Form Lhtc - Livable Home Tax Credit Program (Lhtc) Application - 2011 Page 2
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2FORM LHTC – Tax Year 2011
(Complete only if the LHTC application is related to the retrofitting of an existing unit)
SECTION III
Retrofitting of an Existing Unit:
Retrofitting of an existing residential unit must include at least one accessibility
feature, lifts or elevators and meet the requirements of an existing standard or provide sensory modifications in order
to qualify for tax credits (please see definitions). Please check any accessibility feature or improvement that applies:
Accessible route to a zero-step entrance into the residence
Zero-step entrance into the residence
Doors with at least 32 inches of clear width
Hallways and passages with at least 36 inches of clear width
Accessible light switches, electrical outlets and environmental controls
Accessible bathroom
Accessible and useable kitchen facilities
Lifts
Elevators
Sensory Modifications
Other: Must provide description
(All applicants must complete)
SECTION IV
Tax Calculation:
New residence qualifying for LHTC:
______$5,000.00
Retrofitting of an Existing Unit:
1. Total cost of applicable retrofitting activities
1._______
2. Enter 50 percent of line 1
2.
3. Credit limitation
3._____ $5,000.00
4. Enter the smaller of line 2 or line 3
(The LHTC amount must be approved by the Department of Housing and Community Development before being
claimed on tax return.)
I declare, under penalties provided by law, the information provided above is complete and correct.
Signature
Printed Name
Date
Daytime Phone Number
E-Mail Address
DHCD USE ONLY
Approved Credit
Certificate Number
Date
DHCD Approval
DHCD – FORM LHTC
Page 2 of 4
July 2011
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