Form 54-014a - Iowa Mobile/manufactured/modular Home Owner Application For Reduced Tax Rate - 2009

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Iowa Department of Revenue
2009 Iowa Mobile/Manufactured/Modular Home
Owner Application For Reduced Tax Rate
Claimant’s Last Name
Claimant’s First Name
Claimant’s Social Security Number
Claimant’s Birth Date
County Number
/
/
/
/
Spouse’s First Name
Spouse’s Social Security Number
Spouse’s Last Name
Month
Day
Year
____ ____
/
/
Street Address
City, State, Zip Code
Do Not Write In This Space
YES NO
Were you 23 years of age or older on
12/31/08?. .............................................................................
2008 Household Income
Use Whole DOLLARS Only
0 0
,
1. Wages, salaries, tips, etc. _______________________________________
.
0
0
,
2. In-kind assistance for housing expenses ____________________________
.
0
0
,
3. Title 19 Benefits (excluding medical benefits) _______________________
.
0 0
,
4. Social Security income _________________________________________
.
0
0
,
5. Disability income _____________________________________________
.
0
0
,
6. All pensions and annuities ______________________________________
.
0
0
,
7. Interest and dividend income ____________________________________
.
8. Profits from businesses and/or farming and capital gains.
0
0
,
If less than zero, enter 0 (see instructions) __________________________
.
0
0
,
9. Actual money received from others living with you (see instructions) ____
.
0
0
,
10. Other income (Read instructions before making this entry) _____________
.
11. ADD amounts on Lines 1-10, enter here.
0
0
0
,
(If $20,031 or greater, no credit is allowed) _____________________
.
This is your total household income.
I declare under penalty of perjury that I have reviewed this claim and to the best of my knowledge and belief,
it is true, correct and complete.
________________________________________
_________
( ____ ) ________________________
Claimant’s Signature
Date
Claimant’s Telephone Number
For Use by County Treasurer Only
Income
Reduced
Sq. Footage ________________________________
Tax Rate
Year of manufacture _________________________
If year of manufacture is 2000 -2003,
$ 0.00
-
10,318.99
0
apply 90% factor.
10,319
-
11,532.99
.03
If year of manufacture is 1999 or before,
apply 80% factor.
11,533
-
12,746.99
.06
Regular Tax ________________________________
12,747
-
15,174.99
.10
Reduced Tax _______________________________
15,175
-
17,602.99
.13
Reimbursement _____________________________
17,603
-
20,030.99
.15
This claim must be filed with your county treasurer by June 1, 2009, unless the treasurer extends the filing deadline
to September 30, 2009. The Director of Revenue may extend the time for filing through December 31, 2009.
54-014a (9/4/08)

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