California Form 9000 - Homeowner Assistance Claim - 2002
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1
2YEAR
CALIFORNIA FORM
Homeowner
2002
9000
Assistance Claim
(for income received in 2001)
Your first name
Initial
Last name
STEP A
Spouse’s first name
Last name
Initial
Name,
address,
Apt. no.
PMB no.
and
Present home address — number and street, PO Box or rural route
social
security
State
ZIP Code
City, town, or post office
-
number
Your social security number
Spouse’s social security number
IMPORTANT:
SSN
-
-
-
-
Your social security number
is required.
•
NO
STEP B
1. Are you a United States citizen? Check “Yes” or “No” . .
1.
YES
If you checked “Yes,’’ skip line 2 and go to line 3.
Filing
If you checked “No,’’ go to line 2.
Status
•
2. Benefit Eligibility for Noncitizens
2a.
Alien Status Code
If you are not a citizen of the United States, go to page 19.
•
If you have a qualifying alien status for the United States,
2b.
Alien Registration
enter your alien status code from the chart on page 19 on
Number
line 2a. Then enter your alien registration number on line 2b
•
and your date of entry into the United States on line 2c.
2c.
Date of Entry
•
3. Enter your date of birth (example: 0 5/ 2 1 / 1 9 3 8) . . . . . .
3.
You must enter your date of birth
MM D D
Y Y Y Y
Date of Birth
4. Check the appropriate box if you were one of the following on
December 31, 2001:
•
A.
62 years or older (See Note on page 5, line 4a) . .
A
•
B.
Under 62 and blind . . . . . . . . . . . . . . . . . . . . . . . . .
B
•
C.
Under 62 and disabled (not blind) . . . . . . . . . . . . .
C
See instructions on page 5 and page 6 to see if you must attach a proof
document to your claim. If you cannot check one of the boxes, STOP
HERE. You do not qualify to file for a Homeowner Assistance claim.
STEP C
5. Did you own and live in your home on
December 31, 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
NO
YES
Property
If “No,” stop. You do not qualify for homeowner assistance.
Information
a. Enter the FULL value of your property (after
subtracting your homeowner’s or veteran’s
•
exemption). See page 7 . . . . . . . . . . . . . . . . . . . . . . . .
5a.
$
Complete
line 5
6. Is your property used for rental and/or business
through
as well as personal use? . . . . . . . . . . . . . . . . . . . . . . . .
6.
NO
YES
line 7.
If you checked “Yes,” enter the estimated percentage of
property devoted to your personal use. See page 7 . . . . . . .
6a.
%
7. List name(s) and relationship(s) of anyone, other than
yourself, who is included on your property tax bill.
See page 7.
Did this person live in
your home in 2001?
Name______________________ Relationship________________
NO
YES
Name______________________ Relationship________________
YES
NO
Name______________________ Relationship________________
NO
YES
%
Enter your percentage of ownership . . . . . . . . . . . . . . . .
7.
For Privacy Act Notice, see Page 12.
Complete Side 2, Step D Through Step H.
FTB 9000 2002 Side 1
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