Form Htc-60 - Homeowners' Property Tax Credit Application

PLEASE COMPLETE OTHER SIDE OF APPLICATION FIRST

12a. Do you own any other dwelling or other real estate in the State of Maryland or elsewhere?

Yes

If yes, please attach to this application a separate list of where the properties are located, their property account numbers and their use.

12 b. Do you own or operate a business?

Yes

13. Will you reside in the property on which you are applying for the tax credit on July 1, 2011 and for more than 6 months thereafter?

Yes

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).

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

If yes, then circle which use (a, b, c) and indicate what percentage of the dwelling is used for your own residential purposes: ______________________________%

17. a.) Total number of apartments in the property, including vacant apts. ___________________________________________________

b.) Amount of rent received during 2010 from tenants: Gross __________________________ Net __________________________

(1)

(2)

(3)

OFFICE

18.

SOURCES OF INCOME IN 2010

When a document is requested, please DO NOT send the original, send

APPLICANT

SPOUSE OR

ALL

USE

a copy. If no Social Security, Railroad Retirement or other pension benefits

RESIDENT

OTHERS

ONLY

were received, then you must enter zero (0) in the appropriate space.

CO-OWNER

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 2010 Form SSA-1099); S.S.I. Benefits (Circle which) ..........

Railroad Retirement (Attach copy of 2010 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)......................................................................................

TOTAL INCOME, CALENDAR YEAR 2010

19. Did or will you, and/or your spouse, file a Federal Income Tax Return for 2010?

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