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IRS1040ScheduleR.xsl
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<?xml version="1.0" encoding="UTF-8"?>
<!-- Last Modified by James Ganzy on 9/14/2010 -->
<xsl:stylesheet xmlns:xsl="http://www.w3.org/1999/XSL/Transform" version="1.0">
<xsl:include href="PopulateTemplate.xsl"/>
<xsl:include href="AddHeader.xsl"/>
<xsl:include href="CommonPathRef.xsl"/>
<xsl:include href="AddOnTable.xsl"/>
<xsl:include href="IRS1040ScheduleRStyle.xsl"/>
<xsl:output method="html" indent="yes"/>
<xsl:strip-space elements="*"/>
<xsl:param name="Form1040ScheduleRData" select="$RtnDoc/IRS1040ScheduleR"/>
<xsl:template match="/">
<html lang="EN-US">
<head>
<title>
<xsl:call-template name="FormTitle">
<xsl:with-param name="RootElement" select="local-name($Form1040ScheduleRData)"/>
</xsl:call-template>
</title>
<!-- No Browser Caching -->
<meta http-equiv="Pragma" content="no-cache"/>
<meta http-equiv="Cache-Control" content="no-cache"/>
<meta http-equiv="Expires" content="0"/>
<!-- No Proxy Caching -->
<meta http-equiv="Cache-Control" content="private"/>
<!-- Define Character Set -->
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1"/>
<meta name="Description" content="IRS Form 1040ScheduleR"/>
<script language="JavaScript" src="{$ScriptPath}/FormDisplay.js" type="text/javascript"/>
<xsl:call-template name="InitJS"/>
<style type="text/css">
<xsl:if test="not($Print) or $Print=''">
<!-- Form 1040ScheduleR CSS Styles are located in the template called below -->
<xsl:call-template name="IRS1040ScheduleRStyle"/>
<xsl:call-template name="AddOnStyle"/>
</xsl:if>
</style>
<xsl:call-template name="GlobalStylesForm"/>
</head>
<body class="styBodyClass">
<form name="Form1040ScheduleR">
<!-- WARNING LINE -->
<xsl:call-template name="DocumentHeader"/>
<!-- Begin Form Number and Name -->
<div class="styBB" style="width:187mm;height:7mm;">
<div class="styFNBox" style="width:31mm;height:7mm;">
<div style="line-height:180%;">
<span class="styFormNumber" style="font-size:9pt;">Schedule R</span>
<br/>
<span class="styFormNumber" style="font-size:8pt;padding-top:7mm;">(Form 1040A<br/>or 1040)</span>
</div>
<div style="padding-top:1.3mm;">
<span class="styAgency">Department of the Treasury</span>
<br/>
<span class="styAgency">Internal Revenue Service <span style="width:3mm"/> (99)</span>
</div>
</div>
<div class="styFTBox" style="width:110.6mm;height:7mm; padding-top:1.7mm;">
<div class="styLNDesc" style="height:10mm;font-size: 13pt;font-weight: bold;width:109.6mm;padding-bottom:4.3mm;text-align:right;padding-right:9.6mm">Credit for the Elderly or the Disabled
</div><span style="font-weight:bold;">
<i>See separate instructions.</i></span><br/>
<div class="styFBT" style="height:4mm;width:80mm;font-style:italic;padding-top:0mm;padding-bottom:0mm;">
Complete and attach to Form 1040A or 1040.
</div>
</div>
<div class="styLNDesc" style="height:5mm;width:12mm;padding-top:4mm;">
<img src="{$ImagePath}/1040SchR_Top_Forms.gif" alt="Bullet Image"/>
</div>
<div class="styTYBox" style="width:30mm;height:7mm;">
<div class="styOMB" style="height:2mm;">OMB No. 1545-0074</div>
<div class="styTaxYear">20<span class="styTYColor">12</span>
</div>
<div style="margin-left:3mm; text-align:left;padding-top:1.5mm;">
Attachment<br/>Sequence No. <span class="styBoldText">16</span>
</div>
</div>
</div>
<!-- End Form Number and Name section -->
<div class="styBB" style="width:187mm;">
<div class="styNameBox" style="width:140mm;height:8mm;font-size:7pt;">
Name(s) shown on Form 1040A or 1040<br/>
<xsl:call-template name="PopulateReturnHeaderFiler">
<xsl:with-param name="TargetNode">Name</xsl:with-param>
</xsl:call-template>
</div>
<div class="styEINBox" style="width:45mm;height:8mm;font-size:7pt;padding-left:2mm;">
Your social security number<br/>
<span class="styEINFld" style="width:30mm; text-align:left;font-weight:normal;">
<xsl:call-template name="PopulateReturnHeaderFiler">
<xsl:with-param name="TargetNode">PrimarySSN</xsl:with-param>
</xsl:call-template>
</span>
</div>
</div>
<div class="styNBB" style="width:187mm;font-size:8.5pt;padding-top:1.5mm;">
<div class="styLNDesc" style="width:187mm;height:2mm;padding-top:1.5mm;">
You may be able to take this credit and reduce your tax if by the end of 2012:</div>
<div class="styLNDesc" style="width:53mm;height:2mm;">
<img src="{$ImagePath}/1040SchR_Bullet_Round.gif" alt="Bullet Image"/>
You were age 65 or older <span class="styBoldText">
<span style="width:8px"/>or</span>
</div>
<div class="styLNDesc" style="width:4mm;height:2mm;">
<img src="{$ImagePath}/1040SchR_Bullet_Round.gif" alt="Bullet Image"/>
<span style="width:2px;"/>
</div>
<div class="styLNDesc" style="width:125mm;height:2mm;">
You were under age 65, you retired on <b>permanent and total </b>disability, and<br/>
you received taxable disability income.</div>
</div>
<div class="styBB" style="width:187mm;font-size:8.5pt;">
<div class="styLNDesc" style="width:187mm;height:2mm;">
But you must also meet other tests. See instructions.</div>
<div class="styLNDesc" style="width:187mm;height:2mm;padding-bottom:2.5mm;">
<img src="{$ImagePath}/1040SchR_Tip.gif" alt="Tip Image"/>
