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Projecting your income

of a disability, or your spouse entering the nursing

home.

If you have experienced an event that has

decreased your income to less than the income

In order to qualify under these conditions, you

must file Schedule P, Projected Income Schedule

limits for 2004, and you have met the age and

for Drug Coverage, with your Form IL-1363. To

residency requirements, you may qualify for drug

obtain a copy of Schedule P, see “Where may I get

coverage. For example, a qualifying event might

help or more forms?” on Page 20.

be the death of your spouse, a divorce, the onset

Step 5:

Tell us about the Illinois property tax or rent you paid in 2004.

If your income on Line 25 is less than or

28 Property tax you paid in 2004

close to the amount you paid in mobile home

If you owned the home in which you lived, write

tax, property tax, and/or rent,

the amount of property tax you paid or that was

payable in the year 2004. Include both

you may need to attach proof of

property tax, mobile home tax, or rent

installments.

you paid — see Page 18.

If your taxes are included in your mortgage

payments, your mortgage company can provide

30 Rent you paid in 2004

the property tax amount for you.

Write the total amount of rent you paid if you

If your residence was a farm, you may claim only

rented a residence. Do not include the amount

property tax for your home and the land on

paid by a Section 8 program or any amount of

which it is located which was not assessed as

rent that you did not pay. Check “yes” or “no” to

farmland. Your chief county assessment officer

indicate whether your rent included food.

can help you figure this amount.

Mortgage payments are not considered rent. If

If you shared ownership in the home in which

you are buying your home, see the instructions

you lived with someone other than your spouse,

for Line 28.

write only the amount of property tax you paid

If you shared a rented residence with someone

that represents your share of the home. For

other than your spouse or qualified additional

example, if you and someone other than your

resident, write only the amount that represents

spouse each owned 50 percent of the home,

your portion of the rent. If this other person

write on Line 28 one-half of the property tax you

qualifies, he or she may apply on a separate

paid on the home in 2004.

Form IL-1363 for his or her part of the rent paid

If the other owner qualifies for a Circuit Breaker

on the residence. For example, if two sisters live

grant, he or she may apply on a separate Form

together and share equally the yearly rent of

IL-1363 for his or her share of the property tax

$4,800, each sister may apply on separate

paid on the home.

Forms IL-1363. Each sister may use $2,400 as

If your income on Line 25 is less than or

her share of the total rent.

close to the amount you paid in property tax,

If your income is less than or close to the

you may need to attach proof of

amount you paid in rent,

property tax you paid — see Page 18.

you may need to attach proof of the

rent you paid — see Page 18.

29 Mobile home tax you paid in 2004

30a To whom did you pay rent in 2004?

If you owned a mobile home and lived in it,

Write the name, address, and telephone

write the amount of taxes paid.

number of your landlord from whom you

If you owned the land on which your mobile

rented.

home was located, write on Line 28 the amount

of property tax paid on the land on which your

30b How many months did you rent here in

mobile home is located that was not assessed

2004?

as farmland.

Write the number of months during which

you rented from this landlord.

If you rented (or leased) the land on which

your mobile home was located, write on Line 30

If you now live at a residence that is not

the amount of rent you paid on this land.

subject to property tax (such as public housing),

Apply every year

Renew by March 31

IL-1363 instructions (R-12/04)

Form Il-1363 - Application For Circuit Breaker Grant, License Plate Discount, And Optional Help Paying For Drugs (Pharmaceutical Assistance Or Seniorcare) - 2004 Page 15

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