Form Ri-6238 - Residential Lead Abatement Income Tax Credit - 2014 Page 2
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3State of Rhode Island and Providence Plantations
2014 Form RI-6238
14104099990102
Residential Lead Abatement Income Tax Credit
Name
Your social security number
PART 2
CLAIMANT INFORMATION
YES
NO
8
OWNER OCCUPIED PROPERTY:
Were you a legal resident of Rhode Island for all of 2014? ---------------------------------------------------------------------------
Is your household income equal to or less than $43,750 (use the worksheet in Part 3) ? ------------------------------------
Did you incur the full cost of the lead removal/reduction? -----------------------------------------------------------------------------
Are you the sole owner of the property? --------------------------------------------------------------------------------------------------
If no, what is your ownership percentage?
_________%
Who is the other owner(s)? ________________________________________________________________________
Name
Address
9
RENTER/LESSEE:
Were you a legal resident of Rhode Island for all of 2014? ---------------------------------------------------------------------------
Is your household income equal to or less than $43,750 (use the worksheet in Part 3) ?-------------------------------------
Did you incur any of the cost of the lead removal/reduction? -------------------------------------------------------------------------
Who is your landlord? ____________________________________________________________________________
Name
Address
10
LANDLORD:
Have you rented out property in 2014? ----------------------------------------------------------------------------------------------------
Is your household income equal to or less than $43,750 (use the worksheet in Part 3) ? ------------------------------------
If applicable, is the household income of the tenant(s) in Unit 1 equal to or less than $43,750? ---------------------------
If applicable, is the household income of the tenant(s) in Unit 2 equal to or less than $43,750? ---------------------------
If applicable, is the household income of the tenant(s) in Unit 3 equal to or less than $43,750? ---------------------------
PART 3
WORKSHEET FOR COMPUTING TOTAL HOUSEHOLD INCOME
USE THE FOLLOWING WORKSHEET TO COMPUTE YOUR TOTAL HOUSEHOLD INCOME
11
Social Security (including Medicare premiums) and Railroad Retirement benefits.....................................................
11
12
Unemployment benefits, worker’s compensation........................................................................................................
12
13
Wages, salaries, tips, etc.............................................................................................................................................
13
14
Dividends and interest (taxable and nontaxable)........................................................................................................
14
15
Business and Farm income (net of expenses)...........................................................................................................
15
16
16
Pension and annuity income (taxable and nontaxable)............................................................................................
17
Rental income (net of expenses).............................................................................................................................
17
18
Partnership, estate and trust income.........................................................................................................................
18
19
Total gain on sale or exchange of property..................................................................................................................
19
20
Loss on sale or exchange of property (capital losses are limited to $3,000.00)..........................................................
20
21
21
Cash public assistance (welfare, etc.).........................................................................................................................
22
Alimony and child support received............................................................................................................................
22
23
Nontaxable military compensation and cash benefits..................................................................................................
23
24
Other taxable income, please specify: _____________________ .............................................................................
24
25
TOTAL 2014 HOUSEHOLD INCOME. Add lines 11 through 24. Enter here and use to answer questions in Part 2 above
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Page 2
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