<span style="height:2mm;padding-left:1mm;padding-bottom:1.5mm;">In most cases, the IRS can figure the credit for you. See instructions.</span>
</div>
</div>
<!-- BEGIN Part I Title -->
<div class="styBB" style="width:187mm;">
<div class="styPartName" style="width:12mm;font-size: 9pt;">Part l</div>
<div class="styPartDesc" style="font-size: 9pt;padding-left:6mm;width:160mm;">Check the Box for Your Filing Status and Age</div>
</div>
<!-- END Part I Title -->
<div class="styBB" style="width:187mm;font-size: 9pt;">
<span class="styBoldText">
<span style="width:55mm;">If your filing status is: </span>
<span style="width:85mm;font-size: 9pt;">And by the end of 2012:</span>
<span style="width:46.5mm;font-size: 9pt;text-align:right;">Check only one box:</span>
</span>
</div>
<!-- Primary 65 or Older Ind. -->
<div class="styNBB" style="width:187mm;height:2mm;font-size: 8.5pt;padding-top:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;padding-bottom:0mm;">Single,<br/>Head of household, or</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">1</div>
<div class="styLNDesc" style="width:118mm;padding-bottom:0mm;">
<span style="float:left;clear:none;">
You were 65 or older
</span>
<!--Dotted Line-->
<span class="styDotLn" style="float:right;clear:none;padding-right:2mm;">....................</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">1</div>
<div class="styForm1040SchRCkBox" style="width:12mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/Primary65OrOlderInd"/>
<xsl:with-param name="BackupName">SchRPrimary65OrOlderInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/Primary65OrOlderInd"/>
<xsl:with-param name="BackupName">SchRPrimary65OrOlderInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<!-- Under 65 Retired on Permanent Disability -->
<div class="styBB" style="width:187mm;height:2mm;font-size: 8pt;padding-top:0mm;padding-bottom:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;">Qualifying widow(er)</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">2</div>
<div class="styLNDesc" style="width:118mm;">
<span style="float:left;clear:none;">
You were under 65 and you retired on permanent and total disability
</span>
<!--Dotted Line-->
<span class="styDotLn" style="float:right;clear:none;padding-right:2mm;">...</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">2</div>
<div class="styForm1040SchRCkBox" style="width:12mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/Und65RtdPermnntTotDsbltyInd"/>
<xsl:with-param name="BackupName">SchRUnd65RtdPermnntTotDsbltyInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/Und65RtdPermnntTotDsbltyInd"/>
<xsl:with-param name="BackupName">SchRUnd65RtdPermnntTotDsbltyInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<!-- Both Spouses 65 or Older -->
<div class="styNBB" style="width:187mm;height:2mm;font-size: 8.5pt;padding-top:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;padding-bottom:0mm;"/>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">3</div>
<div class="styLNDesc" style="width:118mm;padding-bottom:0mm;">
<span style="float:left;clear:none;">
Both spouses were 65 or older
</span>
<!--Dotted Line-->
<span class="styDotLn" style="float:right;clear:none;padding-right:2mm;">................</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">3</div>
<div class="styForm1040SchRCkBox" style="width:12mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/BothSpouses65OrOlderInd"/>
<xsl:with-param name="BackupName">SchRBothSpouses65OrOlderInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/BothSpouses65OrOlderInd"/>
<xsl:with-param name="BackupName">SchRBothSpouses65OrOlderInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<!-- Both Under 65, One Retired on Permanent Disability -->
<div class="styNBB" style="width:187mm;height:2mm;font-size: 8.5pt;padding-top:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;padding-bottom:0mm;"/>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">4</div>
<div class="styLNDesc" style="width:118mm;padding-bottom:0mm;">
Both spouses were under 65, but only one spouse retired on permanent and<br/>
total disability
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:2mm;">......................</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-top:4mm;padding-left:0mm;">4</div>
<div class="styForm1040SchRCkBox" style="width:12mm;padding-top:4mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/BothUnder65OneRtdDsbltyInd"/>
<xsl:with-param name="BackupName">SchRBothUnder65OneRtdDsbltyInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/BothUnder65OneRtdDsbltyInd"/>
<xsl:with-param name="BackupName">SchRBothUnder65OneRtdDsbltyInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<!-- Both Under 65, Both Retired on Permanent Disability -->
<div class="styNBB" style="width:187mm;height:2mm;font-size: 8.5pt;padding-top:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;padding-bottom:0mm;">Married filing<br/>jointly</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">5</div>
<div class="styLNDesc" style="width:118mm;padding-bottom:0mm;">
Both spouses were under 65, and both retired on permanent and total<br/>
disability
