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Confidential City and County of Honolulu: Application Form T-Rpt100 Tax Year 2018-2019
Confidential City and County of Honolulu: Application Form T-Rpt100 Tax Year 2018-2019
PARCEL INFORMATION
TAX MAP KEY ______________________________________________________________________
Zone Section Plat Parcel Cpr
APPLICANT INFORMATION
_________________________________________________________________________________________
Last Name First Name Middle Name
_________________________________________________________________________________________
Mailing Address: Street Number Street Name Unit No.
_________________________________________________________________________________________
City State Zip Code Phone E-Mail Address
QUALIFICATION REQUIREMENTS
1, Do you have a home exemption on this property now?
_____ YES * You must maintain a home exemption
_____ NO …If NO, STOP, You do not qualify for the credit. through the Tax Year 2018-2019.
2. Do any of the owners on title own other property on Oahu, elsewhere in Hawaii, in another state or
territory, or in a foreign country?
_____ YES … If YES, STOP, You do not qualify for the credit.
_____ NO
3. Do you expect the property to be sold or the owners on title to change before June 30, 2018?
_____ YES _____ NO
Any sale of the property or ownership change must be reported within 30 days to the address above or the
credit may be voided and a fine may be imposed.
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Application Form, Form T-RPT100
Revised June 30, 2017
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
TOTAL COMBINED GROSS INCOME OF ALL OWNERS ON TITLE $
$60,000 INCOME LIMIT
Is the “TOTAL COMBINED INCOME OF ALL OWNERS ON TITLE” in Section D above greater than $60,000?
____ YES………. STOP. You do not qualify for the credit.
____ NO
_______________________________________ _______________________________________
Signature Date Signature Date
_______________________________________________ _______________________________________________
Signature Date Signature Date
CONTACT PERSON
If we have questions on your application and someone other than yourself should be contacted, please include the
information below.
This hereby authorizes our office to contact the following person(s) other than yourself, regarding this application for
Real Property Tax Credit for Homeowners, Tax Year 2018-2019.
_____________________________________________ _________________________________________________
Name Relationship to Owner
_____________________________________________ _________________________________________________
Address Phone Number Email Address
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Application Form, Form T-RPT100 REAL
PROPERTY TAX CREDIT FOR HOMEOWNERS
Revised June 30, 2017
INCOME AND DOCUMENTS WORKSHEET
All Titleholders must complete this form
XXX-XX-
Last Name First Middle Soc. Sec. No. (last 4 digits) Date of Birth
XXX-XX-
Spouse’s Last name First Middle Soc. Sec. No. (last 4 digits) Date of Birth
(If joint return filed)
IF YOU FILED A FEDERAL INCOME TAX RETURN, YOU MUST COMPLETE THIS SECTION
1. REQUIRED: Tax Return Transcript from the Internal Revenue Service (instructions on page 4))
2. List the gross amount of all income you received in 2016. Do not include prior year losses.
3. Submit highlighted documents with an asterisk: W2, 1099DIV, SCH. D, NOL.
4. We reserve the right to request any other income document to verify your income.
Type of Income $ Gross Type of Income $ Gross
Income
Income
Wages, Salaries, Deferred Comp Veterans Benefits
*W2
Interest, tax exempt interest Social Security/SSI
Dividends *1099DIV Rents/Royalties
State Tax Refund Partnership, Trust Income
Business Profit/Loss Unemployment, Jury Duty
Capital Gains/Losses 2016 * SCH D Other Income: Gambling Winnings,
IRA Distribution Debt Write-off, *NOL
Pensions/Annuities Alimony
Income
of
all
titleholders
cannot
exceed
$60,000
TOTAL
INCOME
$
IF YOU DID NOT FILE A FEDERAL INCOME TAX RETURN, YOU MUST COMPLETE THIS SECTION
1. You must list below all income that you received in 2016
2. You must submit all income documents such as SSA1099, 1099’s, W-2, Etc.
3. If you filed a State of Hawaii Tax Return, you must also submit a copy of the return.
4. We reserve the right to request any other income document to verify your income.
Type of Income $ Gross Income Type of Income $ Gross Income
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Application Form, Form T-RPT 100
Revised June 30, 2017
Call 1-800-908-9946. You will get a recorded message. When you hear the messages listed below, press the number next to
it or enter the information requested. Keep this script in front of you as you place your call.
Listen to the recorded information regarding transcript. Wait until you hear Step 5.
You can order your tax return transcript at http://www.irs.gov and have it be mailed to your address on record.
Visit http://www.irs.gov. Under Tools, click on Get a Tax Transcript by Mail. To have your transcript mailed to you,
click on “Get Transcript by MAIL”. Note: IRS will not mail transcripts to an address other than the one they have on
file.