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2021 Iowa Special Assessment Property Tax Credit, page 2
Instructions
Who is Eligible? Line 8: Profit from business and/or farming and
Total household income was not more than $12,470 capital gain - Enter profit from business and/or
and: farming, and any gain received from the sale or
• Age 65 or older by December 31, 2020, or exchange of capital assets. Capital losses are limited
to the same amount that you are allowed to report for
• Totally disabled and age 18 or older by December
income tax purposes. Any loss must be offset against
31, 2020.
gain, and a net loss must be reported as zero.
Household income includes your income and your
Line 9: Money received from others living with
spouse’s income, if living together, and monetary
you - Enter money received from others living with
contributions received from other persons living with
you. Do not include goods and services received.
you. If you and your spouse are not living together,
each may file a separate claim. Line 10: Other income - Enter total income received
from the following sources:
Line 1: Wages, salaries, unemployment
•
compensation, tips, etc. - Enter the total wages, Child support and alimony payments.
•
salaries, unemployment compensation, tips, Welfare payments. Include Family Investment
bonuses, and commissions received. Program (FIP), children’s Supplemental Security
Income (SSI), and all other welfare program cash
Line 2: In-kind assistance - Enter any portion of
payments. Do not include foster grandparents’
your housing expenses, including utilities, that were
stipends or non-cash government assistance (ex:
paid for you. Do not include Federal Energy
food, clothing, food stamps, medical supplies,
Assistance.
etc.).
Line 3: Title 19 benefits - Enter your Title 19 benefits • Insurance income not reported elsewhere.
received for housing expenses. Do not include • Gambling, and all other income, not reported
medical benefits. elsewhere.
Line 4: Social Security income - Enter the total Line 12: Medical and care expenses - Enter all
Social Security benefits received, even if not medical and necessary care expenses paid during
reportable for income tax purposes. Include any the year which were related to your disability. These
Medicare premiums withheld. are the same as you are allowed to deduct for federal
Line 5: Disability income - Enter the total received income tax. Do not enter an amount on line 12 unless
for disability or injury compensation, even if not you are totally disabled and incurred medical or care
reportable for income tax purposes. expenses attributable to your disability.
Line 6: All pensions and annuities - Enter the total Line 13: Total household income - Subtract line 12
received from pensions and annuities. Include from line 11. If more than $12,470 no credit is
retirement pay for military service, even if not allowed.
reportable for income tax purposes. Additional Information:
Line 7: Interest and dividend income - Enter The location of your county treasurer can be found at
taxable interest income, plus all interest income from the Iowa Treasurers website:iowatreasurers.org. For
federal, state, and municipal securities. information about your Social Security benefits, go to
Enter taxable dividends and distributions received. the Social Security Administration website:
Include cash dividends and dividends paid in the form ssa.gov/myaccount.
of merchandise or other property. Report at fair
market value.
For use by County Treasurer only
Installment number: _________________________ Annual special assessment payment: ______________
State reimbursement: ________________________
54-036b (10/16/2020)
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