Rent Certificate Form 2020

Legal last name Address of rental property property must be in Wisconsin City M. I. Social security number State Time you actually lived at this address in 2016 From M D Zip To Do NOT sign your rent certificate. CAUTION Schedule H or H-EZ must be completed and filed with this rent certificate Rent Certificate Wisconsin Department of Revenue NOTE Attach to Schedule H or H EZ Alterations whiteouts erasures etc* or errors void this Only attach rent certificate if filing a homestead credit claim Renter Claimant Enter Social Security Number AFTER your landlord fills in section below and signs. If your landlord won t sign complete fields above and below and lines 1 to 8 attach rent verification see instructions and check here. Landlord or Authorized Representative Name of property owner Telephone number Address State Zip 1 Is the rental property a long-term care facility CBRF or nursing home 1 Yes No 2 a Is the above rental property subject to property taxes 3a b Home site/Lot 3b 2a b If 2a is No and you are a sec* 66. 1201 municipal housing authority that makes payments in lieu of taxes check here. 2b 3 Is this certificate for rent of a mobile/manufactured a Home c Mobile or manufactured home taxes or municipal permit fees you collected from this renter for 2016. 3c 4 a Total rent collected for this rental unit for 2016 do NOT include amounts received directly from a governmental agency. 4a b If monthly rent charged didn t change during 2016 enter monthly charge. 4b Jan* Feb. Mar* Apr* May June July Aug. Sept. Oct. Nov* Dec* 5 Number of occupants in this rental unit do NOT count spouse or children under 18. 5 6 This renter s share of total 2016 rent. 6 7 Value of food and services provided by landlord this renter s share. 7 8 a Rent paid for occupancy only Subtract line 7 from line 6. 8a b Was heat included in the rent. 8b I certify that the information shown on this rent certificate is true correct and complete to the best of my knowledge. Signature by hand of landlord or authorized representative I-017i R* 8-16 Date Print name must match signature Renter s 2016 Rent Certificate name SSN Page 2 of 2 Shared Living Expenses Schedule To be completed by renter only if line 5 on page one is 2 or more and each occupant did not pay an equal share of the living expenses. Step 1 List name s of other occupants Step 3 Using the amounts listed in Step 2 compute your allowable rent paid for occupancy only 1 Total rent paid line 1a. 1 Step 2 List the total amount not the monthly amount of all shared living expenses rent food utilities and other paid by all occupants and the amount that you paid Expenses Total Paid by All Occupants Amount You Paid 2 Shared living expenses you paid line 5b. 2 3 Total shared living expenses line 5a. 3 4 Divide line 2 by line 3. Fill in decimal amount. 4 Rent 1a 1b Food 2a 2b Utilities 3a 3b Other 4a 4b Total 5a 5b x. 5 Multiply line 1 by line 4. 5 landlord line 7 of page 1. 6 7 Subtract line 6 from line 5. This is your allowable rent.