Form Rtc-60 - Renters' Tax Credit Application

PLEASE COMPLETE OTHER SIDE OF APPLICATION FIRST

17. List all household residents who lived with you in 2012. (If none, write NONE.) You must answer this question.

Name

Date of Birth

Social Security Number

Your Dependent?

Relationship

2012 Income

Yes or No

If more space is needed, attach a separate list

18. Did or will you, and/or your spouse, file a Federal Income Tax Return for 2012?

Yes

If yes, a copy of your return (and if married filing

separately, a copy of your spouse’s return) with all accompanying schedules must be submitted with this application.

19.

AMOUNTS AND SOURCES OF INCOME IN 2012

(1)

(2)

(3)

OFFICE

PROOF OF ALL INCOME MUST BE ATTACHED

APPLICANT

SPOUSE/

ALL

USE

(ATTACH COPIES - NOT ORIGINALS)

CO-TENANT

OTHERS

ONLY

Wages, Salary, Tips, Bonuses, Commissions, Fees................................................................

Interest and Dividends (Includes both taxable and non-taxable)............................................

Capital Gains (Includes non-taxed gains) ..............................................................................

Rental Profits (Net) or Business Profits (Net) (Circle which) ..................................................

Room & Board paid to you by a nondependent resident ......................................................

Unemployment Insurance; Workers’ Compensation (Circle which) ........................................

Alimony; Support Money (Circle which) ................................................................................

Public Assistance (Attach AIMS) or other Government Grants (Circle which)..........................

Social Security (Attach copy of 2012 Form SSA-1099) If none,enter “0” ..............................

S.S.I. Benefits for 2012 (Attach Proof) ..................................................................................

Railroad Retirement (Attach copy of 2012 Verification or Rate letter) ....................................

Veteran’s Benefits per year ..................................................................................................

Other Pensions, Annuities, and IRAs per year (If a rollover, attach proof) ..............................

Gifts over $300; Expenses Paid by Others; Inheritances (Circle which) ................................

All Other Monies Received (Indicate Source) ........................................................................

TOTAL INCOME, CALENDAR YEAR 2012

20. Enter the amount of rent you paid each month in Maryland from January 1 through December 31, 2012

Total Rent for 2012__________________

Jan. _________________ Feb. _________________ March __________________ April _________________ May _________________ June _________________

July _________________ Aug. _________________ Sept. _________________

Oct. _________________

Nov. _________________ Dec. _________________

21. Do you receive any rent subsidy?

Yes, from whom____________________________________________________________________________________

22. Which utilities or services were included in the monthly rent: If none, check None.

Utilities:

Electric (other than for heat)

Gas (other than for heat)

Heat

None

Services:

Meals

Pet Fee

Housecleaning/Medical

Parking Garage Fee

Other

None

23. I declare under the penalties of perjury, pursuant to Sec. 1-201 of the Maryland Tax-Property Code Ann., that this application (including any accompanying forms and

statements) has been examined by me and the information contained herein, to the best of my knowledge and belief, is true, correct and complete, that I have listed all

monies received, and that my net worth is less than $200,000. Further, I hereby authorize the Social Security Administration, Comptroller of the Treasury, Internal

Revenue Service, the Income Maintenance Administration, Unemployment Insurance, the State Department of Human Resources, and the Credit Bureaus to

release to the Department of Assessments and Taxation any and all information concerning the income or benefits received. I further authorize any landlord

listed on this application to provide information about my rental agreement and occupants of the rental unit. I understand that the Department may request

at a later date additional information to verify the amount of income reported on the form, and that independent verifications of the information reported may

be made.

Applicant’s Signature

Date

Spouse’s or Co-tenant’s Signature

Name of Preparer Other Than Applicant

Date

Telephone

Applications are processed in the order in which they are received if additional information is not required.

RETURN TO

FOR INFORMATION CALL

Department of Assessments and Taxation

Baltimore Metropolitan Area