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:2mm;">........................</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-top:4mm;padding-left:0mm;">5</div>
<div class="styForm1040SchRCkBox" style="width:11mm;padding-top:4mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/BothUnder65BothRtdDsbltyInd"/>
<xsl:with-param name="BackupName">SchRBothUnder65BothRtdDsbltyInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/BothUnder65BothRtdDsbltyInd"/>
<xsl:with-param name="BackupName">SchRBothUnder65BothRtdDsbltyInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<!-- One Over 65, Other Retired on Permanent Disability -->
<div class="styNBB" style="width:187mm;height:2mm;font-size: 8.5pt;padding-top:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;padding-bottom:0mm;"/>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">6</div>
<div class="styLNDesc" style="width:118mm;padding-bottom:0mm;">One spouse was 65 or older, and
the other spouse was under 65 and retired<br/>on permanent and total disability
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:1mm;">...............</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-top:4mm;padding-left:0mm;">6</div>
<div class="styForm1040SchRCkBox" style="width:12mm;padding-top:4mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/One65OrOlderOtherRtdDsbltyInd"/>
<xsl:with-param name="BackupName">SchROne65OrOlderOtherRtdDsbltyInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/One65OrOlderOtherRtdDsbltyInd"/>
<xsl:with-param name="BackupName">SchROne65OrOlderOtherRtdDsbltyInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<!-- One Over 65, Other Not Retired -->
<div class="styBB" style="width:187mm;height:2mm;font-size: 8.5pt;padding-top:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;padding-bottom:0mm;"/>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">7</div>
<div class="styLNDesc" style="width:118mm;padding-bottom:0mm;">
One spouse was 65 or older, and the other spouse was under 65 and <b>not </b><br/>
retired on permanent and total disability
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:2mm;">.............</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-top:4mm;padding-left:0mm;">7</div>
<div class="styForm1040SchRCkBox" style="width:12mm;padding-top:4mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/One65OrOlderOtherNotRtdInd"/>
<xsl:with-param name="BackupName">SchROne65OrOlderOtherNotRtdInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/One65OrOlderOtherNotRtdInd"/>
<xsl:with-param name="BackupName">SchROne65OrOlderOtherNotRtdInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<!-- Over 65, Did Not Live With Spouse -->
<div class="styNBB" style="width:187mm;height:2mm;font-size: 8.5pt;padding-top:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;padding-top:4mm;padding-bottom:0mm;">Married filing<br/>separately</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">8</div>
<div class="styLNDesc" style="width:118mm;padding-bottom:0mm;">
<span style="float:left;clear:none;">
You were 65 or older and you lived apart from your spouse for all of 2012
</span>
<!--Dotted Line-->
<span class="styDotLn" style="float:right;clear:none;padding-right:2mm;">.</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-top:1mm;padding-left:0mm;">8</div>
<div class="styForm1040SchRCkBox" style="width:12mm;padding-top:1mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/Age65OrOldrNotLvngTogetherInd"/>
<xsl:with-param name="BackupName">SchRAge65OrOldrNotLvngTogetherInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/Age65OrOldrNotLvngTogetherInd"/>
<xsl:with-param name="BackupName">SchRAge65OrOldrNotLvngTogetherInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<!-- Under 65, Did Not Live With Spouse -->
<div class="styBB" style="width:187mm;height:2mm;font-size: 8.5pt;padding-bottom:2mm;float:left;clear:none;">
<div class="styLNDesc" style="width:45mm;padding-bottom:0mm;"/>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-left:0mm;">9</div>
<div class="styLNDesc" style="width:118mm;padding-bottom:0mm;">
You were under 65, you retired on permanent and total disability, and you<br/>
lived apart from your spouse for all of 2012
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:1mm;">............</span>
</div>
<div class="styForm1040SchRLNRightNumBox" style="height:2mm;width:6mm;padding-top:4mm;padding-left:0mm;">9</div>
<div class="styForm1040SchRCkBox" style="width:12mm;padding-top:4mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/Under65DidNotLiveTogetherInd"/>
<xsl:with-param name="BackupName">SchRUnder65DidNotLiveTogetherInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/Under65DidNotLiveTogetherInd"/>
<xsl:with-param name="BackupName">SchRUnder65DidNotLiveTogetherInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<div class="styBB" style="width:187mm;font-size: 8.5pt;padding-top:.5mm;padding-bottom:.5mm;float:left;clear:none;">
<div class="styPartDesc" style="width:32mm;height:2mm;padding-left:.5mm;
padding-top:1.5mm;padding-bottom:1.5mm;border-style: solid; border-color: black;
border-top-width: 2px;border-bottom-width: 2px; border-left-width: 2px;border-right-width: 2px;">
Did you check<br/>box 1, 3, 7, or 8?
