pdf2json

Government of the District of Columbia 2013 SCHEDULE H Homeowner and Renter Property Tax Credit 2013 SCHEDULE H P1 Homeowner and Renter Property Tax Credit File order 5 Important: Read eligibility requirements before completing. Print in CAPITAL letters using black ink. 7 $ . 00 8 $ . 00 9 $ . 00 Round cents to the nearest dollar. If the amount is zero, leave the line blank. Revised 09/13 Section A Credit claim based on rent paid 1 Total household gross income. From Line w on page 3. If over $20,000, do not claim this credit. 2 Rent paid on the property in 2013. 3 Property tax credit. Use the worksheet . 4 Rent supplements received in 2013 by you or your landlord on your behalf. 5 Property tax credit. 6 Landlord’s name Round cents to the nearest dollar. If the amount is zero, leave the line blank. 1 $ . 00 $ . 00 x.15 > 2 $ . 00 3 $ . 00 4 $ . 00 5 $ . 00 Landlord’s telephone number If 15% of the rent paid amount is more than the line 1 amount do not claim the credit. Landlord’s address (number and street) Apartment number City State Zip Code Section B Credit claim based on real property tax paid From Line w on page 3. If over $20,000, do not claim this credit. Use the worksheet. 10 Mailing address (number, street and apartment) Address of DC property (number, street and apartment) for which you are claiming the credit if different from above City State Zip Code Type of property for which you are claiming the credit. Fill in only one: Personal information ◆ Complete Section A or Section B, whichever applies. ◆ Spouse’s/registered domestic partner’s SSN Your social security number (SSN) Your daytime telephone number Do not claim this credit for an exempt property owned by a government, a house of Fill in if you are: 62 or older Blind or disabled Fill in if spouse/registered domestic partner is: 62 or older Blind or disabled Spouse’s/registered domestic partner’s first name M.I. Last name House Apartment Rooming house worship or a non-profit organization. Subtract Line 4 from Line 3, D-40 filers enter here and on Line 29 of D-40. Enter information from your real property tax bill or assessment. If a section is blank on your property tax bill, leave it blank here. Square number Suffix number Lot number Your first name M.I. Last name 7 Total household gross income. 8 DC real property tax paid by you on the property in 2013. 9 Property tax credit ----------------Page (0) Break---------------- Last name and SSN 2013 SCHEDULE H PAGE 2 are not needed. Claimant’s social security number I certify that the above-named claimant is blind; has a physical or mental impairment that is expected to last continuously for 12 months or more; was physically or mentally impaired on January 1, 2013. Physician’s address (number and street) Suite number City State Zip Code Physician’s signature Date Where Licensed License Number Defi nitions Blind Central visual acuity that does not exceed 20/200 in the better eye with correcting lenses, or visual acuity that is greater than 20/200, than 20 degrees. Disabled Unable to engage in any gainful activity due to a medically determin- able physical or mental impairment which can be expected to last for 12 months or more. Continue to Page 3 Homeowner and Renter Property Tax Credit Revised 09/13 Signature Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is true and correct. Declaration of preparer is based on the information available to the preparer. Your signature Date Preparer’s signature Date File order 6 If you are blind or disabled, you must have this certificate completed to claim the Property Tax Credit. File it with your Schedule H. If a physician’s certification of blindness or disability has been submitted previously and the claimant’s condition is unchanged, additional certifications Claimant’s first name M.I. Last name (fill in all that apply): Physician’s first name M.I. Last name but is accompanied by a limitation in the field of vision such that the widest diameter of the visual field subtends an angle no greater Preparer’s Tax Identification Number (PTIN) Preparer’s telephone number Physician’s certification of blindness or disability. 2013 SCHEDULE H P2 ----------------Page (1) Break----------------