Form Tc-40cy - Low Income Abatement And Homeowner'S Tax Credit Application - 2009
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County Application
Low Income Abatement and
TC-40CY
2009
Homeowner's Tax Credit Application
Rev. 5/09
(For low income, elderly, and widows/widowers)
Homeowners and Mobile Homeowners applying for property tax credit, must file this form with the county where the home is
located by September 1, 2009.
applying for lot rental refund, file the TC-40CB application with the Utah State Tax
Renters and Mobile Homeowners
Commission by December 31, 2009.
Section 1 - Applicant's Name
If more than one person lives in a household, only one person can file an application.
Applicant's Last Name
Applicant's First Name
Middle Initial
Birth Date
Social Security Number
Spouse's Last Name (if spouse is living)
Spouse's First Name
Middle Initial
Birth Date
Social Security Number
Address
City
County
State
ZIP Code
Daytime Telephone Number
Enter your property serial/account number(s)
from your prior property tax billing notice
Section 2 - Household Income
Household income must include ALL household members' incomes.
Complete and add lines A through J and enter the total on line K. Household Income: is income received during
2008 by members of the household as of January 1, 2009, not just the applicant. A "household" is an association of all
people living in the same dwelling, sharing furnishings, facilities, accommodations and expenses.
Total members in household as of January 1, 2009
K. Total 2008 household income from
A. Wages/salaries/tips/other compen.
A
K
all sources (add lines A through J)
B. Total interest, dividends
B
Are you eligible to claim a dependent as a personal exemption on
(taxable/nontaxable)
your 2008 federal income tax return?
C. Pensions, annuities (incl. IRAs)
C
No (enter total 2008 household income from line K on line L)
D. Soc. Sec./Railroad retirement
D
Yes (subtract $1,000 from line K and enter result on line L)
(taxable/nontaxable)
E. Capital gains, loss carry forwards
L. Adjusted 2008 household income
E
L
F. Government assistance
F
G. Unemployment, worker’s comp.
G
You do not qualify if the amount in Box "L" exceeds $28,732.
H. Business, rental, farm income
H
I. Depreciation on claimed residence
I
J. Other income (alimony, etc.)
J
Section 3 - Low Income Abatement
To qualify for low income abatement, applicant must answer all three questions below.
Yes
No
1. Will you be age 66 or older on or before December 31, 2009, or under age 66 and disabled, or under age 66
and it would be an extreme hardship to pay the tax? If you are disabled and applying for the first time, attach a
medical statement signed by your doctor. If you are under extreme hardship, attach an explanation of hardship.
Yes
No
2. Was the total household income (from Section 2, line L) less than $28,732?
Yes
No
3. Will you reside in the home for which you are claiming the abatement for ten months during 2009?
If the answer to all three questions is "Yes," you qualify for the low income abatement.
If you qualify for the low income abatement, you may also qualify for the homeowner's tax credit on the back of this form.
For more information, contact your county government listed below
Beaver County
435-438-6463
Iron County
435-477-8333
Sevier County
435-893-0400
Box Elder County
435-734-3388
Juab County
435-623-3410
Summit County
435-336-4451
Cache County
435-755-1500
Kane County
435-644-2647
Tooele County
435-843-3130
Carbon County
435-636-3200
Millard County
435-743-5227
Uintah County
435-781-5363
Daggett County
435-784-3210
Morgan County
801-829-6811
Utah County
801-851-8254
Davis County
801-451-3329
Piute County
435-577-2840
Wasatch County
435-654-3211
Duchesne County
435-738-1120
Rich County
435-793-5215
Washington Cnty
435-634-5712
Emery County
435-381-5106
Salt Lake County
801-468-3400
Wayne County
435-836-1303
Garfield County
435-676-8826
San Juan County
435-587-3223
Weber County
801-399-8400
Grand County
435-259-1338
Sanpete County
435-835-2142
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