Form 54-001 - Iowa Property Tax Credit Claim - 2006
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Iowa Department of Revenue
Iowa Property Tax Credit Claim
To be filed in 2006
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
Do not write in this space.
ANSWER THESE QUESTIONS TO DETERMINE ELIGIBILITY:
YES NO
1. Did you file a Property Tax Credit claim last year? ___________________________________
2a. Were you 65 or older as of 12/31/05? _____________________________________________
2b. Were you totally disabled and age 18 to 64, as of 12/31/05? Attach Proof of Disability
___
3. Are you an Iowa resident? ______________________________________________________
4. Were you a resident of a nursing home or care facility during 2005? _____________________
If yes, are you renting out your homestead to someone else? ____________________________
5a. Is there more than one owner of your homestead? ___________________________________
5b. Do any of the owners live elsewhere? ____________________________________________
6. Was part of your home rented or used for business purposes during 2005? _________________
If yes, see instructions and enter the percentage used for your home here: _______________ %
Adjust line J accordingly.
7. Was any part of the land in your homestead tract rented during 2005? ____________________
If yes, how many acres are used exclusively by you? __________________________________
County Treasurer - complete the schedule on the reverse side.
2005 Household Income (Claimant and Spouse)
Use Whole DOLLARS Only
00
8. Wages, salaries, tips, etc. ______________________________________
00
9. In-kind assistance for housing expense ___________________________
00
10. Title 19 Benefits (excluding medical benefits) ______________________
00
11. Social Security income (include any Medicare premiums withheld) _____
00
12. Disability income ____________________________________________
00
13. All pensions and annuities _____________________________________
00
14. Interest and dividend income ___________________________________
15. Profit from business and/or farming and capital gains.
00
If less than zero, enter 0. See instructions _________________________
00
16. Actual money received from others living with you. See instructions. ___
00
17. Other income (read instructions before making this entry). ____________
18. ADD amounts on lines 8-17, and enter here. If $18,348 or greater,
00
no credit is allowed. This is your total household income. ____________
I declare under penalty of perjury that I have reviewed this claim and to the best of my knowledge and belief, it
is true, correct, and complete.
_____________
(______)______________
___________________________________________
Date
Telephone Number
Claimant’s Signature
Side 1
54-001a (7/25/05)
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Parent category: Financial