Fillable Form Rtc-60 - Renters' Tax Credit Application

PLEASE COMPLETE OTHER SIDE OF APPLICATION FIRST

17.

List all household residents who lived with you in 1999. (If none, write NONE) You must answer this question.

Name

Date of Birth

Social Security Number

Your Dependent?

Relationship

1999 income

Yes or No

If more space is needed, attach a separate list

□

18.

Did or will you, and/or your spouse, file a Federal Income Tax Return for 1999?

Yes

If yes, a copy of your return (and if married filing

separately, a copy of your spouse’s return) with all accompanying schedules must be submitted with this application.

(2)

OFFICE

AMOUNTS AND SOURCES OF INCOME IN 1999

(1)

SPOUSE/

(3)

USE

19.

(ATTACH COPIES - NOT ORIGINALS)

APPLICANT

CO-TENANT

ALL OTHERS

ONLY

Wages, Salary, Tips, Bonuses, Commissions, Fees ...........................................

Interest and Dividends (Includes both taxable and non-taxable).........................

Capital Gains (Includes non-taxed gains) ...........................................................

Rental Profits (Net) or Business Profits (Net)(Circle which) ................................

Room & Board paid to you by a nondependent resident .....................................

Unemployment Insurance; Workers’ Compensation (Circle which).....................

Alimony; Support Money (Circle which) ..............................................................

Public Assistance (Attach AIMS) or other Government Grants (Circle which).....

Social Security (Attach copy of 1999 Form SSA-1099) If none, enter “0” ...........

S.S.I. Benefits for 1999 (Attach Proof) ................................................................

Railroad Retirement (Attach copy of 1999 Forms RRB-1099 and RRB-1099R) .

Veterans’ Benefits per year .................................................................................

Other Pensions, Annuities, and IRAs per year (If a rollover, attach proof) ..........

Gifts over $300; Expenses Paid by Others; Inheritances (Circle which) .............

All Other Monies Received (Indicate Source)......................................................

TOTAL INCOME, CALENDAR YEAR 1999

20.

Enter the amount of rent you paid each month from January 1 through December 31, 1999.

Total Rent for 1999 ____________________________________

Jan._______________

Feb. ______________

March _____________

April ______________

May ______________

June______________

July _______________

Aug. ______________

Sept. ______________

Oct. _______________

Nov.______________

Dec. ______________

□

21.

Do you receive any rent subsidy?

Yes, from whom ____________________________________________________________________________

22.

Which utilities or services were included in the monthly rent: If none, check None.

□

Utilities:

Electric (other than for heat)

Gas (other than for heat)

Heat

None

□

Service:

Meals

Pet Fee

Housecleaning/Medical

Parking Garage Fee

Other

None

23.

I declare under the penalties of perjury, pursuant to Sec. 1-201 of Maryland Tax-Property Code Ann., that this application (including any accompanying forms and

statements) has been examined by me and the information contained herein, to the best of my knowledge and belief, is true, correct and complete, that I have listed all

monies received, and that my net worth is less than $200,000. Further, I hereby authorize the Social Security Administration, the Income Maintenance

Administration, Unemployment Insurance, the State Department of Human Resources, and Credit Bureaus to release to the Department of Assessments and

Taxation any and all information concerning the income or benefits received. I further authorize any landlord listed on this application to provide information

about my rental agreement and occupants of the rental unit. I understand that the Department may request at a later date additional information to verify the

amounts of income reported on this form, and that independent verifications of the information reported may be made.

_______________________________________________________ ____________

______________________________________________________________

Applicant’s Signature

Date

Spouse’s or Co-tenant’s Signature

_____________________________________________________________________ ____________

________________________________________________

Name of Preparer Other Than Applicant

Date

Telephone

RETURN TO