</div>
<div class="styPartDesc" style="width:120mm;height:2mm;padding-left:0mm;padding-top:0mm;padding-bottom:0mm;float:left;clear:none;">
<div class="styLNDesc" style="padding-bottom:1mm;">
<img src="{$ImagePath}/1040SchR_Line.gif" alt="Line Image"/> Yes
<img src="{$ImagePath}/1040SchR_Line.gif" alt="Line Image"/>
<img src="{$ImagePath}/1040SchR_Bullet_Sm.gif" alt="Bullet Image"/>
<span style="width:2mm;"/>
<span style="font-weight:normal;">Skip Part ll and complete Part lll on the back.</span>
</div>
<img src="{$ImagePath}/1040SchR_Line.gif" alt="Line Image"/> No <span style="width:1mm;"/>
<img src="{$ImagePath}/1040SchR_Line.gif" alt="Line Image"/>
<img src="{$ImagePath}/1040SchR_Bullet_Sm.gif" alt="Bullet Image"/>
<span style="width:2mm;"/>
<span style="font-weight:normal;">Complete Parts ll and lll.</span>
</div>
</div>
<!-- BEGIN Part II Title Statement of Permanent and Total Disability-->
<div class="styBB" style="width:187mm;">
<div class="styPartName" style="width:14mm;font-size: 9pt;">Part ll</div>
<div class="styPartDesc" style="width:173mm;font-size: 8.5pt;padding-left:4mm;">Statement of Permanent and Total Disability
<span style="font-weight:normal;"> (Complete </span>only<span style="font-weight:normal;"> if you checked box 2, 4, 5, 6, or 9 above.)</span>
</div>
</div>
<!-- END Part II Title -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;padding-left:0mm;padding-top:1mm;padding-bottom:.5mm;float:left;clear:none;">
<div class="styPartDesc" style="width:5mm;padding-right:1mm;padding-bottom:0mm;">If:</div>
<div class="styLNLeftNumBox" style="height:2mm;width:5mm;">1</div>
<div class="styLNDesc" style="width:163mm;padding-left:0mm;padding-bottom:0mm;">You filed a physician’s statement for this disability for 1983 or
an earlier year, or you filed or got a<br/>statement for tax years after 1983 and your physician signed line B on the statement,<b> and</b>
</div>
</div>
<!-- Prior Year Statement Indicator -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;padding-left:0mm;padding-top:1mm;padding-bottom:.5mm;float:left;clear:none;">
<div class="styForm1040SchRLNRightNumBox" style="width:6mm;padding-top:1mm;padding-left:9mm;float:left;clear:none;">2</div>
<div class="styLNDesc" style="width:162mm;padding-left:2mm;padding-right:0mm;padding-top:.5mm;padding-bottom:0mm;float:left;clear:none;">
Due to your continued disabled condition, you were unable to engage in any substantial gainful activity<br/>in 2012, check this box
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:1mm;">..........................</span>
<xsl:call-template name="LinkToLeftoverDataTableInline">
<xsl:with-param name="Desc">Part II Line 2 - Spouse Name</xsl:with-param>
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/PriorYearStatementInd/@spouseName"/>
</xsl:call-template>
<xsl:call-template name="LinkToLeftoverDataTableInline">
<xsl:with-param name="Desc">Part II Line 2 - Person First Name</xsl:with-param>
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/PriorYearStatementInd/@personFirstName"/>
</xsl:call-template>
<span style="width:3px;"/>
<img src="{$ImagePath}/1040SchR_Bullet_Sm.gif" alt="Bullet Image"/>
<span style="width:3mm"/>
</div>
<div class="styForm1040SchRCkBox" style="width:12mm;padding-top:4mm;">
<span style="width:2mm;"/>
<span style="width:1px;"/>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/PriorYearStatementInd"/>
<xsl:with-param name="BackupName">SchRPriorYearStatementInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/PriorYearStatementInd"/>
<xsl:with-param name="BackupName">SchRPriorYearStatementInd</xsl:with-param>
</xsl:call-template>
</label>
</div>
</div>
<div class="styNBB" style="width:187mm;font-size: 8.5pt;padding-left:10mm;padding-top:1mm;padding-bottom:.5mm;float:left;clear:none;">
<div class="styPartDesc" style="width:5mm;padding-right:1mm;padding-bottom:0mm;">
<img src="{$ImagePath}/1040SchR_Bullet_Round.gif" alt="Bullet Image"/>
</div>
<div class="styLNDesc" style="width:163mm;padding-left:.5mm;padding-right:2mm;padding-top:.5mm;padding-bottom:0mm;float:left;clear:none;">
If you checked this box, you do not have to get another statement for
2012.
</div>
</div>
<div class="styBB" style="width:187mm;font-size: 8.5pt;padding-left:10mm;padding-top:1mm;padding-bottom:.5mm;float:left;clear:none;">
<div class="styPartDesc" style="width:5mm;padding-right:1mm;padding-bottom:0mm;">
<img src="{$ImagePath}/1040SchR_Bullet_Round.gif" alt="Bullet Image"/>
</div>
<div class="styLNDesc" style="width:163mm;padding-left:.5mm;padding-right:2mm;padding-top:.5mm;padding-bottom:0mm;float:left;clear:none;">
If you <b>did not </b>check this box, have your physician complete the
statement on the last page of the instructions. You<b> must</b> keep the statement for your records.
