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F.1 ending *120180200* F.2 If amending use Form 2012 PIT-X. Social Security Number Print your name (first, middle, last) 1a Blind Over 65 Residency status 1b 1c 1d 1e 1f 2b 2c 2d 2e If taxpayer or spouse died before this return is filed, Enter date of death. 2f Print your spouse's name (first, middle, last) Include spouse if married filing separately. 2a 3a 4. If a deceased taxpayer's refund must be made payable to a person Check this box if the addres.

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