Fillable Form 90r - Oregon Elderly Rental Assistance

Clergy’s rental or housing allowance,

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

in excess of expenses claimed to

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

determine federal AGI ................................. Yes

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

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

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

Depreciation, depletion, and

Rollovers or conversions ................................... No

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

Roth IRA

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

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

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

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

Credit union savings account

Rollovers or conversions ................................... No

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

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

Insurance policy “dividends” (return

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

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

Insurance proceeds

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

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

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

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

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

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

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

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

Personal injury damages (less

Estate and trust income (also see

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

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

Property damage if included in

Farm income (reduced by expenses)

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

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

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

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

Sick pay (employer sickness and

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Form 90r - Oregon Elderly Rental Assistance - 2012 Page 5

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