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Include only the federally taxable portion of pensions IRAs and IRAs converted to Roth IRAs shown on U.S. 1040 Line 15b and 16b or U.S. 1040A Line 11b and 12b. A In 2017 I am or will be 65 years of age or older. b In 2017 my spouse who died in 2017 would have been 65 years of age or older. Note You must sign your Form PTAX-340 and have it notarized before you file it with your CCAO. Return your completed Form PTAX-340 to your CCAO s office or mail it to the address printed 4 of 4. Surviving...
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