. Enter the smaller of line 20 or line 21. Also enter this amount on Form 1040A, line 30, or include on Form 1040, line 53 (check box and enter “Sch R” on the line next to that box) ................. 22 Schedule R (Form 1040A or 1040) 2013 c this amount on Form 1040A, line 30, or include on Form 1040, line 53 (check box this amount on Form 1040A, line 30, or include on Form 1040, line 53 (check box ----------------Page (1) Break----------------