California Form 9000r - Renter Assistance Claim - 2006
ADVERTISEMENT
1
2YEAR
CALIFORNIA FORM
Renter
2006
9000R
Assistance Claim
(for income received in 2005)
Your first name
Initial
Last name
STEP 1
Last name
Spouse’s first name
Initial
Name and
address
Apt. no.
PMB no.
Present home address — number and street, PO Box or rural route
Place
label here,
State
ZIP Code
City, town, or post office
-
type, or print
STEP 2
IMPORTANT:
Your
Your
-
-
-
-
Social security
Your SSN
Spouse’s
SSN
number (SSN)
is required.
SSN
STEP 3
•
1. Are you a United States citizen? Check “Yes” or “No” . .
1.
NO
YES
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
I f you are not a citizen of the United States, go to page 10. If you
have a qualifying alien status for the United States, enter your
•
Alien Registration
2b.
alien status code from the chart on page 10 on line 2a. Then
Number
enter your alien registration number on line 2b and your date
•
2c.
of entry into the United States on line 2c. (MM/DD/YYYY)
Date of Entry
3. Check the appropriate box if you were one of the following on
December 31, 2005:
•
A. 62 years or older (see Note on page 5, line 3a) . . . . . .
A
•
B. Under 62 and blind . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B
•
C. Under 62 and disabled (not blind) . . . . . . . . . . . . . . . .
C
If you cannot check one of the boxes, STOP HERE. You do not qualify to
file for a Renter Assistance claim.
•
4. Enter your date of birth (example: 0 5/ 2 1 / 1 9 4 3) . . . . .
4.
MM DD Y Y Y Y
Date of Birth
You must enter your date of birth
See instructions on page 5 to see if you must attach a proof document
to your claim.
STEP 4
5. Enter the total number of months during 2005 that you
lived in one or more qualified rented residence(s) in
Rental
•
________months
California. See instructions . . . . . . . . . . . . . . . . . . . . . . . . .
5.
information
6. If the address where you lived during 2005 is different than the address you
entered in Step 1, or if the address in Step 1 is a post office box, enter your 2005
residence address. (If more than one rented residence attach a list.)
Street Address
City
¼
_________________________________________________________________________________________
State and ZIP Code
¼
___________________________________________
________________
________________
RENTED FROM
TO
7. Enter the name, address, and telephone number of your landlord or the person
to whom you paid rent during 2005. (If more than one landlord attach a list.)
NAME ___________________________________________________________________________________________________________
ADDRESS ______________________________________________________________________________ APT. OR UNIT NO._________
_____________________
CITY ________________________________________________________ STATE and ZIP CODE_________
TELEPHONE (
) ____________________________________
For Privacy Act Notice, see Page 9.
FTB 9000R 2006 Side 1
Complete Side 2, Step 5 Through Step 9.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial