TC-90CB — Homeowner's Tax Credit Application (with instructions)

# (Circuit Breaker Application)

Rev. 4/26
Clear
You can complete this form in TAP at tap.utah.gov.
NOTE: Only one application per address.

# Section 1 - Applicant Information

Applicant's first name Applicant's last name Spouse's first name Spouse's last name Street address (make corrections, if necessary) City

# • Due Dec. 31, 2026

Birth date Check if widow(er) SSN/Circuit Breaker acct. no.
(mm/dd/yyyy)
Birth date Deceased date SSN/Circuit Breaker acct. no.
(mm/dd/yyyy) (mm/dd/yyyy)
State ZIP Code Daytime telephone number CHECK THIS BOX if you are a manufactured homeowner applying for a lot rental refund: •

# Section 2 - Do You Qualify For A Refund?

A. Were you age 66 or older on or before Dec. 31 of last year? If you are under 66 years, are you an UNMARRIED widow/widower (see instructions)? … A Yes No (Go to question B) (Don't send form)
B. Did you financially support yourself last year and cannot be claimed as a dependent on someone else's tax return? … • B Yes No (Go to question C) (Don't send form)
C. Did you live in Utah all of last year? … • C Yes No (Go to question D) (Don't send form)
D. REQUIRED: How many people in your household received income last year? … • D

# Annual Household Income

(Continue with form)
 Complete lines 1-10 below. If more than one person received income, first use the Household Income Worksheet (TC-90CB_W), and then enter the totals on lines 1-9 below.  ANNUAL amounts 

1. Wages/salaries/tips/other compensations (W-2, 1099-MISC, etc.) … • 1 .00
2. Total interest income, dividends (taxable and nontaxable) … • 2 .00
3. Pensions, annuities (taxable and nontaxable) … • 3 .00
4. Social Security and railroad retirement (but not Social Security Disability) (taxable and nontaxable) . . . . . . • 4 .00
5. Capital gain/loss (exclude carryforwards/carrybacks) … • 5 .00
6. Nontaxable income (see UCA §59-2a-101(20)) … • 6 .00
7. Unemployment, worker's compensation … • 7 .00
8. Business, rental, farm income … • 8 .00
9. Other income (any income not reported above) … • 9 .00
10. Total household income from all sources for last year (add lines 1 through 9) … • 10 .00
11. Maximum income amount … 11 $44,221 If the amount on line 10 is greater than the amount on line 11, you do not qualify for a renter refund.

-Continued on next page

Section 3 - Last Year's Rent Information (see instructions)  List each place you rented last year. Enter the total months you lived at each address LAST YEAR ONLY.
 Enter the total amount of rent YOU paid ONLY. If you received rental assistance, only enter the portion of rent YOU paid out-ofpocket. Do NOT include other fees (such as cable, storage, parking, pet, cleaning, late payment, etc.).
#1 Rental address Landlord name Landlord phone no.

• Months last • Total rent paid last year • Check if gas is included in rent • Check if electricity is included in rent #2 Rental address Landlord name Landlord phone no.
• Months last • Total rent paid last year • Check if gas is included in rent • Check if electricity is included in rent #3 Rental address Landlord name Landlord phone no.
• Months last • Total rent paid last year • Check if gas is included in rent • Check if electricity is included in rent

# Section 4 - Residency Status, Certification and Signature

Under state and federal law, we can not process this application or issue a credit to anyone who does not provide this information.
 Check ONLY ONE box (providing false information subjects the signer to penalties for perjury):

• 1. I am a U.S. citizen.
• 2. I qualify under 8 U.S.C. 1641 and I am in the U.S. lawfully.

 If you checked box 2, you must attach one of the following:
● Documentation showing I-94 (arrival departure) number* ● Alien Registration Number issued by U.S. Citizenship and Immigration Service* *The I-94 (arrival/departure) number and the Alien Registration Number are issued by the U.S. Citizenship and Immigration Service.
Under penalties of perjury, I declare to the best of my knowledge and understanding, all the information on this application is true, correct and complete.
Signature of applicant Date Signature of spouse Date Preparer's name and address or organization (if applicable) Preparer's phone number Complete and sign this application, then mail to:

210 N 1950 W
SALT LAKE CITY, UT 84134
Phone: 801-297-6254 year at address .00 at this address year at address at this address .00 year at address at this address .00 SIGN SIGN

