Disabled Veterans' Household Income Worksheet - California
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2DISABLED VETERANS’ HOUSEHOLD INCOME WORKSHEET
Attach to Claim for Disabled Veterans’ Property Tax Exemption
Household Income (Section 20504)
“Household Income” means all income received by all persons of a household while members of such household.
Include only the income of persons who were members of the household during the calendar year prior to the year of
this claim (if the claim is for 2013/2014 tax year, the income would be for the calendar year 2012).
The term “household” includes the claimant and all other persons, except bona fide renters, minors, or students.
STEP A.
Enter your name and Assessor’s Parcel Number.
ASSESSOR’S
NAME ____________________________________________
PARCEL NUMBER ______________________
STEP B.
Enter the yearly income of you and your spouse. Complete lines 1 through 17.
1.
Wages, salaries, tips, and other employee compensation………………….…... 1. $_______________
2.
Social security, including the amount deducted for Medi-Care premiums…….. 2. $_______________
3.
Railroad retirement…………………………………………………………………... 3. $_______________
4.
Interest and dividends……………………………………………………………….. 4. $_______________
5.
Pensions, annuities, and disability retirement payments………………………... 5. $_______________
6.
SSI/SSP (Supplemental Security Income/State Supplemental Plan), AB (Aid
to the Blind), ATD (Aid to Totally Disabled), AFDC (Aid to Families with
Dependent Children), and APSB (Aid to the Potentially Self-Supporting Blind) 6. $_______________
7.
Rental income (or loss)…………………………………………………………….
7. $_______________
8.
Net income (or loss) from a business…………………………………………….
8. $_______________
9.
Income (or loss) from the sale of capital assets………………………………… 9. $_______________
10.
Life insurance proceeds that exceed expenses……………… …………………10. $_______________
11.
Veterans benefits received from the Veterans Administration …………………11. $_______________
12.
Gifts and inheritances in excess of $300, except between members of the
household………………………………………………………………… …………12. $_______________
13.
Unemployment insurance benefits…………………………………… …………..13. $_______________
14.
Workers compensation for temporary disability (not for permanent disability),.14. $_______________
15.
Amounts contributed on behalf of the claimant to a tax sheltered or deferred
compensation plan (also a deduction), see Line 23 below………….…………..15. $_______________
16.
Sick leave payments……………………………………………… ………………..16. $_______________
17.
Nontaxable gain from the sale of a residence…………………….………………17. $_______________
STEP C.
Enter the Income of Other Household Members.
18.
Do not include income of minors, students, renters, your spouse and you..…..18. $_______________
STEP D.
Subtotal. Enter here and on line 20 on the back.
19.
SUBTOTAL. Add lines 1 through 18……………..………………………………..19. $_______________
0.00
PLEASE CONTINUE ON THE BACK
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