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Get Unified Tax Credit For The Elderly - FormSend

Spouse s Social Security Number Spouse s First Name, Middle Initial, Last Name Present Address (Number and street or rural route) City or Town Do Not Write Above You Must File This Form by June 30, 2005 Taxpayer s date of death State Zip Code m m d d 2004 Spouse s date of death m m d d 2004 1. Your age as of December 31, 2004 Spouse s age as of December 31, 2004 2. Were you a resident of Indiana for six months or more during 2004? Yes 3. Was your spouse a resident of In.

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