Free 2008 I-017 Rent Certificate - Wisconsin Department of Revenue - Wisconsin

CAUTION:
Schedule H or H-EZ must be completed and filed with this rent certificate

Rent Certificate
WisconsinDepartmentofRevenue 1 Name 2 Socialsecuritynumber

NOTE:Alterationsonlines1to13orthesignatureline(whiteouts,erasures,etc.)willvoidthis rentcertificate.Arentcertificatewithanerrorshouldbediscardedandanewonecompleted. Needanadditionalrentcertificate?Gotowww.revenue.wi.gov.

2008

Renter(claimant) Completelines1,3,and4.Haveyourlandlordfill 11 Fill in lines 11a to 11e based on the period of time this rental
inlines6to13andsign,thencompleteline2.

3 Addressofrentalproperty(propertymustbeinWisconsin)

unit was occupied by this renter. Use the additional columns onlines11aand11bonlyifrentrateschangedduringtheyear (seeinstructions).Donotincludeamountsreceiveddirectlyfrom agovernmentalagency.

4 Timeyouactuallylivedherein2008 From(mo./day)

a Rentcollectedper monthforthisrental unitfor2008 . . . . . . $

$

$

$

/

/2008

To(mo./day)

/

/2008

5 Ifyourlandlordwillnotsignyourrentcertificate,completelines6to13, c Totalrentcollectedforthis attachrentverification(seeinstructions),andcheckthisbox.è rentalunitfor2008 . . . . . . . . . . . . . . . . . . $

b Numberofmonthsthis rentalunitwasrented tothisrenterin2008

Landlord
6 Name 7 Address

Fillinlines6to13andsign.

d Numberofoccupantsinthisrentalunit­ donotcountspouseorchildrenunder18. . e Thisrenter'sshareoftotal2008rent. . . . . $ 12 Valueoffoodandservicesprovided bylandlord(thisrenter'sshare). . . . . . . . . $ 1 3a Rentpaidforoccupancyonly­ Subtractline12fromline11e..........$ b Washeatincludedintherent? Yes No c Ifalong-termcarefacility/CBRF/nursinghome, checkthemethodusedtocomputeline13a: Yes Yes No No Standardrate($100perweek). Percentageformula(fillinpercentage) %. OthermethodapprovedbyDepartmentofRevenue. I certify that the information shown on this rent certificate is true, correct, and complete to the best of my knowledge.

8 Telephonenumber 9a Istherentalproperty(line3)subjecttopropertytaxes? Yes No b If9ais"No"andyouareasec.66.1201 municipalhousingauthoritythatmakes paymentsinlieuoftaxes,checkthisbox.è 1 0a Isthisrentcertificateforrentof: Amobileormanufacturedhome? Amobileormanufacturedhomesite?

Sign here

b Mobileormanufacturedhometaxesormunicipalpermitfees youcollectedfromthisrenterfor2008. $

Signature (by hand) of landlord or authorized representative

Date

NEEDHELP? 608-266-8641(Madison)or414-227-4000(Milwaukee)

REMINDERSFORRENTERS: · Ifline11daboveis2ormoreandeachoccupantdid notpayanequalshareoftherent,seeinstructions forSharedLivingExpensesSchedule. · ScheduleHorH-EZmustbecompletedandfiled withthisrentcertificate.

SharedLivingExpensesSchedule
Step1:Listname(s)ofotheroccupants: Step3:UsingtheamountslistedinStep2,computeyourallowablerentpaidforoccupancyonly:
1 Totalrentpaid(line1a). . . . . . . . . . . . . . . . . . .1

Step2:Listthetotalamount(notthemonthlyamount)of allsharedlivingexpenses(rent,food,utilities,andother) paidbyalloccupantsandtheamountthatyoupaid:
SharedLiving Expenses TotalPaidby AllOccupants Amount YouPaid

2 Sharedlivingexpenses youpaid(line5b). . . . . . . . . . 2 3 Totalsharedliving expenses(line5a). . . . . . . . . 3 4 Divideline2byline3.Fill indecimalamount. . . . . . . . . . . . . . . . . . . . . . .4 5 Multiplyline1byline4 . . . . . . . . . . . . . . . . . . .5 . 6 Valueoffoodandservicesprovidedby landlord(line12above). . . . . . . . . . . . . . . . . . .6 7 Subtractline6fromline5.Thisisyourallowable rent.Fillinhereandonline14aor14cof ScheduleH(line9aor9cofScheduleH-EZ). .7 x .


I-017

Rent Food Other Total

1a) 2a) 3a) 4a) 5a)

1b) 2b) 3b) 4b) 5b)

