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 oce 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 benets ........................................................ 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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