Wisconsin Rent Certificate Form – Fill Out and Use This PDF

Complete all fields in the “Renter (Claimant)” section except the social security number. Then give to your landlord to complete and sign.

Enter the Address of rental property, City, State and Zip; the property must be in Wisconsin.

Enter the time you actually lived at the address of rental property in 2025: From and To.

Renter (Claimant): after your landlord returns the completed rent certificate, enter your social security number, complete line 5b if applicable, and then fill in the allowable amounts from lines 3c and 8a (or line 7 of the Shared Living Expenses Schedule) on Schedule H or H-EZ, as appropriate.

Do NOT sign your rent certificate. If your landlord won't sign, complete the fields and lines 1 to 8, attach rent verification (see instructions), and check here.

If your landlord won't sign, 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 verified will not be allowed.

Rent certificates signed by the renter or someone other than the landlord or his/her authorized representative will not be accepted.

Landlord or Authorized Representative: enter the Name of property owner, Telephone number, and Address, City, State, Zip.

Line 1: is the rental property a long-term care facility, CBRF, or nursing home? Yes or No.

Line 2a: is the rental property subject to property taxes? Yes or No.

If 2a is “No” and you are a sec. 66.1201 municipal housing authority that makes payments in lieu of taxes, check here (2b).

If you checked “No” on line 2a, do not complete the rent certificate unless line 2b applies.

Line 3: is this certificate for rent of a mobile/manufactured home (3a) or a home site/lot (3b)? Yes or No.

Mobile or manufactured home taxes or municipal permit fees you collected from this renter for 2025, line 3c.

Enter the total rent collected for this rental unit for 2025 (4a); do NOT include amounts received directly from a governmental agency, Wisconsin rental assistance program payments, security deposits, or late fees.

Line 4a: fill in the total rent collected from all occupants for this unit for the time occupied by this renter in 2025.

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, late fees, security deposit paid during the year, or amounts you received directly from a governmental agency through a subsidy, voucher, grant, etc., or Wisconsin rental assistance program payments for the unit (except amounts an agency paid as a claimant's representative payee).

If monthly rent paid didn't change during 2025, enter monthly rent paid on line 4b.

If monthly rent changed during 2025, enter rent paid for each month, Jan. to Dec. Do not include security deposits or late fees.

Line 5a: fill in the number of adult occupants who lived in this rental unit during the rental period. Do not count the renter's spouse or children under age 18 as of December 31, 2025.

Renters, if line 5a is more than 1, did each occupant pay an equal share of living expenses? Yes or No, line 5b (if no, complete the Shared Living Expenses Schedule).

Line 5b: the landlord does not complete this line. This will be completed by the renter.

Shared Living Expenses Schedule: to be completed by renter only if line 5b is “No.”

Complete this schedule if line 5b on page 1 is “No.” All lines on the schedule must be filled in. If all lines on the schedule are not filled in, paid rent will be divided by the number of occupants.

Step 1: List name(s) of other occupants.

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.

Step 3: Using the amounts listed in Step 2, compute your allowable rent paid for occupancy only. Line 1: Total rent paid (line 1a). Line 2: Shared living expenses you paid (line 5b). Line 3: Total shared living expenses (line 5a).

Line 6: this renter's share of total 2025 rent.

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.

Line 8a: rent paid for occupancy only; subtract line 7 from line 6.

Line 8b: was heat included in the rent? Yes or No.

Handwritten signature of landlord or authorized representative, Date, Print name (must match signature): I certify that the information shown on this rent certificate is true, correct, and complete to the best of my knowledge.

Review the rent certificate to be sure that all applicable fields and lines have an entry.

Signatures that are stamped, typed, or completed by other electronic means will not be accepted by the department.

Only attach the rent certificate if filing a homestead credit claim.