Form Tc-40cy - Low Income Abatement And Homeowner'S Tax Credit Application - 2010 Page 2
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Section 4 - Homeowner's Tax Credit
Applicant must answer all 4 questions.
Yes
No
1. Will you be age 66 or older on or before December 31, 2010, or Are you a widow or widower? If you are a
widow or widower, enter your spouse's date of death:________________.
If filing for the first time as a widow or widower, attach a copy of your deceased spouse's Death Certificate.
Yes
No
2. Was the total household income (from Section 2, line K) less than $28,785?
Yes
No
3. Will you furnish your own financial support for 2010? (You cannot be claimed as a dependent on someone
else's tax return for 2010.)
Yes
No
4. Will you live in Utah for the entire year of 2010?
You must be domiciled in Utah for the entire 2010 calendar year to be eligible.
If your name is not listed as the property owner of the Property Tax Billing Notice, attach legal documentation of ownership.
Only property tax on applicant's primary residence is eligible for property tax credit.
Yes
No
If yes, total number of acres
Is the home located on property that exceeds one acre?
Yes
No
If yes, what percent is rented
Is any portion of the home rented out?
Yes
No
If yes, what percent is used
Is a portion of the home used for business?
You must have owned the home on January 1, 2010 to qualify.
If you qualify for property tax credit, you may also qualify for low income abatement, on the front of this form.
Section 5 - Residency Status of Applicant
Under state and federal law we are prohibited from processing this application or issuing a credit to any person who fails to provide
this information. The Alien Registration Number and the I-94 numbers are issued by the U.S. Citizenship and Immigration Service.
Check one:
I am a U.S. citizen. SSN: __ ___ ___ ___ __ ___
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.
I-94 #: _ _ __ _ __ _ __ _ _ __ _ _
Alien #: _ _ __ _ __ _ __ _ __ _ _
Section 6 - Certification and Signature
Read certification, sign and date.
Under penalties of perjury, I declare to the best of my knowledge and understanding, this information is true, correct and complete.
Signature of applicant
Date
Signature of spouse
Date
(Spouse must sign if home is owned in joint tenancy)
X
X
Preparer's name and address or organization (if not applicant)
Preparer's telephone number
For Tax Commission Use Only
For County Use Only
CB used by county
CB available (max-used)
Tax amount
CB rent possible
CB rent issue <= CB available
Blind and/or veteran
Homeowner's Valuation Reduction (additional 20%)
Property Tax Credit /Renter's Refund Schedule
Circuit breaker
Renter Refund
Total Maximum
Maximum
Total Maximum
2009 Household
Low income abatement
% of Lot Rent
Renter Refund
Homeowner
Homeowner &
Income
Tax Credit
Rental Refund
0
$9,786
$853
9.5%
$853
$1,706
Net tax due
$9,787
13,050
744
8.5%
744
1,488
13,051
16,311
638
7.0%
638
1,276
County government approval
Date approved
16,312
19,573
478
5.5%
478
956
19,574
22,837
372
4.0%
372
744
22,838
25,906
213
3.0%
213
426
25,907
28,785
105
2.5%
105
210
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