Form Tc-40cy - Low Income Abatement And Homeowner'S Tax Credit Application - 2012
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County Application
TC-40CY
Low Income Abatement and
2012
Homeowner's Tax Credit Application
Rev. 3/12
(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, 2012.
Renters and Mobile Homeowners applying for lot rental refund, file the TC-40CB application with the Utah State Tax
Commission by December 31, 2012.
Applicants who check box 2 in Section Five (back of form) must file this form in person.
Section 1 - Applicant's Name
If more than one person lives in a household, only one person may 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 most recent 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 2011
by all members of the household as of January 1, 2012, 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, 2012
F. Government assistance
F
A. Wages/salaries/tips/other compen.
A
G. Unemployment, worker’s comp.
G
B. Total interest, dividends
B
(taxable/nontaxable)
H. Business, rental, farm income
H
(Include copy of federal return and all
C. Pensions, annuities-incl. IRAs
C
schedules. This amount will be reviewed.)
(taxable/nontaxable)(Include copy of federal
return and all schedules. This amount will be reviewed.)
I
I. Depreciation on claimed residence
(Include copy of federal return and all
D. Soc. Sec./Railroad retirement
D
schedules. This amount will be reviewed.)
(taxable/nontaxable) (send supporting
J
J. Other income-alimony, etc. (send
documentation)
supporting documentation)
E. Capital gains, loss carry forwards
E
K. Total 2011 household income from
K
(Include copy of federal return and all
all sources (add lines A through J)
schedules. This amount will be reviewed.)
You do not qualify if the verified amount on line K exceeds $29,919.
The Tax Commission will review and determine eligibility for refund.
You may be required to submit additional information to support your
claims.
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 65 or older on or before December 31, 2012, or under age 65 and disabled, or under age 65
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 K) less than $29,919?
Yes
No
3. Will you reside in the home for which you are claiming the abatement for ten months during 2012?
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
Garfield County
435-676-8826
Rich County
435-793-5515
Utah County
801-851-8110
Box Elder County
435-734-3388
Grand County
435-259-1338
Salt Lake County
801-468-3400
Wasatch County
435-654-3211
Cache County
435-755-1500
Iron County
435-477-8332
San Juan County
435-587-3223
Washington County 435-634-5712
Carbon County
435-636-3200
Juab County
435-623-3410
Sanpete County
435-835-2142
Wayne County
435-836-1303
Daggett County
435-784-3210
Kane County
435-644-2458
Sevier County
435-893-0400
Weber County
801-399-8400
Davis County
801-451-3329
Millard County
435-743-5227
Summit County
435-336-4451
Duchesne County
435-738-1120
Morgan County
801-845-4030
Tooele County
435-843-3130
Emery County
435-381-5106
Piute County
435-577-2840
Uintah County
435-781-5363
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