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previous pagePrevious Page: Instructions for Schedule R (Form 1040), Credit for the Elderly or the Disabled - Part III. Figure Your Credit
next pageNext Page: Instructions for Schedule SE (Form 1040), Self-Employment Tax - 2008 Instructions for Schedule SE (Form 1040)
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taxmap/instr/i1040sr-003.htm#TXMP56251b74

Instructions for Physician's Statement(p4)


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taxmap/instr/i1040sr-003.htm#TXMP04760263

Taxpayer(p4)


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If you retired after 1976, enter the date you retired in the space provided on the statement below.
taxmap/instr/i1040sr-003.htm#TXMP455d3302

Physician(p4)


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A person is permanently and totally disabled if both of the following apply.
  1. He or she cannot engage in any substantial gainful activity because of a physical or mental condition.
  2. A physician determines that the disability has lasted or can be expected to last continuously for at least a year or can lead to death.

Physician's Statement

 I certify that                                                                                          
   Name of disabled person 
was permanently and totally disabled on January 1, 1976, or January 1, 1977, or was permanently and totally disabled on the
date he or she retired. If retired after 1976, enter the date retired.  ▸                              
Physician: Sign your name on either line A or B below.
AThe disability has lasted or can be expected to last continuously for at least a year            
   Physician's signatureDate
BThere is no reasonable probability that the disabled condition will ever improve            
   Physician's signatureDate
Physician's name Physician's address 
    
  
previous pagePrevious Page: Instructions for Schedule R (Form 1040), Credit for the Elderly or the Disabled - Part III. Figure Your Credit
next pageNext Page: Instructions for Schedule SE (Form 1040), Self-Employment Tax - 2008 Instructions for Schedule SE (Form 1040)
 Use previous pagenext page to find additional occurrences of topic items.