California Form 9000h - Homeowner Assistance Claim - 2007
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Homeowner
YEAR
CAlIFORNIA FORM
9000H
Assistance Claim
2007
(for income received in 2006)
STEP 1
Your first name
last name
Initial
Spouse’s first name
last name
Name and
Initial
address
Apt . no .
Present home address — number and street, PO Box, PMB, or rural route no .
Place
label here,
State
ZIP Code
City, town, or post office
-
type, or print
STEP 2
IMPORTANT:
Your
-
-
-
-
Your
Social security
Your SSN
Spouse’s
SSN
is required.
number (SSN)
SSN
STEP 3
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1. Are you a United States citizen? Check “Yes” or “No” . . . . .
1.
NO
YES
If you checked “Yes,’’ skip line 2 and go to line 3 .
Filing
If you checked “No,’’ go to line 2 .
status
I
2. Benefit Eligibility for Noncitizens . . . . . . . . . . . . . . . . . . . . . . .
2a.
If you are not a citizen of the United States, go to page 10 . If
Alien Status Code
I
you have a qualifying alien status for the United States, enter
2b.
your alien status code from the chart on page 10 on line 2a .
Alien Registration
Number
Then enter your alien registration number on line 2b and your
I
2c.
date 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
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B . Under 62 and blind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B
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C . Under 62 and disabled (not blind) . . . . . . . . . . . . . . . . . . . .
C
If you cannot check one of the boxes, STOP HERE. You do not qualify to
file for a Homeowner Assistance claim.
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4. Enter your date of birth (example: 0 5/ 2 1 / 1 9 4 4) . . . . . . . .
4.
Date of Birth
You must enter your date of birth
MM D D
Y Y Y Y
See instructions on page 5 to see if you must attach a proof document to
your claim.
STEP 4
5. Did you own and live in your home on
YES
NO
December 31, 2006? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
Property
If “No,” STOP . You do not qualify for homeowner assistance .
a. Enter the NET value of your property.
information
I
See page 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5a.
$
from
6. Is your property used for rental and/or business
00/00
as well as personal use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.
NO
YES
tax bill
If you checked “Yes,” enter the estimated percentage of
%
property devoted to your personal use . See page 6 . . . . . . . . . . . .
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 2006?
YES
NO
Name______________________ Relationship________________
NO
Name______________________ Relationship________________
YES
NO
Name______________________ Relationship________________
YES
Enter your percentage of ownership . . . . . . . . . . . . . . . . . . . . .
7.
%
For Privacy Notice, see Page 9 .
FTB 9000H 2007 Side 1
Complete Side 2, Step 5 Through Step 7.
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