Check below then fill in either the name of the city,
village, or town, and the county in which you lived
at the end of 2021.
City
Wisconsin
homestead credit
2021
H‑EZ
County of
Claimant’s legal rst nameClaimant’s legal last name
Spouse’s legal rst nameSpouse’s legal last name
Current home address (number and street)
StateCity or post oce Zip code
Spouse’s social security number
M.I.
M.I.
City, village,
or town
Village Town
Special
conditions
(See page 10 of the
Schedule H instructions.)
Apt. no.
Claimant’s social security number
Check here if
an amended return
1 a What was your age as of December 31, 2021? (If you were under 18, you do not qualify for
homestead credit for 2021.) ........................................................ 1a Fill in age
b What was your spouse’s age as of December 31, 2021? .................................. 1b Fill in age
c If you and your spouse were under age 62 as of December 31, 2021, were you or your spouse
disabled? (See instructions) ....................................................... 1c Yes No
d If you and your spouse were not disabled, did you or your spouse have positive earned income
(see Schedule H instructions) in 2021? (If “No”, you do not qualify - see instructions) ........... 1d Yes No
2 Were you a legal resident of Wisconsin from 1-1-21 through 12-31-21? (If “No,” you do not qualify.) 2 Yes No
3 Were you claimed or will you be claimed as a dependent on someone else’s 2021 federal income
tax return? (If “Yes” and you were under age 62 on December 31, 2021, you do not qualify.) ..... 3 Yes No
I-015i
ATTACH rent certificate or property tax bill
Household Income
NO COMMAS; NO CENTS
Print numbers like this
4 Wisconsin income from line 5 of Form 1 (see instructions) ................................. 4
5 If not ling a 2021 Wisconsin return, ll in Wisconsin taxable income below.
a Wages + Interest + Dividends = ... 5a
b Other taxable income (list type and amount) 5b
c Medical and long-term care insurance subtraction. Enter as a negative number ............... 5c
6 Nontaxable income not included on line 4, 5a, or 5b above.
a Unemployment compensation ...................................................... 6a
b Social security, federal and state SSI, SSI-E, SSD, and CTS payments (see instructions) ........ 6b
c Railroad retirement benets ........................................................ 6c
d Pensions, annuities, and other retirement plan distributions ................................ 6d
e Contributions to deferred compensation plans (see box 12 of wage statements) ................. 6e
f Contributions to IRA and SIMPLE plans ............................................... 6f
g Interest on United States bonds and notes and state and municipal bonds .................... 6g
h Child support, maintenance payments, and other support money (court ordered) ............... 6h
i Wisconsin Works (W2) payments, county relief, kinship care, and other cash public assistance .... 6i
7 a Add lines 4 through 6i (if less than the total of lines 8, 9a, and 9c, see instructions) ............. 7a
b Fill in number of qualifying dependents (do not count yourself or your spouse) x $500 = 7b
c Household income.
Subtract line 7b from line 7a (if $24,680 or more, no credit is allowed)
............. 7c
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.00
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.00
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.00
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2021 Schedule H-EZ
Page 2 of 2
SSNName
Mail to:
Wisconsin Department of Revenue
PO Box 34
Madison WI 53786-0001
For Department Use Only
C
Taxes and/or Rent
Before completing this section, see instructions for taxes and/or rent (STEP 4).
8 Homeowners Net 2021 property taxes on your homestead. Attach your 2021 tax bill ............ 8
9 Renters–Rent from line 8a of your rent certicate(s) or line 7 of your Shared Living Expenses
Schedule.
Heat included (8b of rent certicate is “Yes”) ..........9a x .20 (20%) = 9b
Heat not included (8b of rent certicate is “No”) ........9c x .25 (25%) = 9d
10 Add lines 8, 9b, and 9d (or enter amount from line 6 of Taxes/Rent Reduction Schedule) ........ 10
.00
.00
.00
.00
.00
.00
Under penalties of law, I declare this homestead credit claim and all attachments are true, correct, and complete to the best of my knowledge and belief.
Claimant’s signature
Sign
here
Spouse’s signature
Date
Date
Daytime phone number
( )
Daytime phone number
( )
Sign
here
NO COMMAS; NO CENTS
Credit Computation
.00
.00
.00
.00
11 Fill in the smaller of the amount on line 10 or $1,460 .................................... 11
12 Using the amount on line 7c, ll in the appropriate amount from Table A (page 25) ............ 12
13 Subtract line 12 from line 11 (if line 12 is more than line 11, ll in 0; no credit is allowable) ..... 13
14 Homestead credit Using the amount on line 13, ll in the credit from Table B (page 26) ....... 14
NO COMMAS; NO CENTS
Wisconsin Identity Protection PIN (7 characters)
Wisconsin Identity Protection PIN (7 characters)
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