</div>
</div>
<!-- Start of Page End For Page 1 -->
<div style="width:187mm;padding-top:1mm;padding-bottom:4mm;font-size:6.5pt;">
<div style="width:105mm;font-weight:bold;float:left;clear:none;">For Paperwork Reduction Act Notice, see your tax return instructions.</div>
<div style="width:25mm;float:left;clear:none;">Cat. No. 11359K</div>
<div class="styPartDesc" style="width:55mm;text-align:right;font-size:6.5pt;float:right;clear:none;">Schedule R (Form 1040A or 1040) 2012</div>
</div>
<!-- END of Page 1 -->
<div class="pageEnd" style="width:187mm;"/>
<!-- Start of Page 2 -->
<div class="styBB" style="width:187mm;font-size:7pt;">
<div class="styLNDesc" style="width:90mm;padding-top:0mm;">Schedule R (Form 1040A or 1040) 2012</div>
<div class="styLNDesc" style="width:90mm;text-align:right;float:right;clear:none;">Page
<span class="styBoldText" style="font-size:8pt;">2 </span>
</div>
</div>
<!-- BEGIN Part III Title Figure Your Credit-->
<div class="styBB" style="width:187mm;">
<div class="styPartName" style="width:14mm;font-size: 9pt;">Part lll</div>
<div class="styPartDesc" style="width:173mm;font-size: 9pt;padding-left:4mm;">Figure Your Credit
</div>
</div>
<!-- END Part III Title -->
<!-- Filing Status Amount -->
<div class="styNBB" style="width:187mm;font-size:8.5pt;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:4.5mm;padding-left:0mm;padding-top:2mm;">10</div>
<div class="styLNDesc" style="width:80.5mm;height:2mm;padding-top:2mm;">
<b> If you checked (in Part l):</b>
</div>
<div class="styLNDesc" style="width:60mm;height:2mm;padding-right:0mm;padding-top:2mm;">
<b>Enter:</b>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:8mm;width:5.7mm;padding-top:0mm;text-align:center;border-style:solid;
border-right-width:0px;border-left-width:1px;border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:8mm;padding-top:0mm;border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<div class="styNBB" style="width:187mm;font-size:8.5pt;">
<span style="float:left;"><div class="styLNDesc" style="width:100.1mm;height:2mm;padding-left:8mm;padding-top:0mm;padding-right:5px;"><span style="float:left;">Box 1, 2, 4, or 7
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:1mm;">............</span></span><span style="float:right;">$5,000</span>
<span style="float:left;">Box 3, 5, or 6
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:1mm;">.............</span></span><span style="float:right;">$7,500</span>
<span style="float:left;">Box 8 or 9
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:1.5mm;">..............</span></span><span style="float:right;">$3,750</span>
</div>
<div class="styLNDesc" style="height:8mm;width:1mm;padding-top:0mm;">
<img src="{$ImagePath}/1040SchR_Bracket_Sm.gif" alt="Bullet Image"/>
</div>
<div class="styLNDesc" style="height:10mm;width:47.1mm;padding-top:3.5mm;">
<span class="styDotLn" style="float:none;clear:none;padding-left:1.5mm;">.........</span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:14px;width:5.7mm;padding-top:0mm;
padding-bottom:.1mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:14px;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/>
<div class="styLNRightNumBox" style="height:1mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">10
</div>
<div class="styLNAmountBox" style="height:1mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/FilingStatusAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:5.6mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:5.6mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<div class="styNBB" style="width:187mm;font-size: 8.5pt;padding-top:0mm;padding-left:8mm;float:left;clear:none;">
<div class="styPartDesc" style="width:27mm;height:2mm;padding-left:.5mm;border-style: solid;
border-color: black;border-top-width: 2px;
border-bottom-width: 2px; border-left-width: 2px;border-right-width: 2px;float:left;clear:none;">
Did you check<br/>box 2, 4, 5, 6,<br/>or 9 in Part l?
</div>
<div class="styPartDesc" style="width:53mm;height:1mm;padding-left:0mm;padding-top:0mm;
float:left;clear:none;">
<img src="{$ImagePath}/1040SchR_Long_Line.gif" alt="Line Image"/> Yes
<img src="{$ImagePath}/1040SchR_Long_Line.gif" alt="Line Image"/>
<img src="{$ImagePath}/1040SchR_Bullet_Sm.gif" alt="Bullet Image"/>
</div>
<div class="styPartDesc" style="width:61.3mm;height:1mm;padding-top:0mm;float:left;clear:none;">
<span style="width:2mm;"/>
<span style="font-weight:normal;">You<b> must </b>complete line 11.</span>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:6.5mm;width:5.7mm;padding-top:0mm;
text-align:center;border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:6.5mm;padding-top:0mm;border-left:1px solid black;
border-bottom-width:0px;border-right-width:0px;"/>
<div class="styPartDesc" style="width:53mm;height:1mm;padding-top:0mm;padding-left:0mm;
float:left;clear:none;">