TC-90CB_W

# Household Income Worksheet

Use this worksheet if you were not the only person in your household with income last year.
Do not include income of children under 18 or your (or your spouse's) parents and grandparents, even if they live with you.
On each line, enter total ANNUAL amounts for the whole year.
For each line, add the amounts in columns A through E and enter the total in Column F.
Enter the totals from column F in Section 2 (Household Income) of the Renter Refund Application.
A. You B. Your spouse
Name

Social Security Number

1. Wages/salaries/tips/other compensation (W-2, 1099Misc., etc.)
2. Total interest income and dividends (taxable and nontaxable)
3. Pensions and annuities (taxable and nontaxable)
4. Social Security & railroad retirement (but not Social Security Disability)(taxable and nontaxable)
5. Capital gain/loss (exclude carryforwards/carrybacks)
6. Nontaxable income (see UCA §59-2a-101(20))
7. Unemployment, worker's compensation
8. Business, rental and farm income
9. Other income (any income not reported above)

.00 .00 .00 .00 .00 .00 .00 .00 .00
C. Other Person in D. Other Person in Household #1 Household #2 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00
E. Other Person in F. Totals
Household #3 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 Note: If you entered numbers on lines 3, 5, 6 or 8, keep copies of federal returns and schedules with your records.

# Renter Refund Application Instructions

Instructions
For More Information Contact:

801-297-6254, or

1-800-662-4335 ext. 6254

Davis County Aging Services

801-525-5050

Salt Lake County Aging Services

385-468-3200

Utah County Aging Services

801-229-3800

Washington County Aging Services

435-634-5712

Also visit us online at tax.utah.gov Privacy Notice: tax.utah.gov/privacy
What To Attach
Send the following with your application (also keep a copy for your  Submit only ONE application per address. Report total ANNUAL amounts for income and rent - do NOT report monthly amounts.

# Section 1 - Applicant Information

● You must complete all fields.
● If you are a widow(er) age 66 or older, you do not need to provide information about your deceased spouse.
● If you are an unmarried widow(er) under age 66, check the widow(er) box and enter your spouse's name, birth date, death date and SSN or account ID. A surviving spouse must have been a member of the deceased spouse's household at the time of their death, and be unmarried at the time the claim is filed.
Section 2 - Do You Qualify For a Refund?
You must answer questions A - D.

# Annual Household Income

● Household income is ALL INCOME received from ALL PERSONS living in the household last year, not just the applicant. If the applicant is the only household member with income, complete lines 1 - 9. Do not include income of children under 18 or your (or your spouse's) parents and grandparents, even if they live with you.
● If more than one household member received income, you must complete the Household Income Worksheet. Take the totals from column F of the worksheet and copy them to Section 2, lines 1 - 9 of the application. Submit BOTH the application AND the worksheet.
● Keep all federal returns and schedules with your records in case of Tax Commission review.
Section 3 - Annual Rent Information For each location entered, you must complete all fields. Keep proof with your records showing how much rent was paid (receipts, bank copies of cancelled checks, etc.).

# Section 4 - Residency Status, Certification and Signature

Enter your residency status. Check ONE box ONLY.
 Sign the application. If a preparer completed this form on your behalf, enter the preparer's name, address and phone number. records):
● TC-90CB, pages one and two.
● TC-90CB Schedule W if more than one household member received income.
If you are not a U.S. citizen, you must also attach one of the following:
● Documentation showing I-94 (arrival departure) number ● Alien Registration Number issued by U.S. Citizenship and Immigration Service
What To Keep
● Your federal returns and schedules.
● All other supporting documentation, including proof of income and rent paid.
We will review and determine eligibility for refund. You may be required to submit more information to support your claims.
NOTE: Your refund may be delayed and/or reduced if you enter monthly figures for income or rent.
 If you are a homeowner or manufactured homeowner applying for a property tax credit, you must file form TC-90H with the county where the property is located by Sept 1 of this year. Contact your local county agency for more information.
 See Pub 36 for more information about property tax relief. Get Pub 36 online at tax.utah.gov/forms/pubs/.
2025 Renter Refund Schedule
Lower Upper Renter Maximum
Household Household Refund % of Renter Income Limit Income Limit Gross Rent Refund $0 $15,033 9.5% $1,412 15,034 20,048 8.5% 1,245 20,049 25,057 7.0% 1,082 25,058 30,069 5.5% 835 30,070 35,083 4.0% 674 35,084 39,796 3.0% 429 39,797 44,221 2.5% 262