Form 54-001 - Iowa Property Tax Credit Claim - 2002
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1
2I O WA
Iowa Property Tax Credit Claim
d e p a r t m e n t o f R e v e n u e a n d F i n a n c e
To be filed in 2002
Claimant’s Last Name
First Name
Claimant’s Social Security Number
Claimant’s Birth Date
County
Number
/
/
Spouse’s Last Name
First Name
Spouse’s Social Security Number
Month Day
Year
___
___
Street Address
City, State, Zip Code
p
Do not write in this space.
ANSWER THESE QUESTIONS TO DETERMINE ELIGIBILITY:
YES NO
ATTACH PROOF OF DISABILITY
2001 Household Income (Claimant and Spouse)
Use Whole DOLLARS Only
00
00
00
00
00
00
00
00
00
00
00
54-001a (7/19/01)
Side 1
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Parent category: Financial