Form It-Hr-2 - Certification Of Rent Paid For Homestead Relief Credit printable pdf download

WEST VIRGINIA

FORMS AND

HOMESTEAD RELIEF

FILING INSTRUCTIONS

FOR ELDERLY TAXPAYERS

A MESSAGE TO WEST VIRGINIA SENIOR CITIZENS

WHO PAY RENT OR REAL ESTATE TAXES FOR THEIR HOME

If you are 65 years of age or older and received $5,000 or less in total income from all sources (including Social

Security benefits) during the calendar year, you may be eligible to receive a check from the State of West Virginia.

The Homestead Relief Act, commonly referred to as ‘circuit-breaker’, is a State-administered program to assist

senior citizens (65 years of age or older) in maintaining their homestead by refunding a portion of the rent or real

estate taxes they paid for their house, apartment, or mobile home.

The ‘circuit-breaker’ program should not be confused with the county-administered ‘Homestead Exemption’

program, which exempts a portion of the value of a senior citizen’s home from the county’s real property taxes. If

you paid taxes after this exemption was allowed, or you did not qualify for the exemption, you may be eligible for

the ‘circuit-breaker’ program benefits.

You should read through this booklet to learn more of the benefits you may be entitled to claim under the circuit-

breaker program. If you have any questions or need assistance in preparing a claim, please call toll-free 1-800-

982-8297 (in the Charleston area 558-3333).

Should you have any questions concerning the ‘Homestead Exemption’ program, you may contact your County

Assessor’s office.

IF YOU PAID RENT FOR YOUR HOMESTEAD, HAVE YOUR LANDLORD COMPLETE FORM IT-HR-2

AND RETURN IT TO YOU. ATTACH THE COMPLETED FORM IT-HR-2 TO YOUR HOMESTEAD RELIEF CLAIM.

FORM IT-HR-2

WEST VIRGINIA

CERTIFICATION OF RENT PAID

(Rev. 03/02)

STATE TAX DEPARTMENT

FOR HOMESTEAD RELIEF CREDIT

INTERNAL AUDITING DIVISION

Attach to Form IT-HR-1 (if necessary)

NAME OF CLAIMANT

Social Security Number

Amount of Rent per Month

Last Name

First Name and Initial

Number of Months of Rental

Relationship to Landlord

Number of Rooms Rented

Number of Occupants

NAME OF LANDLORD

LANDLORD'S HOME ADDRESS

Last Name

First Name and Initial

(A)

(B)

(C)

(D)

(E)

Total Rent

Rental Value

Value of Utilities

Value of Other

Rent Paid

Paid for Year

of Furnishings

Furnished

Furnished Items

For Occupancy Only

Block A less blocks B, C and D

I, the undersigned, do hereby certify that the above information concerning rent paid to me by the above-named claimant for

and during the year 20____ is true, correct, and complete to the best of my knowledge and belief.

(Date)

(Signature of Landlord or Authorized Representative)

Form It-Hr-2 - Certification Of Rent Paid For Homestead Relief Credit

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