Property Tax Postponement Claim Form - 2007 Page 2
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1
2On lines 17-24, enter your income for the 2006 calendar year. If applicable, include the income of your spouse or registered domestic
partner. On line 25, enter the total income of other household members. (See claim form instructions, line 25.)
17. _____________________
17. Social Security and/or Railroad Retirement ........................................................................................
18. _____________________
18. Interest and/or Dividends ....................................................................................................................
19. _____________________
19. Pensions and/or Annuities ..................................................................................................................
20. _____________________
20. SSI/SSP, AB, and/or ATD ..................................................................................................................
21. _____________________
21. Rental Income (or Loss). Attach Federal Form 1040 and Schedules .................................................
22. _____________________
22. Business Income (or Loss). Attach Federal Form 1040 and Schedules .............................................
23. _____________________
23. Gain (or Loss). Attach Federal Form 1040 and Schedules ................................................................
24. _____________________
24. Other Income (Including Wages) (See claim form instructions, line 24.) .........................................
25. Income of Other Household Members. Do not include income of minors, students or renters. ...........
25. _____________________
(See claim form instructions, line 25.) .................................................................................................
26. SUBTOTAL. Add lines 17-25 ..........................................................................................................
26. _____________________
27. Adjustments to Income. Attach documentation. (See claim form instructions, line 27.) ...............
27. _____________________
28. TOTAL household income. Subtract line 27 from line 26. If line 28 is more than $31,500 (or
28. _____________________
$34,000 if you qualified in 1983), STOP. You do not qualify for property tax postponement. ........
29. Is your residence part of a Cooperative Housing Corporation?
(See claim form instructions, line 29) ...................................................................................................................
YES
NO
30. Is your residence based on a Leasehold (Possessory) Interest? If yes, first-time filers must attach a copy of
the recorded lease agreement and the policy of title insurance.
(See claim form instructions, line 30.)...................................................................................................................
YES
NO
31. Is your residence based on a Life Estate or under a Contract of Sale? If yes, attach written consent from the
Remainderman or Titleholder.
(See claim form instructions, line 31.)...................................................................................................................
YES
NO
32. Is your residence a floating home or mobile home that is situated on Rented or Leased land? If yes, attach a
copy of your current certificate of title and/or registration card.
(See claim form instructions, line 32.)...................................................................................................................
YES
NO
33. Is any portion of your property used for Rental or Business? If yes, enter the percentage devoted to your
personal use. ______________ %
(See claim form instructions, line 33.)...................................................................................................................
YES
NO
The percentage indicated is the amount that is eligible for postponement.
PLEASE SIGN THE COMPLETED FORM. ATTACH ALL REQUIRED DOCUMENTS AND MAIL TO:
JOHN CHIANG, CALIFORNIA STATE CONTROLLER
DIVISION OF COLLECTIONS
PROPERTY TAX POSTPONEMENT PROGRAM
P.O. BOX 942850
SACRAMENTO, CALIFORNIA 94250-5880
Under penalty of perjury, I declare that this claim, including accompanying documents, is to the best of my knowledge true,
correct, and complete.
CLAIMANT’S SIGNATURE
DATE
SIGNATURE OF OTHER OWNER
(
)
TELEPHONE NUMBER
E-MAIL ADDRESS
SIGNATURE OF OTHER OWNER
Signatures of all property owners are required.
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