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2012 Iowa Mobile/Manufactured/Modular Home
IOWA
Owner Application for Reduced Tax Rate
This claim must be filed or mailed to your county treasurer by June 1, 2012. Iowa treasurers’ addresses can be
found at the Iowa Treasurers Association Web site.
Claimant’s Last Name
First Name
Claimant’s Social Security Number
Claimant’s Birth Date
County
Number
/
/
/
/
Spouse’s Last Name
First Name
Spouse’s Social Security Number
Month
Day
Year
___
___
/
/
Street Address
City, State, ZIP
Do not write in this space.
YES NO
Were you 23 years of age or older on
12/31/11. ............................................................................
2011 Household Income
(Claimant and Spouse)
Use Whole DOLLARS Only
0 0
,
1. Wages, salaries, unemployment compensation, 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 gain.
,
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. ____________
.
,
0 0
11. ADD amounts on lines 1-10 and enter here. ________________________
.
0
(If $20,906 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
Sq. Footage _______________________________
Income
Reduced
Year of manufacture ________________________
Tax Rate
$ 0.00 - 10,769.99
0
If year of manufacture is 2003 -2006,
apply 90% factor.
10,770 - 12,036.99
.03
If year of manufacture is 2002 or before,
12,037 - 13,303.99
.06
apply 80% factor.
13,304 - 15,837.99
.10
Regular Tax _______________________________
15,838 - 18,371.99
.13
Reduced Tax ______________________________
18,372 - 20,905.99
.15
Reimbursement ____________________________
54-014a (09/21/11)