Fillable Form 90r - Oregon Elderly Rental Assistance

Compensation for services performed

Gifts and grants (totaling more than $500) Yes

Back pay ....................................................... Yes

Cash .............................................................. Yes

Bonuses ......................................................... Yes

Gifts from spouse/RDP in the same

Clergy’s fees ................................................. Yes

household ........................................................... No

Commissions ............................................... Yes

Gifts other than cash (report at fair

Director’s fees .............................................. Yes

market value) .............................................. Yes

Fees in general (trustee, executor,

Payment of indebtedness by another ...... Yes

jury duty) ..................................................... Yes

Grants and payments by foreign

Lodging for convenience of employer ............. No

governments (nontaxable) ........................... Yes

Meals for convenience of employer ................. No

Grants by federal government for

Salaries .......................................................... Yes

rehabilitation of home ......................................... No

Severance pay .............................................. Yes

Tips ................................................................ Yes

Gratuities ........................................................ Yes

Wages ............................................................ Yes

Hobby income ................................................ Yes

Deferred compensation

Honorariums .................................................. Yes

Contributions made ........................................... No

Individual Retirement Arrangement (IRA)

Payments received ...................................... Yes

Conventional IRA

Depletion in excess of basis ........................ Yes

Payments received ...................................... Yes

Depreciation, depletion, and

Payments contributed ........................................ No

amortization in excess of $5,000 ................. Yes

...... No

Rollovers or conversions not included in AGI

Rollovers or conversions included in AGI .......Yes

Disability income (entire amount) ............ Yes

Roth IRA

Dividends, taxable and nontaxable ........... Yes

Payments received ............................................. No

Credit union savings account

Payments contributed ................................. Yes

“dividends” (interest) ................................. Yes

...... No

Rollovers or conversions not included in AGI

Insurance policy “dividends” (return

Rollovers or conversions included in AGI .......Yes

of premium) ....................................................... No

Inheritance ..................................................... Yes

Return of capital dividends .............................. No

From spouse/RDP who resided with you ...... No

Stock dividends ........................................... Yes

Tax-exempt dividends ................................ Yes

Insurance proceeds

Accident and health .................................... Yes

Earned income credit, advanced........................ No

Disability payments .................................... Yes

Estate and trust income (also see

Employee death benefits ............................ Yes

Inheritance) (losses limited to $1,000)......... Yes

Life insurance .............................................. Yes

Personal injury damages (less

Farm income (reduced by expenses)

attorney fees) .............................................. Yes

(losses limited to $1,000) ................................ Yes

Property damage if included in

Agricultural program payments ............... Yes

federal income ............................................ Yes

Patronage dividends ................................... Yes

Reimbursement of medical expense ............... No

Proceeds from sale of crops/livestock ..... Yes

Sick pay (employer sickness and

Rents ............................................................. Yes

injury pay) ................................................... Yes

Sale of services ............................................. Yes

Strike benefits .............................................. Yes

Fellowships..................................................... Yes

Unemployment compensation .................. Yes

Foreign income (nontaxable) ....................... Yes

Workers’ compensation .............................. Yes

Foster child care (reduced by expenses) .......... No

Interest, taxable and nontaxable ................ Yes

Contracts ...................................................... Yes

Funeral expenses received .................................. No

Municipal bonds and other securities...... Yes

Gains on sales (receipts less cost) .............. Yes

Savings accounts ......................................... Yes

Excluded gain for Oregon on sale of home .... No

Tax-exempt interest ..................................... Yes

Gambling winnings (before losses) .......... Yes

U.S. Savings Bonds ...................................... Yes

150-545-002 (Rev. 12-14)

Form 90r - Oregon Elderly Rental Assistance - 2014 Page 5

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