Utilities

Rent Certificate Instructions
Arentcertificateisusedtoverifytherentpaidtooccupya Wisconsin "homestead" in 2008.A homestead could be a room,apartment,mobileormanufacturedhome,house,farm, ornursinghomeroom. InstructionsforRenter(Claimant) Completelines1,3,and4.Thengivetherentcertificateto yourlandlordtocompletelines6to13andsign.Aseparate rentcertificatemustbecompletedforeachhomesteadyou rentedin2008ifusedincomputingyourhomesteadcredit. Ifyourlandlordwillnotsignyourrentcertificate,check theboxonline5.Completelines2and6to13,andattach copiesofeachcanceledcheckormoneyorderreceiptyou havetoverifyyourrent.Ifyoudonothaveverificationofyour rentpaid,thehomesteadcreditwillnotbeallowed. After you receive the completed rent certificate from your landlord,completeline2andthenfillintheallowableamounts fromlines10band13aonlines13,14a,and14cofScheduleH(lines8,9a,and9cofScheduleH-EZ),asappropriate. Note: If line 11d is 2 or more, see "Renter Instructions for SharedLivingExpensesSchedule"inthenextcolumn. AttachallrentcertificatestooneScheduleHorH-EZ.Ifyou claimlessthan12monthsofrentand/orpropertytaxes,also attachanoteexplainingwhereyoulivedforthebalanceof 2008. InstructionsforLandlord /AuthorizedRepresentative Fill in a separate rent certificate for each renter (claimant) requestingoneforhomesteadcredit.Fillinline1ifitisnot already completed. Fill in lines 6 to 13, sign, and give the completedrentcertificatetotherenter. Note:Youmaynot chargeafeeforfillinginarentcertificate. Line 9b If you checked "No" on line 9a, do not complete therentcertificateunlessyouareasec.66.1201municipal housing authority that makes payments in lieu of property taxes.Ifthisappliestoyou,checktheboxonline9b. Line11aFillintherentyouactuallycollectedpermonthfor thisrentalunit(apartment,room,one-halfofaduplex,etc.)for 2008,forthetimethisrenteroccupieditin2008.Includeinthe monthlyrateanyseparateamountstherenterpaidtoyoufor itemssuchasagarage,parkingspace,utilities,appliances, orfurnishings.Donotincluderentforaprioryearoramounts you received directly from a governmental agency through asubsidy,voucher,grant,etc.,fortheunit(exceptamounts anagencypaidasaclaimant'srepresentativepayee).Ifthe monthly rent for this unit changed in 2008, use the extra columnstofillineachmonthlyrateseparately. Line 11b Fill in the number of months (or partial months) yourentedtheunittothisrenterin2008.Ifyoufilledinmore thanoneamountonline11a,fillinthenumberofmonthsor partialmonthseachrateapplied.Forpartialmonths,fillinthe numberofdaysratherthanafractionoradecimal. Line 11c Fill in the total rent collected for this unit for the periodoftimetheunitwasoccupiedbythisrenterin2008 (generally,multiplyline11aby11b). Example:Yourentedthisunitfor$300permonthfor7monthsand $325permonthfor5months.Fillinlines11a-11casfollows:
a Rentcollectedper monthforthisrental unitfor2008 . . . . . . $ 300 $ 325 $ b Numberofmonthsthis rentalunitwasrented 7 5 tothisrenterin2008 c Totalrentcollectedfor thisrentalunitfor2008. . . . . . . . . . . . . . . . . $ $

3,725

Line11dFillinthetotalnumberofoccupantsinthisrentalunit duringtherentalperiod.Note:Donotcounttherenter'sspouse orchildrenunderage18asofDecember31,2008. Line11eFillinthisrenter'sshareofthetotal2008rentpaid.Do notincluderentpaidforotherrenters,oramountsyoureceived directlyfromagovernmentalagency(exceptamountsanagency paidasaclaimant'srepresentativepayee). Line12Fillinthisrenter'sshareofthevalueoffood,medical, and other personal services, including laundry, transportation, counseling,grooming,recreational,andtherapeuticservices,you providedforthisrentalunit.Donotincludeutilities,furnishings,or appliances.Ifyoudidnotprovideanyoftheitems,fillin0. SignatureReviewtherentcertificatetobesurethatline1and eachofthelines6to13b(and13c,ifapplicable)hasanentry.Sign (byhand),date,andreturntherentcertificatetotherenter.Signaturestamps,photocopiedsignatures,etc.,arenotacceptable. RenterInstructionsforSharedLivingExpensesSchedule Completethisscheduleifline11dshowsmorethanoneoccupant andeachoccupantdidnotpayanequalshareoftherent.You mayclaimonlytheportionofrentthatreflectsthepercentageof sharedlivingexpensesyoupaid. Example:Youandyourroommatepaidsharedlivingexpenses asshownbelow.Yourlandlordprovidedservicesandfilledin$300 asyourshareonline12.
SharedLiving Expenses TotalPaidby AllOccupants Amount YouPaid



Rent Food Utilities Other Total

1a) 2a) 3a) 4a) 5a)

$4,800 2,400 600 200 $8,000

1b) 2b) 3b) 4b) 5b)

$4,800 1,200 -0- -0- $6,000

Your allowable rent for occupancy only is $3,300, computed as follows: $4,800 1 Totalrentpaid(line1a) . . . . . . . . . . . . . . . . . . .1
2 Sharedlivingexpenses youpaid(line5b) . . . . . . . . . . 2 3 Totalsharedliving expenses(line5a) . . . . . . . . . 3 .

$6,000 $8,000
x . 75 $3,600

4 Divideline2byline3.Fill indecimalamount. . . . . . . . . . . . . . . . . . . . . . . .4 5 Multiplyline1byline4. . . . . . . . . . . . . . . . . . . .5 6 Valueoffoodandservicesprovidedby landlord(line12above)....................6 7 Subtractline6fromline5.Thisisyourallowable rent.Fillinhereandonline14aor14cof ScheduleH(line9aor9cofScheduleH-EZ) . .7 .

$300 $3,300