<img src="{$ImagePath}/1040SchR_Long_Line.gif" alt="Line Image"/> No
<span style="width:1mm;"/>
<img src="{$ImagePath}/1040SchR_Long_Line.gif" alt="Line Image"/>
<img src="{$ImagePath}/1040SchR_Bullet_Sm.gif" alt="Bullet Image"/>
</div>
<div class="styPartDesc" style="width:61.3mm;height:2mm;float:left;clear:none;">
<span style="width:2mm;"/>
<span style="font-weight:normal;">
Enter the amount from line 10</span><br/>
<span style="width:2mm;"/>
<span style="font-weight:normal;">
on line 12 and go to line 13.</span>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:6.8mm;width:5.7mm;padding-top:0mm;
text-align:center;border-style:solid;border-right-width:0px;border-left-width:1px;border-top-width:0px;
border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:6.8mm;padding-top:0mm;border-left:1px solid black;
border-bottom-width:0px;border-right-width:0px;width:10mm;"/>
</div>
<!-- Taxable Disability -->
<div class="styNBB" style="width:187mm;font-size:8.5pt;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:2mm;padding-left:0mm;padding-top:0mm;">11</div>
<div class="styLNDesc" style="width:140.5mm;height:2mm;padding-top:0mm;">
<b> If you checked (in Part l):</b>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:5mm;width:5.7mm;padding-top:0mm;
text-align:center;border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:5mm;padding-top:0mm;border-left:1px solid black;
border-bottom-width:0px;border-right-width:0px;"/></span>
<span style="float:left;"><div class="styLNDesc" style="width:102.2mm;height:14mm;padding-left:8mm;padding-top:0mm;">
<img src="{$ImagePath}/1040SchR_Bullet_Round.gif" alt="Bullet Image"/>
Box 6, add $5,000 to the taxable disability income of the<br/>
<span style="width:3mm;"/> spouse who was under age 65. Enter the total.<br/>
<img src="{$ImagePath}/1040SchR_Bullet_Round.gif" alt="Bullet Image"/>
Box 2, 4, or 9, enter your taxable disability income.<br/>
<img src="{$ImagePath}/1040SchR_Bullet_Round.gif" alt="Bullet Image"/>
Box 5, add your taxable disability income to your spouse’s<br/>
<span style="width:3mm;"/> taxable disability income. Enter the total.
</div>
<div class="styLNDesc" style="height:14mm;width:1mm;padding-top:0mm;">
<img src="{$ImagePath}/1040SchR_Bracket_Lg.gif" alt="Bullet Image"/>
</div>
<div class="styLNDesc" style="height:14mm;width:45mm;padding-top:7mm;">
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:1.5mm;">..........</span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:7mm;width:5.7mm;padding-top:0mm;
padding-bottom:.1mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:7mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/>
<div class="styLNRightNumBox" style="height:2mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">11
</div>
<div class="styLNAmountBox" style="height:2mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/TaxableDisabilityAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:9.5mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:9.5mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
<span style="float:left;"><div class="styLNDesc" style="width:148.5mm;height:2mm;">
<img src="{$ImagePath}/1040SchR_Tip.gif" alt="Tip Image"/>
<span style="height:2mm;padding-bottom:1mm;padding-left:2mm;">For more details on what to
include on line 11, See instructions.</span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:8mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:8mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<!-- Smaller of Filing Status Amount or Taxable -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:2mm;padding-left:0mm;padding-top:0mm;">12</div>
<div class="styLNDesc" style="width:140.5mm;height:4mm;padding-top:0mm;">If you completed line 11,
enter the<b> smaller </b>of line 10 or line 11.<b> All others, </b>enter the<br/>amount from line 10
<!--Dotted Line-->
<span class="styDotLn" style="float:none;clear:none;padding-left:.5mm;">.........................</span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:7mm;width:5.7mm;padding-top:4mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">
<span style="height:3.5mm;font-size: 8.5pt;width:5mm;padding-bottom:0mm;
background-color: white;">12</span>
</div>
<div class="styLNAmountBox" style="height:7mm;padding-top:4mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/SmallerOfFSOrTaxableAmt"/>
</xsl:call-template>
</div></span>
</div>
<!-- Nontaxable Social Security and Railroad Benefits Amount -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;padding-top:0mm;
padding-bottom:0mm;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:4mm;padding-left:0mm;padding-top:0mm;
padding-bottom:0mm;">13</div>
<div class="styLNDesc" style="height:4mm;width:102.4mm;padding-top:0mm;
padding-bottom:0mm;">
Enter the following pensions, annuities, or disability income that<br/>you (and your spouse if filing jointly) received in 2012.
