Property Tax Postponement Claim - California State Controller - 2004 Page 2
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2On lines 17-24, enter your income for the 2003 calendar year. If applicable, include the income of your spouse, or domestic
partner. On line 25, enter the total income of other household members.
•
17. Social Security and/or Railroad Retirement.…………………………………….….
17.
_______________
•
18. Interest and/or Dividends.………………………………………………………………
18.
_______________
•
19. Pensions and/or Annuities.…………………………………………………………….
19.
_______________
•
20. SSI/SSP, AB, ATD………………………………………………………………………...
20.
_______________
•
21. Rental Income (or Loss). Attach Federal Form 1040 and Schedules.…………….
21.
_______________
•
22. Business Income (or Loss). Attach Federal Form 1040 and Schedules.………...
22.
_______________
•
23. Capital Gain (or Loss). Attach Federal Form 1040 and Schedules.…………….…
23.
_______________
•
…………………………….
24.
_______________
24. Other Income (Including Wages)..………………..
25. Income of Other Household Members. Do not include income of minors,
•
25.
_______________
students or renters. ………………….……………………………………………………
•
26. SUBTOTAL. Add lines 17-25.………………………………………………….……..…
26.
_______________
•
27. Adjustments to Income. Attach documentation…………….……...………………..
27.
_______________
28. TOTAL HOUSEHOLD INCOME. Subtract line 27 from line 26.…………………….
•
28.
_______________
If line 28 is more than $24,000 (or $34,000 if you qualified in 1983), STOP. You do
not qualify for property tax postponement.
29. IS YOUR RESIDENCE PART OF A COOPERATIVE HOUSING CORPORATION?
YES
NO
30. IS YOUR RESIDENCE BASED ON A LEASEHOLD (POSSESSORY) INTEREST? If yes, first-
time filers must attach a copy of the recorded lease agreement and of the policy of title
YES
NO
insurance.
31. IS YOUR RESIDENCE BASED ON A LIFE ESTATE OR IS IT UNDER A CONTRACT OF
SALE? If yes, attach written consent from the remainderman or titleholder.
YES
NO
32. IS YOUR RESIDENCE A MOBILEHOME OR FLOATING HOME THAT IS SITUATED ON OR
NEAR RENTED OR LEASED LAND? If yes, attach a copy of your current certificate of title
and/or registration card.
YES
NO
33. IS ANY PORTION OF YOUR PROPERTY USED FOR RENTAL OR BUSINESS? If yes, enter
the percentage devoted to your personal use. _________________%
NO
YES
The percentage indicated is the amount that is eligible for postponement.
PLEASE SIGN THE COMPLETED FORM. ATTACH ALL REQUIRED DOCUMENTS AND MAIL TO:
STEVE WESTLY, CALIFORNIA STATE CONTROLLER
DIVISION OF COLLECTIONS
PROPERTY TAX POSTPONEMENT PROGRAM
P.O. BOX 942850
SACRAMENTO, CALIFORNIA 94250-5880
AN INCOMPLETE APPLICATION AND/OR MISSING DOCUMENTS WILL RESULT IN A DELAY IN PROCESSING.
Under penalty of perjury, I declare that this claim, including accompanying documents, is to the best of my knowledge true, correct, and complete.
______________________________
_______________________________
CLAIMANT’S SIGNATURE & DATE
SIGNATURE OF OTHER OWNER
(_____)________________________
_______________________________
TELEPHONE NUMBER
SIGNATURE OF OTHER OWNER
Signatures of all property owners are required.
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