California Form 9000r - Renter Assistance Claim (For Income Received In 1999) - 2000
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1YEAR
CALIFORNIA FORM
Renter
2000
Assistance Claim
9000R
(for income received in 1999)
Use the peel-off label. Otherwise, please print or type.
STEP A
CLAIMANT’S FIRST NAME
INITIAL LAST NAME
CLAIMANT’S SOCIAL SECURITY NUMBER
Name,
SPOUSE’S FIRST NAME
INITIAL LAST NAME
SPOUSE’S SOCIAL SECURITY NUMBER
address,
and
social
PRESENT HOME ADDRESS – NUMBER AND STREET INCLUDING PO BOX OR RURAL ROUTE
PMB NO.
APT. NO.
security
number
CITY, TOWN, OR POST OFFICE, STATE AND ZIP CODE
STEP B
•
1. Are you a United States citizen? Check “Yes” or “No” . .
1.
YES
NO
If you checked “Yes,’’ skip line 2 and go to line 3.
Filing
If you checked “No,’’ go to line 2.
Status
•
2. Benefit Eligibility for Noncitizens . . . . . . . . . . . . . . . . . . . .
2a.
Alien Status Code
If you are not a citizen of the United States, go to page 19.
If you have a qualifying alien status for the United States,
•
enter your alien status code from the chart on page 19 on
2b.
Alien Registration
Number
line 2a. Then complete line 2b and line 2c.
0 7 2 1 1 9 7 0
•
(example:
)
2c.
Date of Entry
0 5 1 2 1 9 2 2
(example:
)
•
3. Enter your date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
Date of Birth
4. Check the appropriate box if you were one of the following on
December 31, 1999:
•
A.
62 years or older
A
•
B.
Under 62 and blind
B
•
C.
Under 62 and disabled (not blind)
C
See instructions on page 6 and page 7 to see if you must attach a proof
document to your claim. If you cannot check one of the boxes, STOP
HERE. You do not qualify to file for a Renter Assistance claim.
STEP C
5. Enter the total number of months during 1999 that you
lived in a qualified rented residence in California.
Rental
•
________months
See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
Information
6. List the street address(es) of residence(s) you rented in California during 1999
that qualified you for renter assistance and list the dates you rented each
Complete
residence:
line 5
Street Address
City, State, and ZIP Code
Dates rented in 1999
through
line 7.
A._________________________________________________________________________________________
B._________________________________________________________________________________________
7. Enter the name, address, and telephone number of your landlord or the person
to whom you paid rent during 1999.
NAME ___________________________________________________________________________________________________________
ADDRESS ______________________________________________________________________________ APT. OR UNIT NO._________
_____________________
CITY ________________________________________________________ STATE and ZIP CODE_________
/
/
/
/
________________
_________________
TELEPHONE (
) ______________________________________ RENTED FROM
TO
For Privacy Act Notice, see Page 11.
Complete Side 2, Step D Through Step H.
FTB 9000R 2000 Side 1
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