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:7.3mm;width:5.9mm;border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:7.3mm;
border-left-width:1px solid black;border-bottom-width:0px;border-right-width:0px;"/>
<div class="styForm1040SchRColBoxGrey" style="height:7.3mm;width:5.7mm;
border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:7.3mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<div class="styNBB" style="width:187mm;font-size: 7.5pt;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftLtrBox" style="height:2mm;">a</div>
<div class="styLNDesc" style="width:102.4mm;height:4mm;">
Nontaxable part of social security benefits and nontaxable part of <br/>railroad retirement benefits
treated as social security (see <br/>
<span style="float:left;">instructions)</span>
<!--Dotted Line-->
<span class="styDotLn" style="float:right;padding-right:2mm;">...................</span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:11.2mm;width:5.9mm;padding-top:7mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">
<span style="height:4mm;font-size: 7.5pt;width:5.6mm;background-color: white;">13a</span>
</div>
<div class="styLNAmountBox" style="height:11.2mm;padding-top:7.8mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/NontxSocSecAndRlrdBenefitsAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:11.2mm;width:5.7mm;
text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:11.2mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<!-- Nontaxable Other Amount -->
<div class="styNBB" style="width:187mm;font-size: 7.5pt;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftLtrBox" style="height:7mm;">b</div>
<div class="styLNDesc" style="width:102.4mm;height:11.3mm;">
Nontaxable veterans’ pensions and any other pension, annuity, or <br/>disability benefit
that is excluded from income under any other<br/>
<span style="float:left;">provision of law (see instructions)</span>
<!--Dotted Line-->
<span class="styDotLn" style="float:right;padding-right:2mm;">............</span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:11.3mm;width:5.9mm;padding-top:7.1mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">
<span style="height:4mm;font-size: 7.5pt;width:5.6mm;background-color:white;">13b</span>
</div>
<div class="styLNAmountBox" style="height:11.3mm;padding-top:7.9mm;padding-bottom:0mm;
border-left-width:1px solid black;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/NontaxableOtherAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:11.3mm;width:5.7mm;
padding-bottom:0mm;border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;"/>
<div class="styLNAmountBox" style="height:11.3mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<!-- Total Nontaxable Amount -->
<div class="styNBB" style="width:187mm;font-size: 7.5pt;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftLtrBox" style="height:2mm;">c</div>
<div class="styLNDesc" style="width:102.4mm;height:12mm;padding-bottom:0mm;">
Add lines 13a and 13b. (Even though these income items are not<br/>taxable, they
<span class="styBoldText"> must</span> be included here to figure your credit.)
If you<br/>did not receive any of the types of nontaxable income
listed on<br/>line 13a or 13b, enter -0- on line 13c
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:2mm;">...........</span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:14.4mm;width:5.9mm;padding-top:10mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">
<span style="height:4mm;font-size: 7.5pt;width:5.6mm;background-color: white;">13c</span>
</div>
<div class="styLNAmountBox" style="height:14.4mm;padding-bottom:0mm;padding-top:10.7mm;
border-left-width:1px;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/TotalNontaxableAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:14.4mm;width:5.7mm;padding-top:8.9mm;
padding-bottom:1.5mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:14.4mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<!-- Tax Return AGI Amount -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:4mm;padding-left:0mm;padding-top:0mm;">14</div>
<div class="styLNDesc" style="width:64.3mm;height:4mm;padding-top:0mm;padding-bottom:0mm;">
Enter the amount from Form 1040A, <br/>line 22, or Form 1040, line 38
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:2mm;">....</span>
</div></span>
<span style="float:right;"><div class="styLNRightNumBox" style="height:7.8mm;width:6mm;padding-top:3.7mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:1px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">14
</div>
<div class="styLNAmountBox" style="height:7.8mm;padding-top:3.7mm;padding-bottom:0mm;
border-left-width:0px;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/TaxReturnAGIAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:7.8mm;width:5.9mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:7.8mm;padding-top:0mm;padding-bottom:0mm;
border-left-width:1px;border-bottom-width:0px;border-right-width:0px;"/>
<div class="styForm1040SchRColBoxGrey" style="height:7.8mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:7.8mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<!-- Exemption Amount -->
<div class="styNBB" style="width:187mm;font-size:8.5pt;">
<span style="float:left;"><div class="styLNLeftNumBox" style="padding-left:0mm;">15</div>
<div class="styLNDesc" style="width:64.3mm;padding-right:15px;">
<span style="float:left;"><b> If you checked (in Part l):</b></span>
<span style="float:right;"><b>Enter:</b></span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:4.8mm;width:6mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:1px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="padding-top:0mm;padding-bottom:0mm;
border-left-width:0px;border-bottom-width:0px;border-right-width:0px;"/>
<div class="styForm1040SchRColBoxGrey" style="height:4.8mm;width:5.9mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:4.8mm;padding-top:0mm;padding-bottom:0mm;
border-left-width:1px;border-bottom-width:0px;border-right-width:0px;"/>
<div class="styForm1040SchRColBoxGrey" style="height:4.8mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:4.8mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<div class="styNBB" style="width:187mm;font-size:8.5pt;">
<span style="float:left;"><div class="styLNDesc" style="width:69.6mm;height:auto;padding-left:8mm;padding-top:0mm;padding-right:5px;"><span style="float:left;">Box 1 or 2
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:2mm;">.......</span></span><span style="float:right;">$7,500</span>
<span style="float:left;">
Box 3, 4, 5, 6, or 7
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:0mm;">....</span></span><span style="float:right;">$10,000</span>
<span style="float:left;">
