California Form 9000r - Renter Assistance Claim - 2007

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Renter
YEAR
CAlIFORNIA FORM
9000R
Assistance Claim
2007
(for income received in 2006)
STEP 1
Your first name
last name
Initial
last name
Name and
Spouse’s first name
Initial
address
Present home address — number and street, PO Box, PMB, or rural route no .
Apt no .
Place
label here,
State
ZIP Code
City, town, or post office
-
type, or print
STEP 2
IMPORTANT:
Your
Social security
-
-
-
-
Your
Your SSN
Spouse’s
number (SSN)
SSN
is required.
SSN
STEP 3
I 1.
1. Are you a United States citizen? Check “Yes” or “No” . . .
NO
YES
If you checked “Yes,’’ skip line 2 and go to line 3 .
Filing
If you checked “No,’’ go to line 2 .
I 2a.
2. Benefit Eligibility for Noncitizens . . . . . . . . . . . . . . . . . . . .
status
Alien Status Code
I f you are not a citizen of the United States, go to page 10 . If you
have a qualifying alien status for the United States, enter your
I 2b.
Alien Registration
alien status code from the chart on page 10 on line 2a . Then
Number
enter your alien registration number on line 2b and your date
I 2c.
of entry into the United States on line 2c . (MM/DD/YYYY)
3. Check the appropriate box if you were one of the following on
Date of Entry
December 31, 2006:
I
A . 62 years or older (See page 5, line 3A) . . . . . . . . . . . .
A
I
B . Under 62 and blind . . . . . . . . . . . . . . . . . . . . . . . . . . .
B
I C
C . Under 62 and disabled (not blind) . . . . . . . . . . . . . . . .
If you cannot check one of the boxes, STOP HERE. You do not qualify to
file for a Renter Assistance claim.
4. Enter your date of birth (example: 0 5/ 2 1 / 1 9 4 4) . . . . . . . I 4.
Date of Birth
You must enter your date of birth
MM DD Y Y Y Y
See instructions on page 5 to see if you must attach a proof document to
your claim.
5. Enter the total number of months during 2006 that you
STEP 4
lived in one or more qualified rented residence(s) in
California. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . I 5.
Rental
________months
information
6. If the address where you lived during 2006 is different than the address you
entered in Step 1, or if the address in Step 1 is a post office box, enter your 2006
residence address. (If more than one rented residence attach a list.)
Street Address
City
I
______________________________________________________________________________________
State and ZIP Code
I
_____________________________________________
________________
________________
RENTED FROM
TO
7. Enter the name, address, and telephone number of your landlord or the person
to whom you paid rent during 2006. (If more than one landlord attach a list.)
NAME ____________________________________________________________________________________________________________
ADDRESS _________________________________________________________________________________ APT . or UNIT NO ._________
_____________________
CITY _________________________________________________________ STATE and ZIP CODE_________
TElEPHONE (
) _____________________________________
For Privacy Notice, see Page 9 .
FTB 9000R 2007  Side 1
Complete Side 2, Step 5 Through Step 7.

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