Form 54-036 - Iowa Special Assessment Credit - 2012 Page 2
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2IOWA
2012 Iowa Special Assessment Credit
Instructions
WHO IS ELIGIBLE:
You are eligible to claim a special assessment credit if your total household income was not more than $10,770
and you were: (a) 65 years of age or older by December 31, 2011, or (b) totally disabled and 18 years of age or
older by December 31, 2011.
Line 1: Wages, salaries, unemployment
Line 9: Monetary contributions - Enter money
compensation, tips, etc. - Enter the total wages,
received from others living with you. Do not include
salaries, unemployment compensation, tips,
goods and services received.
bonuses, and commissions received.
Line 10: Other income - Enter total income
Line 2: In-kind assistance - Enter any portion of
received from the following sources:
your housing expenses, including utilities that was
(a) Child support and alimony payments.
paid for you. Do not enter Federal Energy
(b) Welfare payments. Report FIP and all
Assistance.
other welfare program cash payments. Do
Line 3: Title 19 benefits - Enter your Title 19
not include foster grandparents’ stipends
benefits received for housing expenses. Do not
or non-cash government assistance (food,
include medical benefits.
clothing, food stamps, medical supplies,
etc.)
Line 4: Social Security income - Enter the total
Social Security benefits received, even if not
(c) Insurance income not reported elsewhere.
reportable for income tax purposes. Include any
(d) Gambling, and all other income not
Medicare premiums withheld.
reported elsewhere.
Line 5: Disability income - Enter the total received
Line 11: Total - Add lines 1 through 10. Enter total
for disability or injury compensation, even if not
here.
reportable for income tax purposes.
Line 12: Medical and care expenses - Enter all
Line 6: All pensions and annuities - Enter the total
medical and necessary care expenses paid during the
received from pensions and annuities, even if not
year which were related to your disability. These are
reportable for income tax purposes.
the same as you are allowed to deduct for federal
income tax.
Line 7: Interest and dividend income - Enter
taxable interest income, plus all interest income
Line 13: Total household income - Subtract line 12
from federal, state, and municipal securities.
from line 11. If more than $10,770, no credit is
Enter taxable dividends and distributions received.
allowed.
Include cash dividends and dividends paid in the
Return this completed claim to your county
form of merchandise or other property and report at
treasurer by September 30, 2012.
fair market value.
Line 8: Profit from business and/or farming and
capital gain - Enter profit from business and/or
For Assistance:
farming, and any gain received from the sale or
exchange of capital assets. Capital losses are limited
Contact your
to the same amount that you are allowed to report
for income tax purposes. Any loss must be offset
county treasurer.
against gain, and a net loss must be reported as
zero.
54-036b (09/28/11)
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Parent category: Financial