Form Tc-40cy - Low Income Abatement And Homeowner'S Tax Credit Application - 2015 Page 2
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1
2Section 4 - Homeowner's Tax Credit Applicant must answer all 4 questions.
1. Will you be age 66 or older on or before December 31, 2015, or Are you a widow or widower? If you are a
Yes
No
widow or widower, enter your spouse's date of death:__________________________.
If filing for the first time as a widow or widower, attach a copy of your deceased spouse's Death Certificate.
2. Was the total household income (from Section 2, line 11) less than $31,702?
Yes
No
3. Will you furnish your own financial support for 2015? (You cannot be claimed as a dependent on someone
Yes
No
else's tax return for 2015.)
4. Will you live in Utah for the entire year of 2015?
Yes
No
You must be domiciled in Utah for the entire 2015 calendar year to be eligible.
If your name is not listed as the property owner of the Property Tax Billing Notice, attach legal documentation of ownership.
Only property tax on applicant's primary residence is eligible for property tax credit.
Yes
No
If yes, total number of acres
Is the home located on property that exceeds one acre?
Yes
No
If yes, what percent is rented
Is any portion of the home rented out?
Yes
No
If yes, what percent is used
Is a portion of the home used for business?
You must have owned the home on January 1, 2015 to qualify.
If you qualify for property tax credit, you may also qualify for low income abatement, on the front of this form.
Section 5 - Residency Status of Applicant
Under state and federal law we are prohibited from processing this application or issuing a credit to any person who
fails to provide this information.
Check one (providing false information subjects the signer to penalties for perjury):
1.
I am a U.S. citizen and have provided my Social Security Number on the front of this form.
2.
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.
I-94 Number*: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
If you checked box 2, you must file this form
Alien Registration Number*: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
in person and bring proof of your I-94 Number
*The I-94 (arrival/departure) number and the Alien Registration
and Alien Registration Number.
Number are issued by the U.S. Citizenship and Immigration Service.
Under penalties of perjury, I declare that I am a U.S. citizen OR that I qualify under 8 U.S.C 1641 and am present in the
United States lawfully.
Signature of applicant
Date signed
X
Section 6 - Certification and Signature Read certification, sign and date.
Under penalties of perjury, I declare to the best of my knowledge and understanding, this information is true, correct and complete.
Signature of applicant
Date
Signature of spouse
Date
(Spouse must sign if home is owned in joint tenancy)
X
X
Preparer's name and address or organization (if not applicant)
Preparer's telephone number
For Tax Commission Use Only
For County Use Only
CB used by county
CB available (max-used)
Tax amount
Blind and/or veteran
CB rent possible
CB rent issue <= CB available
Homeowner's Valuation Reduction (additional 20%)
Property Tax Credit /Renter's Refund Schedule
Circuit breaker
Renter Refund
Total Maximum
Maximum
Total Maximum
2014 Household
Low income abatement
% of Lot Rent
Renter Refund
Income
Homeowner
Homeowner &
Tax Credit
Rental Refund
0
$10,778
$939
9.5%
$939
$1,878
Net tax due
$10,779
14,372
819
8.5%
819
1,638
14,373
17,964
702
7.0%
702
1,404
County government approval
Date approved
17,965
21,556
526
5.5%
526
1,052
21,557
25,151
409
4.0%
409
818
25,152
28,531
234
3.0%
234
468
28,532
31,702
115
2.5%
115
230
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