Every claimant (renter) who files a 2000 Wisconsin homestead credit claim,
Schedule H, must attach a completed 2000 rent certificate to the Schedule H, to
verify the rent paid to occupy a Wisconsin "homestead" in 2000. A homestead
could be a room, apartment, mobile home, house, farm, or nursing home room.
Alterations (whiteouts, erasures, etc.) will void this rent certificate. A rent
certificate with an error should be discarded and a new one completed.
A rent certificate has two parts. The renter is to fill in the first part (lines 1 to 4),
and the landlord is to fill in the second part (lines 5 to 14). The landlord may not
charge a fee for filling in a rent certificate.
Instructions for claimant Fill in the information requested on lines 1
to 4. Then give the rent certificate to your landlord to fill in lines 5 to 14.
After you receive the completed rent certificate from your landlord, fill in the
allowable amounts from lines 10b and 13a on lines 13, 14a, and 14c of Schedule
H, as appropriate, and attach it to your Schedule H. A separate rent certificate
must be completed for each homestead you rented in 2000 if rent for each is used
in computing your homestead credit. All rent certificates must be attached to one
Schedule H. If you claim less than 12 months of rent and/or property taxes on
Schedule H, attach a note explaining where you lived for the balance of 2000.
Instructions for landlord/authorized representative Fill
in a separate rent certificate for each claimant (renter) requesting one for
homestead credit. Fill in line 1 if it is not already completed. Fill in lines 5 to 14
(SSN on line 7 is optional), then give the completed rent certificate to the renter.
LINES 5 to 8
Fill in all the information requested. On line 7, SSN means social
security number, and FEIN means federal employer identification number.
LINE 9
If you checked “No,” do not complete the rent certificate unless you are
a municipal housing authority that makes payments in place of property taxes. If
this applies to you, attach a signed explanation to the certificate.
LINES 10a to 10b Check the appropriate boxes under line 10a. If you
collected mobile home taxes, mobile home parking permit fees, or municipal
fees from the renter for the period of occupancy, fill in the amount you
collected on line 10b. If no amount was collected, fill in -0-.
LINE 11a
Fill in the rent you actually collected per month for this rental unit
(apartment, room, one-half of a duplex, etc.) for 2000, for the time this renter
occupied it in 2000. Include separate amounts the renter paid to you for items
such as a garage, parking space, utilities, appliances, or furnishings. Do not
include rent for a prior year or amounts you received directly from a governmental
agency through a subsidy, voucher, grant, etc., for the unit. If the monthly rent
for this unit changed in 2000, fill in each monthly rate separately. Above each
amount, fill in the number of months you collected this amount of rent. For
example, if you rented this unit for $300 per month for 7 months and $325 per
month for 5 months, fill in line 11a as follows:
75
$ 300 325
LINE 11b
Fill in the number of months you rented the unit to this renter in 2000.
LINE 11c
Multiply line 11a by line 11b. This is the total rent collected for this
unit for the period of time the unit was occupied by this renter in 2000.
LINE 11d Fill in the total number of occupants in this rental unit during the rental
period. Note: Do not count the claimant’s spouse or children who were under
age 18 as of December 31, 2000.
LINE 11e
Fill in this renter’s share of the total 2000 rent paid. Do not include
rent paid for renters other than the renter listed on line 1 of this certificate, or
amounts you received directly from a governmental agency.
LINE 12
Fill in this renter’s share of the value of food, medical, and other
personal services, including laundry, transportation, counseling, grooming,
recreational, and therapeutic services, you provided for this rental unit. Do not
include utilities, furnishings, or appliances. If you did not provide any of the items,
fill in -0- on line 12.
LINE 13a
Subtract line 12 from line 11e. This is the allowable rent paid for
occupancy only.
LINE 13b If heat was included for this rental unit, check the “Yes” box. If heat
was not included for this rental unit, check the “No” box.
LINE 14
Review the rent certificate to be sure that line 1 and each of the lines
5 to 13b has an entry. Sign (by hand), date, and return the rent certificate to the
renter. Signature stamps, photocopied signatures, etc., are not acceptable.
Instructions for Preparing a Rent Certificate
Landlord Fill in ALL lines 5 to 14 (SSN is optional)
5 Last name
First name and initial
6 Telephone number
7 SSN (optional) or FEIN
8 Address
9 Is the rental property (line 3) subject to property taxes?
If no, see instructions Yes No
10 a. Is this rent certificate for rent of:
A mobile home? Yes No
A mobile home site? Yes No
b. Mobile home taxes or parking permit fees, or municipal fees
you collected from this renter for 2000 $
11 Answer lines 11a to 11e based on the period of time this rental
unit was occupied by this claimant (renter) in 2000. Do not
include amounts collected directly from a governmental agency
a. Rent collected per month for this
rental unit, for 2000 $
b. Number of months this rental unit was
rented to this renter in 2000
c. Total rent collected for this unit, for 2000 $
d. Number of occupants in this rental unit
do not count spouse or children under 18
e. This renter’s share of total 2000 rent (do not
include rent paid for other renters) $
12 Value of food and services provided by landlord
(this renter’s share) $
13 a. Rent paid for occupancy only —
Subtract line 12 from line 11e $
b. Was heat included in the rent? Yes No
14 I certify that the information shown on this rent certificate for 2000
is true, correct, and complete to the best of my knowledge.
1 Claimant's Last name
First name and initial
2 Social security number
3 Address of rental property (property must be in Wisconsin)
4 Time you actually lived here in 2000
From (mo/day) To (mo/day)
2000 Rent Certificate
Wisconsin
Department of Revenue
Claimant
(
renter
)
Fill in lines 1 to 4
• Have your landlord fill in lines 5 to 14
• Fill in the amount from line 10b on line 13, 14a, or 14c of Schedule H,
as appropriate
•
Fill in the amount from line 13a on line 14a of Schedule H if
line 13b is “Yes,” or on line 14c of Schedule H if line 13b is “No”
• If your landlord will not sign, see paragraph 2 under “Exceptions:
Renters,” on page 9 of the Schedule H instructions
• Attach completed rent certificate (not a photocopy) to Schedule H
I-017
Signature (by hand) of landlord or authorized representative Date
Alterations (whiteouts, erasures, etc.) will void this rent certificate. A rent
certificate with an error should be discarded and a new one completed.
