California Form 9000 - Homeowner Assistance Claim - 2003
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YEAR
CALIFORNIA FORM
Homeowner
2003
Assistance Claim
9000
(for income received in 2002)
Your first name
Initial
Last name
STEP A
Spouse’s first name
Last name
Initial
Name,
address,
and
Present home address — number and street, PO Box or rural route
Apt. no.
PMB no.
social
security
State
ZIP Code
City, town, or post office
-
number
Your social security number
Spouse’s social security number
IMPORTANT:
SSN
-
-
-
-
Your social security number
is required.
•
STEP B
1. Are you a United States citizen? Check “Yes” or “No” . .
1.
YES
NO
If you checked “Yes,’’ skip line 2 and go to line 3.
Filing
If you checked “No,’’ go to line 2.
Status
•
2. Benefit Eligibility for Noncitizens
2a.
Alien Status Code
If you are not a citizen of the United States, go to page 15.
•
If you have a qualifying alien status for the United States,
2b.
Alien Registration
enter your alien status code from the chart on page 15 on
Number
line 2a. Then enter your alien registration number on line 2b
•
and your date of entry into the United States on line 2c.
2c.
Date of Entry
3. Check the appropriate box if you were one of the following on
December 31, 2002:
•
A. 62 years or older (See Note on page 7, line 3a) . . .
A
•
B. Under 62 and blind . . . . . . . . . . . . . . . . . . . . . . . . . .
B
•
C. Under 62 and disabled (not blind) . . . . . . . . . . . . . .
C
•
4. Enter your date of birth (example: 0 5/ 2 1 / 1 9 3 8) . . . . . .
4.
You must enter your date of birth
MM D D
Y Y Y Y
Date of Birth
See instructions on page 7 and page 8 to see if you must attach a proof
document to your claim. If you cannot check one of the boxes, STOP HERE.
You do not qualify to file for a Homeowner Assistance claim.
STEP C
5. Did you own and live in your home on
December 31, 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
YES
NO
Property
If “No,” stop. You do not qualify for homeowner assistance.
Information
a. Enter the FULL value of your property (after
subtracting your homeowner’s or veteran’s
•
exemption). See page 8 . . . . . . . . . . . . . . . . . . . . . . . .
5a.
$
Complete
line 5
6. Is your property used for rental and/or business
through
as well as personal use? . . . . . . . . . . . . . . . . . . . . . . . .
6.
YES
NO
line 7.
If you checked “Yes,” enter the estimated percentage of
property devoted to your personal use. See page 9 . . . . . . .
6a.
%
7. List name(s) and relationship(s) of anyone, other than
yourself, who is included on your property tax bill.
See page 9.
Did this person live in
your home in 2002?
Name______________________ Relationship________________
YES
NO
Name______________________ Relationship________________
NO
YES
Name______________________ Relationship________________
NO
YES
%
Enter your percentage of ownership . . . . . . . . . . . . . . . .
7.
For Privacy Act Notice, see Page 14.
FTB 9000 2003 Side 1
Complete Side 2, Step D Through Step H.
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Parent category: Financial