Form I-016 - Schedule H, Wisconsin Homestead Credit - 2016
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1
2
3H
Wisconsin
2016
Check here if
homestead credit
an amended return
Claimant’s social security number
Spouse’s social security number
Check below then fill in either the name of city,
village, or town, and the county in which you lived
at the end of 2016.
Claimant’s legal last name
Legal first name
M.I.
City
Village
Town
Spouse’s legal last name
Spouse’s legal first name
M.I.
City, village,
or town
Current home address (number and street)
Apt. no.
County of
City or post office
State
Zip code
Special
(See page 7.)
conditions
1a What was your age as of December 31, 2016?
1a Fill in age
(If you were under 18, you do not qualify for homestead credit for 2016.)
b If your spouse was age 65 or over as of December 31, 2016, check where indicated . . . . . . . . . . . . . . . . . . . . .
1b Check here
2
Were you a legal resident of Wisconsin from 1-1-16 through 12-31-16? (If “No,” you do not qualify.) . . . . . . . . . . 2
Yes
No
3
Were you claimed or will you be claimed as a dependent on someone else’s 2016 federal income tax return?
(If “Yes” and you were under age 62 on December 31, 2016, you do not qualify.) . . . . . . . . . . . . . . . . . . . . . . . 3
Yes
No
4a Are you now living in a nursing home? (If “Yes,” indicate the date you entered
and the
nursing home name and address
) . . . 4a
Yes
No
b If “Yes,” are you receiving medical assistance under Title XIX?
. . . . 4b
Yes
No
(If both 4a and 4b are “Yes,” you do not qualify.)
5
Did you become
married or
divorced in 2016? (If “Yes,” fill in date
; see page 16.) . . . . 5
Yes
No
6a If married for any part of 2016, did you and your spouse maintain separate homes during any part of the year?
(If “Yes,” see page 15.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a
Yes
No
b If you and your spouse maintained separate homes while married during 2016, did either spouse notify
the other of their marital property income? (See page 15.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b
Yes
No
Print numbers like this
Not like this
NO COMMAS; NO CENTS
Household Income
Include all 2016 income as listed below. If married, include the incomes of both spouses. See pages 7 to 11.
.00
7
Wisconsin income from your 2016 income tax return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8
If you or you and your spouse are not filing a 2016 Wisconsin return, fill in Wisconsin
taxable income on lines 8a and 8b.
.00
.00
.00
.00
a Wages
+ Interest
+ Dividends
= . . . 8a
.00
b Other taxable income. Attach a schedule listing each income item . . . . . . . . . . . . . . . . . . . . . . . . 8b
9
Nontaxable household income. Do not include amounts filled in on line 7, 8a, or 8b.
.00
a Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a
b Social security, federal and state SSI, SSI-E, SSD, and CTS payments.
.00
Include Medicare premium deductions (see page 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b
.00
c Railroad retirement benefits. Include Medicare premium deductions . . . . . . . . . . . . . . . . . . . . . . . 9c
.00
d Pensions and annuities, including IRA, SEP, SIMPLE, and qualified plan distributions
9d
(see page 9)
.00
e Contributions to deferred compensation plans (see box 12 of wage statements, and page 9) . . . . 9e
.00
f Contributions to IRA, self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . . . 9f
.00
g Interest on United States securities (e.g., U.S. Savings Bonds) and state and municipal bonds . . 9g
.00
h Scholarships, fellowships, grants (see page 9), and military compensation or cash benefits . . . . 9h
i Child support, maintenance payments, and other support money (court ordered) . . . . . . . . . . . . . 9i
.00
j Wisconsin Works (W2), county relief, kinship care, and other cash public assistance
9j
(see page 9)
.00
10
Add lines 7 through 9j. Enter here and on line 11a, at the top of page 2 . . . . . . . . . . . . . . . . . . . 10
.00
I-016i
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