Enlarge image
2025 Iowa Special Assessment Property Tax Credit Claim
Iowa Code section 425.23(3) and Iowa Administrative Code rule 701—104.27
Complete the following personal information:
Your name: ______________________________ Spouse name: ______________________________
Your Social Security Number: ________________ Spouse Social Security Number: _______________
Your birth date (MM/DD/YYYY): ______________ Spouse birth date (MM/DD/YYYY): ______________
Address: _________________________________ City: ______________________________________
State: ________________ ZIP: _______________ Phone: ____________________________________
Were you age 65 or older, or totally disabled and age 18 or older, as of
December 31, 2024? .................................................................................................................. Yes ☐ No ☐
If “No,” stop. No credit is allowed.
If you are under age 65 and totally disabled, you must include proof of disability. Provide proof of disability
such as a current statement from Social Security Administration, Veterans Administration, your doctor, or
Form SSA-1099.
2024 Total household income for the entire year
Use whole dollars only
Read instructions before completing
1. Iowa taxable income (see instructions) If less than zero, enter 0 ......................... , .00
2. In-kind assistance for housing expenses ............................................................. , .00
3. Title 19 benefits (excluding medical benefits) ...................................................... , .00
4. Social Security income ......................................................................................... , .00
5. Disability income and workers’ compensation ...................................................... , .00
6. All retirement income ........................................................................................... , .00
7. Interest income from federal, state, or local government .....................................
, .00
8. Capital gains and income from a farm tenancy agreement
If less than zero, enter 0 ...................................................................................... , .00
9. Money received from others living with you ......................................................... , .00
10. Other income ....................................................................................................... , .00
11. Add amounts from lines 1 through 10 .................................................................. , .00
12. Medical and care expenses (totally disabled individuals only) ............................. , .00
13. Total household income (Subtract line 12 from line 11) ....................................... , .00
(If line 13 is more than $13,507 stop. No credit is allowed.)
I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this claim, and,
to the best of my knowledge and belief, it is true, correct, and complete.
Your signature: _______________________________________________ Date: _____________________
This claim must be filed or mailed to your county treasurer on or before September 30, 2025.
54-036a (07/09/2024)
