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4 State of Rhode Island Division of Taxation 4
5 2023 Form RI-1040H 5
6 Rhode Island Property Tax Relief Claim 23100299990101 6
7 7
8 8
9 First nameYour first name MI Last name MI Last name Suffix Deceased?Deceased?Deceased? Y YYour social security numberour social security numberour social security number 9
10 XXXXXXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXX XX YessYe 999999999 10
11 Spouse’s first name MI Last name Suffix Deceased?Deceased? Spouse’Spouse’s social security numbers social security number 11
12 XXXXXXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXX XX YessYe 999999999 12
13 MailingMailing addressaddress NewNew address?address? DaytimeDaytimetelephonetelephonenumbernumber 13
14 XXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX YeYess (999) 999-9999 14
15 CityCity, town or post office, town or post office StateState ZIP codeZIP codeZIP code CityCityCity ororor towntowntown ofofof legallegallegal residenceresidenceresidence 15
16 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XX 99999 XXXXXXXXXXXXXXXX 16
17 HomeHomeHomeHome Address if using a PO Box or if your Mailing Address is different from Home AddressAddressEmailEmailEmailEmailif usingaddressaddressaddressaddressa PO Box or if your Mailing Address is different17from Home AddressAddress if using a PO Box or if your Mailing Address is different from Home AddressAddress if using a PO Box or if your Mailing Address is different from Home Address
18 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX 18
19 19
20 PART 1ELIGIBILITY. IF YOU ANSWER NO TO ANY OF THESE QUESTIONS, YOU ARE NOT ELIGIBLE FOR THIS CREDIT. 20
STOP HERE. DO NOT COMPLETE THE REST OF THIS FORM.
21 21
22 A Were you domiciled in Rhode Island for all of 2023?.................................................................................. A YES NO 22
23 23
24 B In 2023 did you live in a household or rent a dwelling that was subject to property tax?............................ B YES NO 24
25 25
26 C Are you current for property taxes or rent due on the homestead for 2023 and all prior years?................. C YES NO 26
27 27
D Were you or your spouse 65 years of age or older and/or disabled as of December 31, 2023?................ D
28 ELIGIBILITY YES NO 28
29 29
30 E Was your 2023 total household income from page 2, line 32 $37,870 or less?.......................................... E YES NO 30
31 31
32 PART 2 ADDITIONAL INFORMATION - ATTACH A COPY OF YOUR 2023 SOCIAL SECURITY AWARD LETTER OR FORM 1099 TO 1040H FORM32
33 1a Enter the total amount of public assistance received by all members of your household........................... 1a 999999999 99 33
34 b Enter your total household income from page 2, line 32............................................................................. 1b 999999999 99 34
35 35
36 c Enter your date of birth ............................ 07/13/1955/ / 1d Enter spouse's date of birth ..................... 07/13/1955/ / 36
37 37
38 INFO e Were you or your spouse disabled and receiving Social Security Disability payments during 2023? 1e YES NO 38
39 39
40 f Indicate the number of persons in your household ..................................................................................... 1f 999999999999 40
41 g Enter the number of persons from 1f who are dependents under the age of 18........................................ 1g 999999999999 41
42 DRAFT 42
43 PART 3 TO BE COMPLETED BY HOMEOWNERS ONLY– ATTACH A COPY OF YOUR 2023 PROPERTY TAX BILL TO 1040H FORM 43
44 2 Enter the amount of property taxes you paid or will pay for 2023............................................................... 2 999999999 99 44
45 3 Using your household income from line 1b enter percentage from the computation table located on pg 3 3 0.9999 % 45
46 4 Multiply amount on line 1b by percentage on line 3.................................................................................... 4 999999999 99 46
47 HOME 5 Tentative credit. Subtract line 4 from line 2. If line 4 is greater than line 2, enter zero.............................. 5 999999999 99 47
48 OWNERS 6 PROPERTY TAX RELIEF. Line 5 or $650.00, whichever is LESS.............................................................. 6 999999999 99 48
49 49
50 PART 4 TO BE COMPLETED BY RENTERS ONLY– ATTACH A COPY OF YOUR 2023 LEASE OR 3 RENT RECEIPTS TO 1040H 50
LANDLORD INFORMATION (REQUIRED)
51 51
52 Name: XXXXXXXXXXXXXXXXXXX Address: XXXXXXXXXXXXXXXXXXXXXX Telephone number:999-999-999952
7 Enter the amount of rent you paid in 2023..................................................................................................09/01/20237
53 999999999 99 53
54 8 Multiply the amount on line 7 by twenty (20) percent (0.2000).................................................................... 8 999999999 99 54
55 9 Using your household income from line 1b enter percentage from the computation table located on pg 3 9 0.9999 % 55
56 10 Multiply amount on line 1b by percentage on line 9.................................................................................... 10 999999999 99 56
57 11 Tentative credit. Subtract line 10 from line 8. If line 10 is greater than line 8, enter zero.......................... 11 999999999 99 57
RENTERS 12 PROPERTY TAX RELIEF. Line 11 or $650.00, whichever is LESS............................................................ 12
58 999999999 99 58
59 59
60 CREDIT 13 PROPERTY TAX RELIEF. Line 6 or line 12, whichever applies. Enter here and on Form RI-1040, line 14c....... 13 999999999 99 60
61 61
62 RETURN MUST BE SIGNED - SIGNATURE IS LOCATED ON PAGE 2 62
1111111111222222222233333333334444444444555555555566666666667777777777888Mailing address: RI Division of Taxation, One Capitol Hill, Providence, RI 02908-5806
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