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Fillable Printable Tc-90Cy - Utah State Tax Commission

Fillable Printable Tc-90Cy - Utah State Tax Commission

Tc-90Cy - Utah State Tax Commission

Tc-90Cy - Utah State Tax Commission

County Application
Low Income Abatement and
Homeowner's Tax Credit Application
(For low income, elderly, and widows/widowers)
TC-90CY
Rev. 1/17
Homeowners and Mobile Homeowners applying for property tax credit must file this form with the county where the home is
located by September 1, 2017.
Renters and Mobile Homeowners applying for lot rental refund, file the TC-90CB application with the Utah State Tax
Commission by December 31, 2017.
Section 1 - Applicant's NameIf more than one person lives in a household, only one person may file an application.
Applicant's Last NameApplicant's First NameMiddle InitialBirth DateSocial Security Number
Spouse's Last Name (if spouse is living)Spouse's First NameMiddle InitialBirth DateSocial Security Number
AddressCityCountyStateZIP CodeDaytime Telephone Number
Enter your property serial/account number(s)
from your most recent property tax billing notice
Section 2 - Household IncomeHousehold income must includeALL household members' incomes.
Complete and add lines 1 through 10 and enter the total on line 11. Household income is income received during 2016 from all members
living in the household as of January 1, 2017, not just the applicant. A “household” is an association of all people living in the same
dwelling, sharing furnishings, facilities, accommodations and expenses. Send supporting income documentation for information
provided below.
Total members in household as of January 1, 2017
Section 3 - Low Income AbatementTo qualify for low income abatement, applicant must answer all three questions below.
YesNo
1.Will you be age 65 or older on or before December 31, 2017, or under age 65 and disabled, or under age 65
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.
YesNo
2.Was the total household income (from Section 2, line 11) less than $32,101?
YesNo
3.Will you reside in the home for which you are claiming the abatement for ten months during 2017?
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
You do not qualify if the amount on line 11 is greater than $32,101. The Tax
Commission will review your applicationand determine eligibility for refund.
You may be required to submit additional information to support your claims.
Applicants who check box 2 in Section 5 (back of form) must file this form in person.
1. Wages/salaries/tips/other compensation
(W-2, 1099Misc, etc.)
1
5. Current year capital gain or loss
(Include copy of federal return and all
schedules. This amount will be reviewed.)
5
2. Total interest income, dividends
(taxable/nontaxable)
2
6. Government assistance
6
3. Pensions, annuities-include IRAs
(taxable/nontaxable)(Include a copy of federal
return and all schedules. This amount will be reviewed.)
3
7. Unemployment, worker’s compensation
7
4. Social Security/Railroad retirement
(taxable/nontaxable) (send supporting
documentation)
4
8. Business, rental, farm income
(Include copy of federal return and all
schedules. This amount will be reviewed.)
8
11. Total 2016 household income from
all sources (add lines 1 through 10)
10. Other income received under Utah Code
Section 59-2-1202 such as alimony, nontaxable
interest, etc. (send supporting documentation)
10
11
9. Depreciation on claimed residence
(Include copy of federal return and all
schedules. This amount will be reviewed.)
9
Beaver County 435-438-6463
Box Elder County 435-734-3317
Cache County 435-755-1500
Carbon County 435-636-3221
Daggett County 435-784-3210
Davis County 801-451-3332
Duchesne County 435-738-1120
Emery County 435-381-5106
Garfield County 435-676-1109
Grand County 435-259-1338
Iron County 435-477-8332
Juab County 435-623-3410
Kane County 435-644-2458
Millard County 435-743-5227
Morgan County 801-845-4030
Piute County 435-577-2840
Rich County 435-793-5155
Salt Lake County 385-468-8300
San Juan County 435-587-3237
Sanpete County 435-835-2142
Sevier County 435-893-0401
Summit County 435-336-3016
Tooele County 435-843-3140
Uintah County 435-781-5361
Utah County 801-851-8109
Wasatch County 435-657-3190
Washington County 435-634-5712
Wayne County 435-836-1300
Weber County 801-399-8400
2017
Clear form
Section 4 - Homeowner's Tax CreditApplicant must answer all 4 questions.
YesNo
1.Will you be age 66 or older on or before December 31, 2017, orAre you a widow or widower? If you are a
widow or widower, enter your spouse's date of death:__________________________.
YesNo
2.Was the total household income (from Section 2, line 11) less than $32,101?
YesNo
3.Will you furnish your own financial support for 2017 (You cannot be claimed as a dependent on someone
else's tax return for 2017.)
YesNo
4.Will you live in Utah for the entire year of 2017?
You must be domiciled in Utah for the entire 2017 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.
Is the home located on property that exceeds one acre?
YesNoIf yes, total number of acres
Is any portion of the home rented out?
YesNoIf yes, what percent is rented
Is a portion of the home used for business?
YesNoIf yes, what percent is used
You must have owned the home on January 1, 2017 to qualify.
If you qualify for property tax credit, you may also qualify for low income abatement, on the front of this form.
Section 6 - Certification and SignatureRead 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 applicantDateSignature of spouse (Spouse must sign if home is owned in joint tenancy)Date
XX
Preparer's name and address or organization (if not applicant)Preparer's telephone number
For Tax Commission Use OnlyFor County Use Only
CB used by countyCB available (max-used)Tax amount
CB rent possibleCB rent issue <= CB available
Blind and/or veteran
Homeowner's Valuation Reduction (additional 20%)
Circuit breaker
Low income abatement
Net tax due
County government approval
Date approved
Section 5 - Residency Status of Applicant
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
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 qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully. I-94 Number*:
_______________
Alien Registration Number*:
_______________
*The I-94 (arrival/departure) number and/or the Alien Registration
Number are issued by the U.S. Citizenship and Immigration Service.
If you checked box 2, you must file this form
in person and bring proof of your I-94 Number
and/or Alien Registration Number.
X
Property Tax Credit / Renter Refund Schedule
2016 Household
Maximum
Renter Refund Total Maximum
Total Maximum
Income
Homeowner
% of Lot Rent Renter Refund
Homeowner &
Tax Credit
Rental Refund
$0 $10,913 $951 9.5% $951 $1,902
10,914 14,553 829 8.5% 829 1,658
14,554 18,190 71 1 7.0% 71 1 1,422
18,191 21,828 533 5.5% 533 1,066
21,829 25,468 415 4.0% 415 830
25,469 28,890 237 3.0% 237 474
28,891 32,101 1 17 2.5% 1 17 234
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