Free TC-40cy, Low Income Abatement and Homeowner's Tax Credit Application - Utah

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County Application

2009

Low Income Abatement and Homeowner's Tax Credit Application
(For low income, elderly, and widows/widowers)

TC-40CY
Rev. 5/09

Homeowners and Mobile Homeowners applying for property tax credit, must file this form with the county where the home is located by September 1, 2009. Renters and Mobile Homeowners applying for lot rental refund, file the TC-40CB application with the Utah State Tax

Commission by December 31, 2009.

Section 1 - Applicant's Name
Applicant's Last Name

If more than one person lives in a household, only one person can file an application.
Applicant's First Name Middle Initial Birth Date Social Security Number

Spouse's Last Name (if spouse is living)

Spouse's First Name

Middle Initial

Birth Date

Social Security Number

Address

City

County

State

ZIP Code

Daytime Telephone Number

Enter your property serial/account number(s) from your prior property tax billing notice

Section 2 - Household Income

Household income must include ALL household members' incomes.

Complete and add lines A through J and enter the total on line K. Household Income: is income received during 2008 by members of the household as of January 1, 2009, not just the applicant. A "household" is an association of all people living in the same dwelling, sharing furnishings, facilities, accommodations and expenses. Total members in household as of January 1, 2009 A. Wages/salaries/tips/other compen. B. Total interest, dividends (taxable/nontaxable) C. Pensions, annuities (incl. IRAs) D. Soc. Sec./Railroad retirement (taxable/nontaxable) E. Capital gains, loss carry forwards F. Government assistance G. Unemployment, worker's comp. H. Business, rental, farm income I. Depreciation on claimed residence J. Other income (alimony, etc.) A B C D E F G H I J K. Total 2008 household income from K all sources (add lines A through J) Are you eligible to claim a dependent as a personal exemption on your 2008 federal income tax return?
No (enter total 2008 household income from line K on line L) Yes (subtract $1,000 from line K and enter result on line L)

L. Adjusted 2008 household income

L

Section 3 - Low Income Abatement To qualify for low income abatement, applicant must answer all three questions below.
Yes No 1. Will you be age 66 or older on or before December 31, 2009, or under age 66 and disabled, or under age 66 and it would be an extreme hardship to pay the tax? If you are disabled and applying for the first time, attach a medical statement signed by your doctor. If you are under extreme hardship, attach an explanation of hardship. 2. Was the total household income (from Section 2, line L) less than $28,732? 3. Will you reside in the home for which you are claiming the abatement for ten months during 2009?

Yes Yes

No No

If the answer to all three questions is "Yes," you qualify for the low income abatement. If you qualify for the low income abatement, you may also qualify for the homeowner's tax credit on the back of this form. For more information, contact your county government listed below
Beaver County Box Elder County Cache County Carbon County Daggett County Davis County Duchesne County Emery County Garfield County Grand County 435-438-6463 435-734-3388 435-755-1500 435-636-3200 435-784-3210 801-451-3329 435-738-1120 435-381-5106 435-676-8826 435-259-1338 Iron County Juab County Kane County Millard County Morgan County Piute County Rich County Salt Lake County San Juan County Sanpete County 435-477-8333 435-623-3410 435-644-2647 435-743-5227 801-829-6811 435-577-2840 435-793-5215 801-468-3400 435-587-3223 435-835-2142 Sevier County Summit County Tooele County Uintah County Utah County Wasatch County Washington Cnty Wayne County Weber County 435-893-0400 435-336-4451 435-843-3130 435-781-5363 801-851-8254 435-654-3211 435-634-5712 435-836-1303 801-399-8002

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Section 4 - Homeowner's Tax Credit
Yes No Applicant must answer all 4 questions.

1. Will you be age 66 or older on or before December 31, 2009, 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. 2. Was the total household income (from Section 2, line L) less than $28,732? 3. Will you furnish your own financial support for 2009? (You cannot be claimed as a dependent on someone else's tax return for 2009.) 4. Will you live in Utah for the entire year of 2009? You must be domiciled in Utah for the entire 2009 calendar year to be eligible.

Yes Yes Yes

No No No

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. Is the home located on property that exceeds one acre? Is any portion of the home rented out? Is a portion of the home used for business? Yes Yes Yes No No No If yes, total number of acres If yes, what percent is rented If yes, what percent is used

You must have owned the home on January 1, 2009 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. The Alien Registration Number and the I-94 numbers are issued by the U.S. Citizenship and Immigration Service.

Check one: I am a U.S. citizen. SSN: ________________ I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully. I-94 #:________________ Alien #:_______________

Section 6 - Certification and Signature
Signature of applicant

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.
Date Signature of spouse (Spouse must sign if home is owned in joint tenancy) Date

X
Preparer's name and address or organization (if not applicant)

X
Preparer's telephone number

For Tax Commission Use Only
CB used by county CB rent possible CB available (max-used) CB rent issue <= CB available Tax amount Blind and/or veteran

For County Use Only

Homeowner's Valuation Reduction (additional 20%)

Property Tax Credit /Renter's Refund Schedule
2008 Household Income
Maximum Renter Refund Total Maximum Homeowner % of Lot Rent Renter Refund Tax Credit Total Maximum Homeowner & Rental Refund

Circuit breaker Low income abatement Net tax due County government approval Date approved

0 $9,769 13,027 16,282 19,538 22,796 25,859

$9,768 13,026 16,281 19,537 22,795 25,858 28,732

$851 742 637 477 371 212 105

9.5% 8.5% 7.0% 5.5% 4.0% 3.0% 2.5%

$851 742 637 477 371 212 105

$1,702 1,484 1,274 954 742 424 210