and Renter Property Tax Credit
Square number Suffixnumber Lot number
$ $ $1 Wages salaries tips etc 1
$0 $24 999
$0 $60 000
$1000 00
$25 000 $40 000
$Fill in if minus
(: A) Unchecked
(: C) Unchecked
(: H) Unchecked
(: R) Unchecked
(20% of rent paid) in excess of the applicable percentage of the total federal adjusted gross income of the tax filing unit The
(B SSN)
(Bank Account Number)
(Bank Routing Number)
(C SSN)
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(CHECKING ACCT: C) Unchecked
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(Column A)
(Column A)
(Column A)
(Column B)
(Column C)
(DC real property tax paid for current tax yearsurrent year)
(DEPENDENT #2) (DEPENDENT #3) (DEPENDENT #4)
(DEPENDENT #5) (DEPENDENT #6) (DEPENDENT #7)
(Home address 2)
(IAT yes indicator: NO) Unchecked
(IAT yes indicator: YES) Unchecked
(NO: 1) Unchecked
(NO: 2) Unchecked
(NO: 3) Unchecked
(paid preparers Federal ID SSN or PTIN)
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(Primary First name)
(Primary Last name)
(Primary Last name)
(Primary Middle )
(Primary SSN)
(Primary SSN)
(Primary SSN)
(Primary SSN)
(Primary SSN)
(Property rax credit)
(Property tax credit allowed)
(Rent supplements received in current tax year)
(Secondary SSn)
(Secondary SSn)
(Spouse/domestic partner's last name)
(Spouse/Domestic partner's)
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(Total gross incoe)
(Total household gross income)
(Total rent paid)
*159980110002*
*159980120002*
*159980130002*
*159980140002*
1 $ 00
1 Enter federal AGI of tax filing unit (Line 1 Section A Schedule
1 Federal adjusted gross income of the tax filing unit from Line 32 on page 2 (see instructions)
1 Wages salaries tips etc $1
10 $ 00
10 Pensions and annuities: Taxable amount 10
10 Pensions and annuities: Taxable amount 10
10 Property tax credit Use the "Computing Your Property Tax Credit" worksheet Enter here and on Line 28 of the D 40
11 Enter information from your real property tax bill or assessment If a section is blank on your property tax bill leave it blank here
11 Rental real estate royalties partnerships S Corp trusts etc
11 Rental real estate royalties partnerships S Corp trusts etc Fill in if minus 11
12 Farm income
12 Farm income Fill in if minus 12
13 Unemployment compensation 13
13 Unemployment compensation 13
14 Social security benefits Taxable amount 14
14 Social security benefits Taxable amount 14
15 Other income Attach separate sheet(s)
15 Other income Attach separate sheet(s) Fill in if minus 15
16 Add Lines 1 through 15 in each column
16 Add Lines 1 through 15 in each column Fill in if minus 16
17 Educator expenses 17
17 Educator expenses 17
18 Certain business expenses of reservists performing artists and
18 Certain business expenses of reservists performing artists and
19 Health savings account deduction 19
19 Health savings account deduction 19
2 Enter property taxes paid in 2015 or 20% of rent paid in 2015
2 Money from other sources used to pay rent not included in AGI:
2 Taxable interest 2
2 Taxable interest 2
20 Moving expenses 20
20 Moving expenses 20
2015 SCHEDULE H P1
2015 SCHEDULE H PAGE 2 Last name and SSN
2015 SCHEDULE H PAGE 3 Last name and SSN
2015 SCHEDULE H PAGE 4 Last name and SSN
2015 SCHEDULE H WORKSHEET P2
2015 SCHEDULE H WORKSHEET P3
2015 SCHEDULE H WORKSHEET P4
2015 SCHEDULE H WORKSHEET P5
21 Deductible part of self employment tax 21
21 Deductible part of self employment tax 21
22 Self employed SEP SIMPLE and qualified plans 22
22 Self employed SEP SIMPLE and qualified plans 22
23 Self employed health insurance deduction 23
23 Self employed health insurance deduction 23
24 Penalty on early withdrawal of savings 24
24 Penalty on early withdrawal of savings 24
25 Alimony paid 25
25 Alimony paid 25
26 IRA deduction 26
26 IRA deduction 26
27 Student loan interest deduction 27
27 Student loan interest deduction 27
28 Tuition and fees per Federal form 8917 28
28 Tuition and fees per Federal form 8917 28
29 Domestic production activities deduction 29
29 Domestic production activities deduction 29
3 $ 00
3 Multiply Line 1 by the applicable percentage ( 03 or 04)
3 Ordinary Dividends 3
3 Ordinary Dividends 3
3 Rent paid on the property in 2015
30 Add Lines 17 through 29 in each column 30
30 Add Lines 17 through 29 in each column 30
31 Subtract Line 30 from Line 16
31 Subtract Line 30 from Line 16 Fill in if minus 31
32 Total federal adjusted gross income Add amounts entered on Line 31 Columns A I
4 $ 00
4 Balance (Subtract Line 3 from Line 2)
4 Property tax credit Use the "Computing Your Property Tax Credit" worksheet
4 Taxable refunds credits or offsets of state and local income taxes 4
4 Taxable refunds credits or offsets of state and local income taxes 4
5 $ 00
5 Alimony received 5
5 Alimony received 5
5 Property Tax Credit Limit
5 Rent supplements received in 2015 by you or your landlord on your behalf
6 $ 00
6 Business Income Fill in if minus 6
