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Iowa Department of Revenue

2004 Iowa Mobile/Manufactured/Modular Home

Owner Application For Reduced Tax Rate

Instructions

WHO IS ELIGIBLE:

You are eligible to claim a reduced tax rate if your 2003 household income was less than $17,771 and you

were 23 years of age or older as of December 31, 2003. Household income includes income of the claimant,

the claimant’s spouse, and monetary contributions received from other persons living with the claimant.

Line 1: Wages, salaries, tips, etc. - Enter the total

exchange of capital assets. Capital losses are

wages, salaries, tips, bonuses, and commissions

limited to the same amount that you are allowed to

received.

report for income tax purposes. Any loss must be

offset against gains, and a net loss must be

Line 2: In-kind Assistance - Enter any portion of

reported as zero.

your housing expenses including utilities that were

paid for you. Do not enter Federal Energy

Line 9: Monetary contributions - Enter money

Assistance.

received from others living with you. Do not include

goods and services received.

Line 3: Title 19 Benefits - Enter your Title 19

benefits received for housing expenses. Do not

Line 10: Other income - Enter total income

include medical benefits.

received from the following sources:

Line 4: Social Security Income - Enter the total

(a) Child support and alimony payments.

Social Security benefits received even if not

(b) Welfare payments. Do not include non-

reportable for income tax purposes. Include any

cash government assistance (food,

Medicare premiums withheld.

clothing, food stamps, medical supplies,

etc.)

Line 5: Disability - Enter the total received for

disability or injury compensation, even if not

reportable for income tax purposes.

elsewhere.

Line 6: All pensions and annuities - Enter the

(d) Other income not reported on Lines 1

total received from pensions and annuities, even if

through 9.

not reportable for income tax purposes.

Line 11: Total household income - Add Lines 1

through 10. Enter total here.

Line 7: Interest and Dividend income - Enter

taxable interest income, plus all interest income

from federal, state and municipal securities.

This claim must be filed with your County

Enter taxable dividends and distributions received.

Treasurer by June 1, 2004.

Include cash dividends and dividends paid in the

The treasurer may extend the filing deadline to

form of merchandise or other property and report at

September 30, 2004,

fair market value.

or the Director of Revenue may extend the filing

deadline to December 31, 2004.

Line 8: Profit from business and/or farming and

capital gains - Enter profit from business and/or

farming, and any gains received from the sale or

For Assistance:

contact your

county treasurer

54-014b 6/5/03

Form 54-014a - Iowa Mobile/manufactured/modular Home Owner Application For Reduced Tax Rate - 2004 Page 2

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