Form 54-001a - Iowa Property Tax Credit Claim - 2015-2016
ADVERTISEMENT
1
2IOWA
2015-2016 Iowa Property Tax Credit Claim
Complete all information below:
Your Last Name
Your First Name
Your Social Security Number
Your Birth Date
/
/
/
/
Spouse’s Last Name
Spouse’s First Name
Spouse’s Social Security Number
Month Day
Year
/
/
Street Address
City, State, ZIP
Answer These Questions to Determine Eligibility
1. Are you currently an Iowa resident? If “no”, STOP. You do not qualify. ................................
Yes
No
2. Did you file a Property Tax Credit claim last year? ................................................................
Yes
No
3a. Were you 65 or older as of 12/31/14? ....................................................................................
Yes
No
3b. Were you totally disabled and age 18 to 64, as of 12/31/14? See instructions .....................
Yes
No
4. Were you a resident of a nursing home or care facility during 2014? See instructions .........
Yes
No
If “yes”, are you renting out your homestead to someone else? ............................................
Yes
No
5a. Is there more than one owner of your homestead? ...............................................................
Yes
No
5b. Do any of the owners live elsewhere? ...................................................................................
Yes
No
If “yes” how many live elsewhere?
6. Was part of your home rented or used for business purposes during 2014? ........................
Yes
No
If “yes”, see instructions and enter the percentage here:
%
7. Was any part of the land in your homestead tract rented during 2014? ................................
Yes
No
If “yes”, how many acres were used exclusively by you? ____________________________
2014 Total Household Income for the Entire Year (For You and Your Spouse)
Use whole dollars only
Read instructions before completing.
,
.00
8. Wages, salaries, unemployment compensation, tips, etc. ...................................
9. In-kind assistance for housing expense. ..............................................................
,
.00
10. Title 19 benefits (excluding medical benefits). .....................................................
,
.00
,
.00
11. Social Security income (include any Medicare premiums withheld). ...................
12. Disability income...................................................................................................
,
.00
13. All pensions and annuities. ...................................................................................
,
.00
14. Interest and dividend income. ..............................................................................
,
.00
15. Profit from business and/or farming and capital gain.
If less than zero, enter 0. ......................................................................................
,
.00
16. Actual money received from others ......................................................................
,
.00
17. Other income ........................................................................................................
,
.00
18. Total household income. Add amounts from lines 8-17.
If $22,011 or greater, no credit is allowed ............................................................
,
.00
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. Note: You may be contacted for additional information.
Your Signature:
Date:
Telephone Number:(
)
Return this form to your county treasurer on or before June 1, 2015, or, if the treasurer has extended the filing deadline,
on or before September 30, 2015. The Director of Revenue may extend the filing deadline through December 31 , 2016, for good
cause.
Page 1
54-001a (7/29/14)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial