Form Tc-40cb - Property Tax/renter Refund Application - Utah Tax Comission, 1998
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1
21998
Utah State Tax Commission
Property Tax/Renter Refund Application TC-40CB
(Circuit Breaker Application)
Rev. 4/98
For more information, contact your county; or for a listing of other agencies to contact,
see the reverse side of this form (at the bottom).
Claimant's Name
If more than one person lives in a houshold, only one person can file an application.
Claimant's Last Name
Claimant'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
Do You Qualify For A Refund?
Renters and Mobile Homeowners:
You should file this application with the Utah State Tax Commission by
December 31, 1998.
Homeowners:
You should first file for
property tax relief through your county government.
Contact your county government
to obtain the application and filing deadline. If you miss your county government deadline, then file this application with the Utah
State Tax Commission by
December 31, 1998.
I am filing for: (check only one)
Renter refund
Mobile Homeowner refund
Homeowner refund
ALL APPLICANTS must answer questions 1 through 3.
1.
Will you be age 65 or older before December 31, 1998?
OR
Are you a widow or widower who is
Yes
No
NOT REMARRIED? Enter spouse's date of death: _____________. Include a copy of
(Go on to
(STOP, you do
the death certificate if this is the first year you are claiming benefits as a widow or widower.
question 2)
NOT qualify)
2. 1997 Household Income
(from
all
household members).
Taxable Income
Non-taxable Income
A. Wages/salaries
A
E. Social Security/other government programs
E
B. Pensions/annuities
B
F. Capital gains/pensions/annuities
F
C. Interest/dividends/trusts
C
G. Interest/dividends/trust income
G
D. Alimony/other income
D
H. Loss carryforwards/rental depreciation
H
I.
I
Total 1997 household income
from all sources
(add lines A through H)
Total members in household
You
do not
qualify if the amount in Box
I
exceeds $21,644.
Is the amount in Box
I
above
less than or equal to $21,644?
Household Income is income received
Yes
No
during 1997 by
all
members of a household (not just the claimant) living in the same dwelling,
(Go on to
(STOP, you do
question 3)
NOT qualify)
sharing furnishings, facilities, accommodations and expenses.
3.
Did you furnish your own financial support for 1997. If you are claimed as a dependent on someone's
No
Yes
tax return, you did not furnish your own financial support, and do not qualify.
(Go on to
(STOP, you do
question 4 or 5)
NOT qualify)
RENTERS must answer question 4.
No
4.
Did you live in Utah for the entire year of 1997? You must have lived in Utah for the entire calendar
Yes
year to be eligible.
(Go on to
(STOP, you do
next page)
NOT qualify)
HOME OWNERS and MOBILE HOME OWNERS must answer question 5.
5.
Will you live in Utah for the entire year of 1998? You must live in Utah for the entire calendar
No
Yes
year to be eligible.
(Go on to
(STOP, you do
next page)
NOT qualify)
This Box for Tax
Commission Use Only
R
40CB.FRM Rev. 4/98
P
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