California Form 9000h - Homeowner Assistance Claim - 2008
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1
2Homeowner
YEAR
CALIFORNIA FORM
9000H
Assistance Claim
2008
(for income received in 2007)
STEP 1
Your first name
Initial
Last name
Spouse’s/RDP’s first name
Last name
Name and
Initial
address
Apt. no.
Address (including number and street, PO Box, or PMB no.)
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/RDP’s
SSN
is required.
number (SSN)
SSN
STEP 3
I
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
I
2. Benefit Eligibility for Noncitizens . . . . . . . . . . . . . . . . . . . . . . .
2a.
Alien Status Code
If you are not a citizen of the United States, go to page 10. If
I
you have a qualifying alien status for the United States, enter
2b.
your alien status code from the chart on page 10 on line 2a.
Alien Registration
Number
Then enter your alien registration number on line 2b and your
I
2c.
date of entry into the United States on line 2c. (MM/DD/YYYY)
3. Check the appropriate box if you were one of the following on
Date of Entry
December 31, 2007:
I
A
A. 62 years or older (See page 5, line 3A) . . . . . . . . . . . . . . . .
I
B
B. Under 62 years and blind. . . . . . . . . . . . . . . . . . . . . . . . . . .
I
C. Under 62 years and disabled (not blind) . . . . . . . . . . . . . . .
C
If you cannot check one of the boxes, STOP HERE. You do not qualify to
file for a Homeowner Assistance claim.
I
4. Enter your date of birth (example: 0 5/ 2 1 / 1 9 4 5) . . . . . . . .
4.
Date of Birth
You must enter your date of birth
MM D D
Y Y Y Y
See instructions on page 5 and page 6 to see if you must attach a proof
document to your claim.
STEP 4
5. Did you own and live in your home on
NO
December 31, 2007? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
YES
Property
If “NO,” STOP. You do not qualify for homeowner assistance.
Complete form FTB 9000R, if you are a qualified renter.
information
a. Enter the NET value of your property.
from
I
1
5a.
$
See page 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2007/2008
6. Is your property used for rental and/or business
tax bill
YES
NO
as well as personal use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.
If you checked “Yes,” enter the estimated percentage of
100.00
%
property devoted to your personal use. See page 6 . . . . . . . . . . . .
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 7.
your home in 2007?
YES
NO
Name______________________ Relationship________________
NO
YES
Name______________________ Relationship________________
NO
YES
Name______________________ Relationship________________
%
Enter your percentage of ownership . . . . . . . . . . . . . . . . . . . . .
7.
100.00
For Privacy Notice, see Page 9.
FTB 9000H 2008 Side 1
Complete Side 2, Step 5 Through Step 7.
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