Box 8 or 9
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:2mm;">.......</span></span><span style="float:right;">$5,000</span>
</div>
<div class="styLNDesc" style="height:4mm;width:2.6mm;padding-top:0mm;">
<img src="{$ImagePath}/1040SchR_Bracket_Sm.gif" alt="Bullet Image"/>
</div></span>
<div class="styLNAmountBox" style="height:7.5mm;padding-top:0mm;padding-bottom:0mm;
border-left-width:1px;border-bottom-width:0px;border-right-width:0px;float:right"/>
<div class="styForm1040SchRColBoxGrey" style="height:7.5mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;float:right"/>
<div class="styLNAmountBox" style="height:7.5mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;float:right"/>
<div class="styForm1040SchRColBoxGrey" style="height:7.5mm;width:5.9mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;float:right"/>
<div class="styLNAmountBox" style="height:7.5mm;padding-top:3.5mm;padding-bottom:0mm;
border-left-width:0px;border-bottom-width:1px;border-right-width:0px;float:right">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/ExemptionAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:7.5mm;width:6mm;padding-top:3.5mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:1px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;float:right">
<span style="height:3.5mm;font-size:8.5pt;width:5.4mm;background-color: white;">15</span>
</div>
<!-- Start -->
<div class="styLNAmountBox" style="height:5.8mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;float:right;"/>
<div class="styForm1040SchRColBoxGrey" style="height:5.8mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;border-left-width:1px;
border-top-width:0px;border-bottom-width:0px;border-color:black;float:right;"/>
<div class="styLNAmountBox" style="height:5.8mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;float:right;"/>
<div class="styForm1040SchRColBoxGrey" style="height:5.8mm;width:5.9mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;float:right;"/>
<div class="styLNAmountBox" style="height:5.8mm;padding-top:0mm;padding-bottom:0mm;float:right;
border-left:0px solid black;border-bottom-width:0px;border-right-width:0px;"/>
<div class="styForm1040SchRColBoxGrey" style="height:5.8mm;width:6mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:1px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;float:right;"/>
</div>
<!-- Adjusted Gross Income Amount -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;padding-top:0mm;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:4mm;padding-left:0mm;padding-top:0mm;">16</div>
<div class="styLNDesc" style="width:64.3mm;height:4mm;padding-top:0mm;padding-bottom:0mm;">
Subtract line 15 from line 14. If zero or<br/>less, enter -0-
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:1mm;">..........</span>
</div></span>
<span style="float:right;"><div class="styForm1040SchRColBoxGrey" style="height:4mm;width:6mm;padding-top:3.7mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:1px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">
<span style="height:3.5mm;font-size:8.5pt;width:5mm;background-color: white;">16</span>
</div>
<div class="styLNAmountBox" style="height:4mm;padding-top:3.7mm;padding-bottom:0mm;
border-left-width:0px;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/AGIAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:7.8mm;width:5.9mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:7.8mm;padding-top:0mm;padding-bottom:0mm;
border-left-width:1px;border-bottom-width:0px;border-right-width:0px;"/>
<div class="styForm1040SchRColBoxGrey" style="height:7.8mm;width:5.7mm;padding-top:0mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:7.8mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<!-- Half Adjusted Gross Income Amount -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;padding-top:0mm;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:4mm;padding-left:0mm;padding-top:1mm;">17</div>
<div class="styLNDesc" style="width:102.4mm;height:4mm;padding-top:1mm;padding-bottom:0mm;">
Enter one-half of line 16
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:1mm;">...............</span>
</div></span>
<span style="float:right;"><div class="styLNRightNumBox" style="height:5mm;width:5.9mm;padding-top:1mm;
padding-bottom:0mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">17
</div>
<div class="styLNAmountBox" style="height:5mm;padding-top:1mm;padding-bottom:0mm;
border-left-width:1px;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/HalfAGIAmt"/>
</xsl:call-template>
</div>
<div class="styForm1040SchRColBoxGrey" style="height:5.2mm;width:5.7mm;padding-top:0mm;
padding-bottom:1.5mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:0px;
border-color:black;"/>
<div class="styLNAmountBox" style="height:5.2mm;padding-top:0mm;padding-bottom:0mm;
border-left:1px solid black;border-bottom-width:0px;border-right-width:0px;"/></span>
</div>
<!-- Adjusted Credit Amount -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:4mm;padding-left:0mm;padding-top:3mm;">18</div>
<div class="styLNDesc" style="width:140.5mm;height:4mm;padding-top:3mm;">Add lines 13c and 17
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:2mm;">........................</span>
</div></span>
<span style="float:right;"><div class="styLNRightNumBox" style="height:4.5mm;width:5.7mm;padding-top:3mm;
padding-bottom:.5mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">18
</div>
<div class="styLNAmountBox" style="height:4.5mm;padding-top:3mm;padding-bottom:.5mm;
border-left-width:1px;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/AdjustedCreditAmt"/>
</xsl:call-template>
</div></span>
</div>
<!-- Net Credit Amount -->
<div class="styNBB" style="width:187mm;font-size: 8.5pt;float:left;clear:none;">
<span style="float:left;"><div class="styLNLeftNumBox" style="height:7mm;padding-left:0mm;padding-top:.5mm;">19</div>
<div class="styLNDesc" style="width:140.5mm;height:7mm;padding-top:.5mm;">Subtract line 18 from line
12. If zero or less, <b> stop;</b> you <b>cannot</b> take the credit. Otherwise,<br/>go to line 20
<!--Dotted Line-->
<span class="styDotLn" style="float:none;padding-left:2mm;">...........................</span>
</div></span>
<span style="float:right;"><div class="styLNRightNumBox" style="height:7.5mm;width:5.7mm;padding-top:4mm;
padding-bottom:.5mm;text-align:center;border-style:solid;border-right-width:0px;
border-left-width:1px;border-top-width:0px;border-bottom-width:1px;
border-color:black;">19
</div>
<div class="styLNAmountBox" style="height:7.5mm;padding-top:4mm;padding-bottom:.5mm;
border-left-width:1px;border-bottom-width:1px;border-right-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form1040ScheduleRData/NetCreditAmt"/>
</xsl:call-template>
</div></span>
</div>