Form Ri-1040h - Rhode Island Property Tax Relief Claim
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1
22001
RI-1040H
Rhode Island Property Tax Relief Claim
FIRST NAME(S) AND INITIAL(S) OF CLAIMANT AND SPOUSE
LAST NAME
Your Social Security Number
STREET ADDRESS
APARTMENT NUMBER
Spouse's Social Security Number
CITY, TOWN, POST OFFICE
STATE
ZIP CODE
City or Town of Legal Residence
PART 1 Answer the following questions to determine if you qualify for property tax relief
A.
Are you a legal resident of Rhode Island for all of 2001…………………………………………………………………………………………………. YES
A.
NO
YES
NO
B.
B.
Did you live in a household or rent a dwelling that was subject to property tax…………………………………………………………………………………..
C.
C.
YES
NO
Are you current for property taxes or rent due on the homestead for all prior years……………………………………………………………………………….
YES
NO
D.
Are you current on 2001 property taxes or rent and will pay any unpaid installments………………………………………………………………………..
D.
Was your household income $30,000 or less (from part 2, line 8 below)…………………………………………………………………………………. YES
NO
E.
E.
If you answer NO to any of these questions, you are not eligible for this credit. Stop here. Do not complete this form.
PART 2 Enter all income received by you and other members living in your household
1.
Adjusted Gross Income - Federal Form 1040, line 33; 1040A, line 19, 1040EZ, line 4; Telefile item I
1.
If no Federal return is filed complete page 2, part 6 and enter result on line 8 below…………………………………………………………………………………..
2.
Non-taxable interest and dividends……………………………………………………………………………………………………………………………………………….
2.
3.
Capital gains not included in line 1……………………………………………………………………………………………………………………………………………
3.
4.
Social Security (including Medicare premiums) and Railroad Retirement Benefits not included in line 1………………………………………….
4.
5.
Worker's compensation and tax exempt pensions…………………………………………………………………………………………………………….
5.
6.
Cash public assistance payments (welfare, etc.)………………………………………………………………………………………………………………………….
6.
7.
Other non-taxable income - specify: ______________________________________………………………………………………………………………..
7.
8.
8.
Total 2001 household income (add lines 1 through 7 or enter amount from page 2, part 6, line 37)………………………………………………………………..
PART 3 Additional information
/
/
9A.
9A.
Enter your date of birth………………………………………………………………………………………………………………………………………………
/
/
9B.
9B.
Enter spouse's date of birth……………………………………………………………………………………………………………………………………………………
9C.
9C.
Are you or your spouse disabled and receiving social security disability payments during 2001………………………………………………………… YES
NO
9D.
9D.
Indicate the number of persons in your household………………………………………………………………………………………………………………………
PART 4 To be completed by homeowners only
10.
10.
Enter the amount of property taxes you paid or will pay in 2001……………………………………………………………………………………………………….
11.
11.
Enter amount from line 8 above………………………………………………………………………………………………………….
%
12.
12.
Enter percentage from computation table on back page…………………………………………………………………………………
13.
13.
Multiply amount on line 11 by percentage on line 12…………………………………………………………………………………………………………………..
14.
Tentative credit - line 10 minus line 13 (if line 13 is greater than line 10, then enter zero)………………………………………………………………..
14.
15.
RI Property Tax Relief Credit (line 14 or $250.00 whichever is less) enter here and on RI-1040, page 1, line 18C………………………………..
15.
PART 5 To be completed by renters only
Landlord's name
Landlord's address
Enter landlord's name and address……………………………..
16.
16.
Enter amount of rent you paid in 2001………………………………………………………………………………………………………………………….
17.
17.
Multiply the amount on line 16 by 20%……………………………………………………………………………………………………………………………………..
18.
18.
Enter amount from line 8 above……………………………………………………………………………………………………..
%
19.
19.
Enter percentage from computation table on back page………………………………………………………………………………
20.
20.
Multiply amount on line 18 by percentage on line 19………………………………………………………………………………………………………………….
21.
21.
Tentative credit - line 17 minus line 20 (if line 20 is greater than line 17, then enter zero)……………………………………………………………………..
22.
22.
RI Property Tax Relief Credit (line 21 or $250.00 whichever is less) enter here and on RI-1040, page 1, line 18C……………………………………
I hereby certify that the property taxes accrued and used for the purpose of the property tax relief credit have been or will be paid by me and there are no delinquent property taxes on my homestead.
Your
Spouse's
Ø
Ø
Signature
Signature
Date
Date
PAID PREPARER'S SIGNATURE & ADDRESS
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