California Form Ftb 9000 - Homeowner Assistance Claim - 2000
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1
2YEAR
CALIFORNIA FORM
Homeowner
2000
Assistance Claim
9000
(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
•
1. Are you a United States citizen? Check “Yes” or “No” . .
1.
NO
STEP B
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
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,
2b.
Alien Registration
enter your alien status code from the chart on page 19 on
Number
line 2a. Then complete line 2b and line 2c.
•
2c.
0 7 2 1 1 9 7 0
(example:
)
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 Homeowner Assistance claim.
5. Did you own and live in your home on
STEP C
December 31, 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
YES
NO
If “No,” stop. You do not qualify for homeowner assistance.
Property
a. Enter the FULL value of your property (after
Information
subtracting your homeowner’s or veteran’s
•
$
exemption). See page 8 . . . . . . . . . . . . . . . . . . . . . . . .
5a.
Complete
line 5
6. Is your property used for rental and/or business
through
NO
as well as personal use? . . . . . . . . . . . . . . . . . . . . . . . .
6.
YES
line 7.
If you checked “Yes,” enter the estimated percentage of
%
property devoted to your personal use. See page 8 . . . . . . .
6a.
7. List name(s) and relationship(s) of anyone, other than
yourself, who is included on your property tax bill.
Did this person live in
See page 8.
your home in 1999?
Name______________________ Relationship________________
YES
NO
Name______________________ Relationship________________
YES
NO
Name______________________ Relationship________________
NO
YES
%
Enter your percentage of ownership . . . . . . . . . . . . . . . .
7.
For Privacy Act Notice, see Page 13.
Complete Side 2, Step D Through Step H.
FTB 9000 2000 Side 1
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