Form Ri-6238 - Residential Lead Abatement Income Tax Credit - 2009

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RI-6238
2009
RESIDENTIAL LEAD ABATEMENT INCOME TAX CREDIT
First Name
Initial
Last Name
Social Security Number
Spouse’s First Name
Initial
Last Name
Social Security Number
Address
City, Town or Post Office
State
Zip Code
Pursuant to R.I.G.L. 44-30.3-3, a claimant must have been domiciled in the state of Rhode Island for the entire calendar year for which he/she
files a claim for relief under this chapter.
DO NOT COMPLETE THIS FORM
if you were not a resident of the state of Rhode Island for all of 2009.
PART 1
DWELLING UNIT INFORMATION
(CREDIT MAY BE TAKEN FOR UP TO THREE (3) DWELLING UNITS)
Unit #1
Unit #2
Unit #3
.
1
Property Address:
(Number, Street, Apt. Number)
(Number, Street, Apt. Number)
(Number, Street, Apt. Number)
(City or Town)
(City or Town)
(City or Town)
2.
For each unit:
Owner Occupant
Owner Occupant
Owner Occupant
Check one that applies and
Renter
Renter
Renter
complete the corresponding
section in Part 2.
Landlord
Landlord
Landlord
.
For each unit:
3
Removal
Removal
Removal
Check the type of lead
Reduction
Reduction
Reduction
removal.
$
$
$
.
Costs incurred:
4
$
$
$
.
Maximum Credit:
5
If removal/abatement, enter $5,000.00 You must have a Department of Health Lead Safe Certificate for removal/abatement.
If reduction/mitigation, enter $1,500.00. You must have a Rhode Island Housing Resources Commission Lead Hazard Mitigation Certificate of Conformance.
.
$
$
$
Maximum Credit:
6
(Enter the smaller of line 4 or line 5)
.
$
7
Total Credit (Add all credit amounts from line 6):
PART 2
CLAIMANT INFORMATION
YES
NO
OWNER OCCUPIED PROPERTY:
8.
Were you a legal resident of Rhode Island for all of 2009? ------------------------------------------------------------------------------
Is your household income equal to or less than $40,900 (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 2009? ------------------------------------------------------------------------------
Is your household income equal to or less than $40,900 (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 2009? -------------------------------------------------------------------------------------------------------
Is your household income equal to or less than $40,900 (use the worksheet in Part 3) ? --------------------------------------
If applicable, is the household income of the tenant(s) in Unit 1 equal to or less than $40,900? ------------------------------
If applicable, is the household income of the tenant(s) in Unit 2 equal to or less than $40,900? ------------------------------
If applicable, is the household income of the tenant(s) in Unit 3 equal to or less than $40,900? ------------------------------
Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete.
Date
Spouse’s signature
Your signature
Date
Paid preparer’s signature, address and phone number

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