Rent Certificate Form - Wisconsin Department Of Revenue - 2013 Page 2
Download a blank fillable Rent Certificate Form - Wisconsin Department Of Revenue - 2013 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Rent Certificate Form - Wisconsin Department Of Revenue - 2013 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Tab to navigate within form. Use mouse to check
Instructions
Save
Print
Clear
applicable boxes, press spacebar or Enter.
Rent Certificate
NOTE: • Attach to Schedule H or H-EZ
2013
• Alterations (whiteouts, erasures, etc .) or errors void this rent certificate.
Wisconsin Department of Revenue
You can get a new one at www .revenue .wi .gov, select “Forms .”
– Complete fields below. Enter Social Security Number AFTER your landlord fills in section below and signs.
Renter (Claimant)
Legal first name
M.I.
Legal last name
Social security number
Address of rental property (property must be in Wisconsin)
City
State
Zip
2013
2013
Time you actually lived at this address in 2013 . .
From
To
M
M
D
D
M
M
D
D
Do NOT sign your rent certificate .
If your landlord won’t sign, complete fields above and below and lines 1 to 5, attach rent verification (see instructions), and check here.
– Complete fields below and lines 1 to 5, sign, and print your name.
Landlord or Authorized Representative
Name of property owner
Telephone number
(
)
Address
City
State
Zip
1 a Is the above rental property subject to property taxes? . . . . . . 1a
Yes
No
b If 1a is “No” and you are a sec . 66 .1201 municipal housing authority that makes payments in lieu of taxes, check here . . 1b
2 a Is this certificate for rent of a mobile/manufactured:
home?
home site?
2a
Yes
No
. . .
2a
Yes
No
.00
b Mobile or manufactured home taxes or municipal permit fees you collected from this renter for 2013 . . . 2b
3
Fill in lines 3a to 3e based on the period of time this rental unit was occupied by this renter . Use the additional columns below
only if rent rates changed during the year (see instructions) . Do not include amounts received directly from a governmental agency .
.00
.00
.00
a Rent collected per month for this rental unit for 2013 . . . . . . . . . 3a
b Number of months this rental unit was rented to this renter in 2013
.00
c Total rent collected for this rental unit for 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3c
d Number of occupants in this rental unit – do NOT count spouse or children under 18 . . . . . . . . . . . . . . . . . . . . 3d
.00
e This renter’s share of total 2013 rent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3e
.00
4
Value of food and services provided by landlord (this renter’s share) . . . . . . . . . . . . . 4
.00
5 a Rent paid for occupancy only – Subtract line 4 from line 3e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a
b Was heat included in the rent?
Yes
No
c If a long-term care facility/CBRF/nursing home, check method used
to compute line 5a:
Standard rate ($100 per week)
Percentage formula (fill in percentage)
%
Other method approved by Department of Revenue
I certify that the information shown on this rent certificate is true, correct, and complete to the best of my knowledge.
Signature (by hand) of landlord or authorized representative
Date
Name of landlord or authorized representative (print)
Shared Living Expenses Schedule
–
To be completed by renter only if line 3d above is 2 or more and each occupant did not pay an
equal share of the rent .
Step 1: List name(s) of other occupants:
Step 3: Using the amounts listed in Step 2, compute your allowable
rent paid for occupancy only:
.00
1 Total rent paid (line 1a) . . . . . . . . . . . . . . . . 1
2 Shared living expenses
.00
Step 2: List the total amount (not the monthly amount) of
you paid (line 5b) . . . . . . . . 2
all shared living expenses (rent, food, utilities, and other)
3 Total shared living
paid by all occupants and the amount that you paid:
.00
expenses (line 5a) . . . . . . . 3
Shared Living
Total Paid by
Amount
4 Divide line 2 by line 3 . Fill
Expenses
All Occupants
You Paid
in decimal amount . . . . . . . . . . . . . . . . . . . . 4
x .
.00
.00
Rent
1a)
1b)
.00
5 Multiply line 1 by line 4 . . . . . . . . . . . . . . . . . 5
.00
.00
Food
2a)
2b)
6 Value of food and services provided by
.00
.00
.00
Utilities
3a)
3b)
landlord (line 4 above) . . . . . . . . . . . . . . . . . 6
7 Subtract line 6 from line 5 . This is your allowable
.00
.00
Other
4a)
4b)
rent . Fill in here and on line 14a or 14c of
.00
.00
.00
Total
5a)
5b)
Schedule H (line 9a or 9c of Schedule H-EZ) 7
I-017i
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Cl-001 - Railroad Company's Annual Report Of Car Line Taxes Withheld - Wisconsin Department Of Revenue - 2013
Financial
Form S-229 - Biotechnology Business Certification Request - Wisconsin Department Of Revenue
Financial
Form Ct-103 - Schedule Of Cigaretts Stamped For Sale Form - Wisconsin Department Of Revenue
Financial
Form St-28ee - Clean Drinking Water Fee Exemption Certificate Form - Kansas Department Of Revenue
Financial
Related Categories
Parent category: Financial