6 Enter the smaller of Line 4 or Line 5 here on Line 6 and on Line 4
6 Property tax credit Subtract Line 5 from Line 4 D 40 filers enter here and on Line 28 of the D 40
7 Capital gain Fill in if minus 7
7 Landlord s name
8 $ 00
8 Other gains Fill in if minus 8
9 $ 00
9 DC real property tax paid by you on the property in 2015
9 IRA distributions: Taxable amount 9
9 IRA distributions: Taxable amount 9
a house of worship or a non profit organization
a Source
Account Number
Address of DC property (number street and suite/apartment number if applicable) for which you are claiming the credit if different from above
ADJUSTMENTS
and enter total here on Line 32 and on Section A Line 1 or Section B Line 8
any data on this form other than your signature
b Source
Business Income Fill in if minus
Capital gain Fill in if minus
checking OR
COLUMN A (YOU) COLUMN B (SPOUSE/DP) COLUMN C (DEPENDENT #1)
COLUMN D COLUMN E COLUMN F
COLUMN G COLUMN H COLUMN I
Complete Section A or Section B whichever applies u Do not claim this credit for an exempt property owned by a government
completing Print in CAPITAL letters using black ink
COMPUTING YOUR PROPERTY TAX CREDIT WORKSHEET
Date of Birth (MMDDYYYY)
Date of Birth (MMDDYYYY)
Direct deposit
Direct Deposit To have your refund deposited to your
District of Columbia
Federal adjusted gross income of the tax filing unit (see instructions)
Federal Adjusted Gross Income of the tax filing unit (see instructions) Report the AGI of every member of your tax filing unit
Federal Adjusted Gross Income of the tax filing unit (see instructions) Report the AGI of every member of your tax filing unit including
Federal AGI of your tax filing unit is
fee basis government official 18
fee basis government official 18
File order 5
File order 7
Fill in if minus
Fill in if minus
Fill in if minus
Fill in if minus
Fill in if minus
For STANDALONE FILERS only please complete the following "Refund Options" information Will this refund go to an account outside of the US?
From Line 32 on page 2
Government of the
Homeowner and Renter Property Tax Credit
Homeowner and Renter Property Tax Credit
Homeowner and Renter Property Tax Credit
If the amount is zero or less leave the line blank
If you are age 70 or older and the
If you are under age 70 and the
Important: Read eligibility requirements before
including income subject to federal but not DC income tax See following pages to add additional dependents
INCOME
income subject to federal but not DC income tax If you have more than 7 dependents list them on an attachment
income subject to federal but not DC income tax See following page to add additional dependents
INCOMEADJUSTMENTS
Landlord s address (number and street) Apartment number
Landlord s telephone number
Line 8 Section B Schedule H)
Mailing address (number street and suite/apartment number if applicable)
Mark one refund choice:
maximum credit amount is $1000
Name (Last First)
Name (Last First)
name M I Last name
of Schedule H Section A for credit based on rent paid or Line 10
of Schedule H Section B for credit based on property tax paid
OFFICIAL USE ONLY Vendor ID#0002
on same return File order 6
Other gains Fill in if minus
Paper check
Percentage
Personal information
Refund Options: For information on the tax refund card and program limitations see instructions or visit our website otr dc gov/refundprepaidcards
Revised 04/2015
Revised 04/2015
Round cents to the nearest dollar
Round to the nearest whole dollar
Routing Number
savings account fill in oval and enter bank routing and account numbers See instructions
SCHEDULE H Homeowner
Section A Credit claim based on rent paid
Section B Credit claim based on real property tax paid
Signature Under penalties of law I declare that I have examined this return and to the best of my knowledge it is correct Declaration of paid preparer is based on information available to the preparer
Social Security Number (SSN)
Social Security Number (SSN)
Spouse s/domestic partner s signature if filing jointly or separately Date Preparer's Tax Identificatio Number (PTIN) PTIN telephone number
Spouse s/registered domestic partner s firs name M I Last name
Spouse s/registered domestic partner s SSN
State Zip Code +4
Tax refund card
The amount of property tax that exceeds 3 0% of the adjusted gross income of the tax filing unit
The amount of property tax that exceeds 4 0% of the adjusted gross income of the tax filing unit
The credit equals a percentage of the property taxes paid or the portion of the rent paid that is equivalent to property taxes
This credit may not be claimed if you live in a property owned by a government a house of worship or a nonprofit organizatio
This is a FILL IN format Please do not handwrite
Type of property for which you are claiming the credit Fill in only one: House Apartment Rooming house Condominium
x 20 =
Your daytime telephone number
Your first
Your signature Date Preparer s signature Date
Your social security number (SSN)