Schedule H Homeowner And Renter Property Tax Credit - Government Of The District Of Columbia - 2015 Page 2
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2
3
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*159980120000*
2015 SCHEDULE H PAGE 2 Last name and SSN
Federal Adjusted Gross Income of the tax filing unit (see instructions) –
Report the AGI of every member of your tax filing unit, including
income subject to federal but not DC income tax. See following pages to add additional dependents.
COLUMN A (YOU)
COLUMN B (SPOUSE/DP)
COLUMN C (DEPENDENT #1)
Name (Last, First)
Social Security Number (SSN)
Date of Birth (MMDDYYYY)
1
$
$
$
Wages, salaries, tips, etc.
1
2
2
Taxable interest
3
3
Ordinary Dividends
4
4
Taxable refunds, credits, or offsets of state and local income taxes
5
5
Alimony received
6
6
Business Income
Fill in if minus
7
7
Capital gain
Fill in if minus
8
8
Other gains
Fill in if minus
9
9
IRA distributions: Taxable amount
10
10
Pensions and annuities: Taxable amount
11
11
Fill in if minus
Rental real estate, royalties, partnerships, S-Corp., trusts, etc.
12
12
Farm income
Fill in if minus
13
13
Unemployment compensation
14
14
Social security benefits: Taxable amount
15
15
Other income. Attach separate sheet(s)
Fill in if minus
16
16
Add Lines 1 through 15 in each column.
Fill in if minus
17
17
Educator expenses
18
Certain business expenses of reservists, performing artists, and
18
fee-basis government officials
19
19
Health savings account deduction
20
20
Moving expenses
21
21
Deductible part of self-employment tax
22
22
Self-employed SEP , SIMPLE, and qualified plans
23
23
Self-employed health insurance deduction
24
24
Penalty on early withdrawal of savings
25
25
Alimony paid
26
26
IRA deduction
27
27
Student loan interest deduction
28
28
Tuition and fees per Federal form 8917
29
29
Domestic production activities deduction
30
30
Add Lines 17 through 29 in each column
31
31
Subtract Line 30 from Line 16
Fill in if minus
32
Total federal adjusted gross income. Add amounts entered on Line 31, Columns A - I
$
and enter total here on Line 32 and on Section A, Line 1 or Section B, Line 8.
Fill in if minus
For STANDALONE FILERS only, please complete the following "Refund Options" information
Will this refund go to an account outside of the US?
Yes
No
Refund Options:
For information on the tax refund card and program limitations, see instructions or visit our website otr.dc.gov/refundprepaidcards.
Mark one refund choice:
Direct deposit
Tax refund card
Paper check
Direct Deposit.
To have your refund deposited to your
checking OR
savings account, fill in oval and enter bank routing and account numbers. See instructions.
Routing Number
Account Number
Signature
Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on information available to the preparer.
Your signature
Date
Preparer’s signature
Date
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Spouse’s/domestic partner’s signature if filing jointly or separately
Date
Preparer's Tax Identification Number (PTIN)
PTIN telephone number
File order 6
on same return.
2015 SCHEDULE H WORKSHEET P2
Revised 04/2015
Homeowner and Renter Property Tax Credit
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