Form Htc-60 - Homeowners' Property Tax Credit Application - 2017 Page 2

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PLEASE COMPLETE OTHER SIDE OF APPLICATION FIRST
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n
12a. Do you own any other dwelling or other real estate in the State of Maryland or elsewhere?
Yes
No
If yes, please attach to this application a separate list of where the properties are located, their property account numbers and their use.
n
n
12 b. Do you own or operate a business?
Yes
No
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13. Will you reside in the property on which you are applying for the tax credit on July 1, 2017 and for more than 6 months thereafter?
Yes
No
If no, explain: _______________________________________________________________________________________________________________________________________
(
You must answer this question
)
14. You MUST list the name of every resident over 18 years of age in your household
who is not a co-owner and who cannot be claimed as your dependent for
IRS purposes. (If more space is needed, attach a separate list). If none,
write NONE and not N/A. Income or room and board must be reported for
Name
Relationship
any nondependent filing an income tax return from this address.
15. Report here the amount of reasonable fixed charges for room and board, rent or
$
per
expenses paid by the persons listed in item 14. If none is paid, write NONE and
(week/month)
then list the total gross incomes of such residents in item 18, Column 3 (All Others).
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16. Is any portion of the property for which this application is being made used for: a.) farming
b.) a business and/or
c.) a rental purpose?
Yes
No
If yes, then circle which use (a, b, c) and indicate what percentage of the dwelling is used for your own residential purposes: ______________________________%
a.) Total number of apartments in the property, including vacant apts. ___________________________________________________
17.
b.) Amount of rent received during 2016 from tenants: Gross __________________________ Net __________________________
(1)
(2)
(3)
OFFICE
18.
SOURCES OF INCOME IN 2016
APPLICANT
SPOUSE OR
ALL
USE
When a document is requested, please DO NOT send the original, send
RESIDENT
OTHERS
ONLY
a copy. If no Social Security, Railroad Retirement or other pension benefits
CO-OWNER
were received, then you must enter zero (0) in the appropriate space.
Wages, Salary, Tips, Bonuses, Commissions, Fees ................................................................
Interest (taxable and non-taxable) ........................................................................................
Dividends (& nontaxable distributions) ..................................................................................
Capital Gains (Includes non-taxed gains) ..............................................................................
Rental Income (Net) ..............................................................................................................
Business Income (Net) ..........................................................................................................
Room & Board (see instructions for line 15) ..........................................................................
Unemployment Insurance; Workers’ Compensation (Circle which) ........................................
Alimony; Support Money; Public Assistance Grants (Circle which) ........................................
Social Security (Attach copy of 2016 Form SSA-1099); S.S.I. Benefits (Circle which) ......
Railroad Retirement (Attach copy of 2016 Verification or Rate letter) ..........................
Other Federal Pensions (Not including VA Benefits ) per year ................................................
Veteran’s Benefits per year ....................................................................................................
Pensions (If a rollover, see instructions for Line 18) ..............................................................
Annuities (If a rollover, see instructions for Line 18) ..............................................................
IRAs (If a rollover, see instructions for Line 18) ......................................................................
Deferred Compensation (Attach a W-2 Statement)..............................................................
Gifts over $300; Expenses Paid by Others; Inheritances (Circle which)..................................
All other income (Indicate Source)......................................................................................
2016
TOTAL INCOME, CALENDAR YEAR
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19. Did or will you, and/or your spouse, file a Federal Income Tax Return for 2016?
Yes
No If yes, a copy of your return (and if married filing
separately, a copy of your spouse’s return) with all accompanying schedules must be submitted with this application.
20. I declare under the penalties of perjury, pursuant to Sec. 1-201 of the Maryland Tax-Property Code Ann., that this application (including any accompanying forms and
statements) has been examined by me and the information contained herein, to the best of my knowledge and belief, is true, correct and complete, that I have reported
all monies received, that I have a legal interest in this property, that this dwelling will be my principal residence for the prescribed period, and that my net worth is less
than $200,000 excluding the value of the subject dwelling and homesite, IRAs and qualified retirement savings plans. I understand that the Department may request at a later
date additional information to verify the statements reported on this form, and that independent verifications of the information reported may be made.
Further, I hereby authorize the Social Security Administration, Comptroller of the Treasury, Internal Revenue Service, the Income Maintenance Administration,
Unemployment Insurance, the State Department of Human Resources, and Credit Bureaus to release to the Department of Assessments and Taxation any
and all information concerning the income or benefits received.
·
Applicant’s Signature
Date
Spouse’s or Resident Co-owner’s Signature
Name of Preparer Other Than Applicant
Date
Telephone
RETURN TO
FOR INFORMATION CALL
Department of Assessments and Taxation
Baltimore Metropolitan Area
Homeowners’ Tax Credit Program
410-767-4433
301 W. Preston Street
All Other Areas
9th Floor, Room 900
1-800-944-7403
Baltimore, Maryland 21201
THIS APPLICATION IS NOT OPEN TO PUBLIC INSPECTION - FILING DEADLINE IS September 1, 2017
AT8-60H

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