Completing The Claim Form Instruction (Page 3 of 9) in pdf

Completing The Claim Form Instruction Page 3

Check the appropriate box. If you check “Yes,” see "Required

Documentation" for required documentation.

Line 16 – List name(s), relationship(s), Social Security number(s), and age(s)

of all owners of your property.

Anyone who owns an interest in the property, other than your spouse

or a direct-line relative, must also meet the eligibility requirements.

(See "Program Description".)

Line 17 – Social Security and/or Railroad Retirement

Enter the yearly amount of Social Security (including the amount

deducted for Medicare premiums) and/or railroad retirement payments

received by you and your spouse for the 2000 calendar year.

Line 18 – Interest and/or Dividends

Enter the yearly amount of interest and/or dividends you and your

spouse received, regardless of source or taxability.

Line 19 – Pensions and/or Annuities

Enter the yearly amount of pensions and/or annuities you and your

spouse received, regardless of source or taxability. Include disability

retirement payments and IRA distributions.

Line 20 – SSI/SSP, AB and/or ATD

Enter all Social Security Income/State Supplementary Payment

Program (SSI/SSP), Aid to the Blind (AB), and Aid to the Totally

Disabled (ATD) payments received in 2000 by you and your spouse.

Do not report Temporary Assistance for Needy Families (TANF) or

non-cash assistance such as homemaker/chore services.

Line 21 – Rental Income (or Loss)

Enter the amount of net rental income (or loss). See "Required

Documentation" for required documentation.

Line 22 – Business Income (or Loss)

Enter the amount of net income (or loss) from your business or farm.

See "Required Documentation" for required documentation.

Line 23 – Capital Gain (or Loss)

Enter the amount of gain (or loss) from the sale of business property

and/or capital assets. Examples of capital assets are stocks, bonds, and

rental real estate. The maximum net loss you may deduct from the sale

of capital assets is $3,000.

See "Required Documentation" for

required documentation.

Completing The Claim Form Instruction Page 3