Homestead and Attachments

The claimant needs to fill in the appropriate spaces as necessary and enter required notes in the alphanumeric data field. When copies of documents are required, attach them to the Form W-RA that must be submitted. The page column indicates the page in the Schedule H and H-EZ instruction booklet that refers to the description.

No. Description Page
1 Former spouse must pay a tax liability owed to the Department of Revenue per attached divorce judgment. 5
2 Sources of income reported on Line 8b of Schedule H (Line 5b of Schedule H-EZ) note is attached. 8
3 The distributive share of partnership, limited liability company (LLC), and tax-option (S) corporation depreciation, Section 179 expense, depletion, amortization, and intangible drilling costs is "None." 10
4 Car or truck expenses claimed using the standard mileage rate. Fill in the number of miles _____. 10
5 Adjusted basis of car or truck reached zero using standard mileage rate. 10
6 Car or truck expenses claimed using the actual expense method. 10
7 The computation of gain from the sale or exchange of a principal residence excluded from taxable income under section 121 of the Internal Revenue Code note is attached. 10
8 Claimant or spouse are age 65 or over and received no social security, SSI, or railroad retirement benefits. 11
9 All or part of a pension or annuity distribution includes a rollover or a tax-free exchange. 9
10 Nontaxable repaid amounts note is attached. 11
11 Very little or no household income note is attached. 11
12 Ownership of property document is attached. 12
13 Partial ownership interest was inherited with terms of the will requiring payment of all the property taxes. Copy of will is attached. 12
14 Personal property tax bill is for a mobile or manufactured home. 12
15 Two or more property tax bills. Drawing showing description, size, and location of each parcel is attached. 12
16 No lottery and gaming credit on property tax bill. Fill in the amount claimed $_______.__. 12
17 No lottery and gaming credit on property tax bill. Lottery and gaming credit not claimed by homeowner. 12
18 Landlord will not sign rent certificate. Rent verification is attached. 13
19 Claimant moved during the year. Note of the address of each dwelling and the dates lived there is attached. 13
20 Less than 12 months of property taxes and/or rent are claimed. Note of where claimant lived for the balance of the year is attached. 13
21 When more than one acre of land if rented, note from landlord indicating the amount of rent for home and one acre of land is attached. 14
22 Moved to tax-exempt housing. Claiming property taxes for up to 12 months after the move note is attached. 14
23 Married but separated all year: Claimant and spouse did not reside together at all during the year and neither the claimant or claimant's spouse notified each other of marital property income. 15
24 Married but separated all year: Claimant and spouse did not reside together at all during the year and one or both spouses notified the other spouse of marital property income. Required information is attached. 15
25 Married but separated part of year: Required information is attached. 15
26 Marriage took place during year: Required information is attached. 16
27 Divorce took place during year: Claimant and spouse did not reside together at all during the year and neither the claimant or claimant's spouse notified each other of marital property income. 16
28 Divorce took place during year: Claimant and spouse did reside together for part of the year and/or one or both spouses notified the other spouse of marital property income. Required information is attached. 16
29 Spouse died during year: Date of death - ___ / ___ / 2014 16
30 Claimant resided in property address shown on tax bill but used a different mailing address on tax return. ---
31 Registered notes and explanations in following data fields ---
-- Alphanumeric data field: You will be able to enter up to four lines of 80 characters per line.  

December 16, 2014