//1ä1SCHEDULE 3 CREDIT FOR THE ELDERLY ORÝ(Form 1040A) DISABLED FOR FORM 1040A FILERSò 1990ò OMB NO. 1545-0085Ýò-OÝò =SSN:ßãNAME*ßFãSSN*Ýò=OÝPART I - FILING STATUS AND AGE (at end of 1990)Ýò-OÝSINGLE 1. You were 65 or olderò. 1. [ ]ß=áÝò 2. Under 65 and retired on disabilityò. 2. [ ]ß=áÝò-OÝMARRIED 3. Both spouses were 65 or olderò. 3. [ ]ß=áÝFILING 4. Both under 65, one disabledò. 4. [ ]ß=áÝJOINTLY 5. Both under 65, both disabledò. 5. [ ]ß=áÝò 6. One 65, one under 65 and disabledò. 6. [ ]ß=áÝò 7. One 65, one under 65 but not disabled.... 7. [ ]ß=áÝò-OÝMARRIED 8. 65 and did not live with spouse in 1990.. 8. [ ]ß=áÝSEPARATE 9. Under 65, disabled, not live with spouse. 9. [ ]ß=áÝò=OÝPART II - DISABILITY STATEMENTÝò-OÝIf: 1. You filed a physician's statement for this disability for 1983 orÝò earlier or physician signed line B on later tax returns, ANDÝÝ 2. You were unable to work in 1990 due to disability, check box. [ ]ßIá Ýò-OÝò Physician's StatementÝò-OÝI Certify that ò_,Ýwas permanently and totally disabled on Jan. 1, 1976 or Jan. 1, 1977, or wasÝpermanently and totally disabled on the date he or she retired. Date retiredÝif retired after Dec. 31, 1976 >>>ß$îá ïÝ ÝPhysician: Sign your name on either line A or B below.Ý ÝA. Disability has lasted or can be expected to last continuously forÝ at least a year.Ý Ýò Signature: ò_ Date: ò_ ßá Ý ÝB. There is no reasonable probability that the disabled condition willÝ ever improve.Ý Ýò Signature: ò_ Date: ò_ ßá Ýò-OÝPhysician's Name:ò | Physician's address:ò |Ýò '|ò %|Ýò-OÝFor Paperwork Reduction Act Notice, see instr.ò Schedule 3 (Form 1040A) 1990ÝAM Software H838ðä2ÝÝSCHEDULE 3 (Form 1040A) 1990ò -Page 2Ýò=OÝPART III - FIGURE CREDITÝò-OÝ10. Enter: $5000 if checked box on line 1, 2, 4, or 7 ORò |Ýò $7500 if checked box on line 3, 5, or 6 ORò |Ýò $3750 if checked box on line 8 or 9ò. 10.|ßDá Ýò A|ò- Ý11. Taxable disability income ò. 11.|ßDáÝò A|ò- Ý12. If you completed line 11, enter smaller of lines 10 and 11. |Ý Otherwise, enter the amount from line 10 on this line.... 12.|ßDáÝò 6ò- |ò- Ý13a Non-taxable social security benefits ò.13a.|ò |ò# ß8áÝò 5|ò- |ò# Ý b Non-taxable pensions and any other benefitò |ò |ò# Ý excluded from income by lawò.13b.|ò |ò# ß8áÝò 5|ò- |ò# Ý c Add lines 13a and 13b ò.13c.|ò |ò# ß8áÝò 5|ò- |ò# Ý14. Amount from Form 1040A, line 17ò.14.|ò |ò# ß8áÝò 5|ò- |ò# Ý15. Enter:$ 7500 if checked 1 or 2ò |ò |ò# Ýò $10000 if checked 3,4,5,6,7ò |ò |ò# Ýò $ 5000 if checked 8 or 9ò.15.|ò |ò# ß8áÝò 5|ò- |ò# Ý16. Subtract line 15 from line 14ò.16.|ò |ò# ß8áÝò 5|ò- |ò# Ý17. Divide line 16 by 2 ò.17.|ò |ò# ß8áÝò 6ò- |ò- Ý18. Add lines 13c and 17. Enter the totalò.18.|ßDáÝò A|ò- Ý19. Subtract line 18 from line 12 ò.19.|ßDáÝò A|ò- Ý20. Percentage used to figure credit ò.20.| x .15Ýò A|ò- Ý21. Line 19 times line 20. Enter on Form 1040A, line 24b.....21.|ßDáÝò=OÝAM Software H838ð//2ä1ôN90A31*ß" XÝÝÝÝßSCH3ÝÝß ãNAME*ßBãSSN*ÝÝÝÝÝÝÝÝÝÝßKáÝÝßKáÝÝßKáÝÝßKáÝÝßKáÝÝÝßKáÝÝÝßKáÝÝÝßKáÝÝÝßKáÝÝÝÝÝÝÝÝßKá ÝÝÝÝÝÝÝÝÝßGá ÝÝÝß.á ÝÝß.á Ýðä2ôN90A32*ß" XÝÝÝÝÝÝÝßDá ÝÝÝÝÝÝÝÝßDáÝÝÝßDáÝÝÝÝÝÝÝÝß5áÝÝÝÝß5áÝÝÝÝÝß5áÝÝß5áÝÝÝÝÝß5áÝÝß5áÝÝß5áÝÝßDáÝÝßDáÝÝÝÝßDáÝðÿÿÿ