Wi Revenue Certificate Details

A rent certificate form is an important document that proves that a tenant is up to date on their rent payments. This document can be used in a court of law to prove that the tenant is in good standing with their landlord. In some cases, a rent certificate may also be used as evidence of residency.Landlords often require tenants to provide a rent certificate as proof of payment before signing a lease agreement. This document can also help landlords determine whether or not they should offer a tenant credit for future rent payments. In some cases, landlords will offer credits for up to one year's worth of rent payments. Therefore, it is important for tenants to carefully review their lease agreement and understand the terms and conditions before signing any documents.

The listing provides details about the rent certificate. You might like to look at it before filling out the gaps.

QuestionAnswer
Form NameRent Certificate
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other names2014 certificate, wi dor certificate, rent certificate paid, wi revenue certificate

Form Preview Example

CAUTION:

Schedule H or H-EZ must be completed and filed with this rent certificate

Rent Certiicate

2014

Wisconsin Department of Revenue

 

NOTE: • Attach to Schedule H or H-EZ

Alterations (whiteouts, erasures, etc.) or errors VOID this rent certiicate.

Renter (Claimant) – Enter Social Security Number AFTER your landlord ills in section below and signs.

Legal last name

Legal irst name

M.I.

Social security number

Address of rental property (property must be in Wisconsin)

City

State Zip

Time you actually lived at this address in 2014 FROM

 

 

 

 

 

 

 

2014

TO

 

 

 

 

 

 

 

2014

 

M M

 

D D

 

M M D D

Do NOT sign your rent certiicate.

If your landlord won’t sign, complete ields above and below and lines 1 to 8, attach rent veriication (see instructions), and check here.

Landlord or Authorized Representative

Name of property owner

 

Telephone number

 

 

(

)

 

 

 

 

Address

City

State

Zip

 

 

 

 

1

Is the rental property a long-term care facility, CBRF or nursing home?

1

 

Yes

 

2a

Is the above rental property subject to property taxes?

2a

 

Yes

 

bIf 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 certiicate for rent of a mobile/manufactured: a Home?

3a

 

Yes

 

c

b Home site/Lot?

3b

 

Yes

 

Mobile or manufactured home taxes or municipal permit fees you collected

 

 

 

from this renter for 2014

. . . .

. . .

. . . . . .

4a

Total rent collected for this rental unit for 2014

. . . .

. . .

. . . . . .

bIf monthly rent did not change during the year, go to line 5. Otherwise, enter monthly amounts below.

No

No

No

No

3c.00

4a.00

Jan.

.00

Feb.

.00

Mar.

.00

Apr.

.00

May

.00

June

.00

July

.00

Aug.

.00

Sept.

.00

Oct.

.00

Nov.

.00

Dec.

.00

5

Number of occupants in this rental unit – do NOT count spouse or children under 18 . . . .

. . .

.

5

 

6

This renter’s share of total 2014 rent

. . . .

. . .

. . . . . .

6

 

 

.00

7

Value of food and services provided by landlord (this renter’s share) . . .

. . . .

. . .

. . . . . .

7

 

 

.00

8a

Rent paid for occupancy only – Subtract line 7 from line 6

. . . .

. . .

. . . . . .

8a

.00

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .b Was heat included in the rent?

8b

 

Yes

 

 

 

No

 

 

 

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

Date

Name of landlord or authorized representative (print)

I-017i (R. 10-14)

2014 Rent Certiicate

Name

Address of rental property

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:

 

.00

 

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:

Shared Living

Total Paid by

 

 

Amount

Expenses

All Occupants

 

 

You Paid

Rent

1a)

.00

1b)

.00

Food

2a)

.00

2b)

.00

Utilities

3a)

.00

3b)

.00

Other

4a)

.00

4b)

.00

Total

5a)

.00

5b)

.00

2

Shared living expenses

 

.00

 

you paid (line 5b)

2

3

Total shared living

 

.00

 

expenses (line 5a)

3

4Divide line 2 by line 3. Fill

 

in decimal amount

4

x .

5

Multiply line 1 by line 4

5

.00

6

Value of food and services provided by

 

.00

 

landlord (line 7 of page 1)

6

7

Subtract line 6 from line 5. This is your

 

 

 

allowable rent. Fill in here and on

 

 

 

 

 

 

line 14a or 14c of Schedule H

 

.00

 

(line 9a or 9c of Schedule H-EZ)

7

Instructions for Renter (Claimant)

Complete all ields except the social security number. Then give to your landlord to complete and sign.

If your landlord won’t sign, place a checkmark in the designated area. Complete the “Landlord or Authorized Representative” section, and attach a copy of each canceled check or bank money order you have to verify your rent. Any portion not veriied will not be allowed.

After your landlord returns the completed rent certiicate, enter your social security number and then ill in the allowable amounts from lines 3c and 8a on Schedule H or H-EZ, as appropriate.

Instructions for Landlord/Authorized Representative

Lines 2a and 2b If you checked “No” on line 2a, do NOT complete the rent certiicate unless line 2b applies.

Line 4a Fill in the total rent collected for this unit for the time occupied by this renter in 2014. Include any separate amounts the renter paid to you for items such as parking, a garage, 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 (except amounts an agency paid as a claimant’s representative payee).

LINE 7 Fill in this renter’s share of the value of food and personal services (medical, laundry, transportation, counseling, grooming, recreational, therapeutic, etc.) you provided for this rental unit.

Signature Review the rent certiicate to be sure that all applicable ields and lines have an entry. Sign (by hand) and date, print your name, and return the rent certiicate to the renter. Only an original signature is acceptable.

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