Form Tc-40cy - Low Income Abatement And Homeowner'S Tax Credit Application - 2012 Page 2
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Section 4 - Homeowner's Tax Credit
Applicant must answer all 4 questions.
Yes
No
1. Will you be age 66 or older on or before December 31, 2012, or Are you a widow or widower? If you are a
widow or widower, enter your spouse's date of death:________________.
If filing for the first time as a widow or widower, attach a copy of your deceased spouse's Death Certificate.
Yes
No
2. Was the total household income (from Section 2, line K) less than $29,919?
Yes
No
3. Will you furnish your own financial support for 2012? (You cannot be claimed as a dependent on someone
else's tax return for 2012.)
Yes
No
4. Will you live in Utah for the entire year of 2012?
You must be domiciled in Utah for the entire 2012 calendar year to be eligible.
If your name is not listed as the property owner of the Property Tax Billing Notice, attach legal documentation of ownership.
Only property tax on applicant's primary residence is eligible for property tax credit.
Yes
No
If yes, total number of acres
Is the home located on property that exceeds one acre?
Yes
No
If yes, what percent is rented
Is any portion of the home rented out?
Yes
No
If yes, what percent is used
Is a portion of the home used for business?
You must have owned the home on January 1, 2012 to qualify.
If you qualify for property tax credit, you may also qualify for low income abatement, on the front of this form.
Section 5 - Residency Status of Applicant
Under state and federal law we are prohibited from processing this application or issuing a credit to any person who fails to provide
this information.
Check one (providing false information subjects the signer to penalties for perjury):
1.
I am a U.S. citizen and have provided my Social Security Number on the front of this form.
2. I
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.
I-94 Number*: _ _ __ _ __ _ __ __ _ __
If you checked box 2, you must file this form
Alien Registration Number*: _ _ __ _ _ __ _ __ __ _ _
in person and bring proof of your I-94 Number
*The I-94 (arrival/departure) number and the Alien Registration
and Alien Registration Number.
Number are issued by the U.S. Citizenship and Immigration Service.
Under penalties of perjury, I declare that I am a U.S. citizen OR that I qualify under 8 U.S.C 1641 and am present in the
United States lawfully.
Signature of applicant
Date signed
Section 6 - Certification and Signature
Read certification, sign and date.
Under penalties of perjury, I declare to the best of my knowledge and understanding, this information is true, correct and complete.
Signature of applicant
Date
Signature of spouse
Date
(Spouse must sign if home is owned in joint tenancy)
X
X
Preparer's name and address or organization (if not applicant)
Preparer's telephone number
For Tax Commission Use Only
For County Use Only
CB used by county
CB available (max-used)
Tax amount
CB rent possible
CB rent issue <= CB available
Blind and/or veteran
Homeowner's Valuation Reduction (additional 20%)
Property Tax Credit /Renter's Refund Schedule
Circuit breaker
Renter Refund
Total Maximum
Maximum
Total Maximum
2011 Household
Low income abatement
% of Lot Rent
Renter Refund
Homeowner
Homeowner &
Income
Tax Credit
Rental Refund
0
$10,172
$886
9.5%
$886
$1,772
Net tax due
$10,173
13,564
773
8.5%
773
1,546
13,565
16,954
663
7.0%
663
1,326
County government approval
Date approved
16,955
20,344
496
5.5%
496
992
20,345
23,737
386
4.0%
386
772
23,738
26,926
221
3.0%
221
442
26,927
29,919
109
2.5%
109
218
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