To Qualify:
To qualify for a refund, you must be the person whose name appears
on the utility bills and the total Gross income of everyone in
your household must have been less that $8,700.00 during the last
calendar year or income tax year.
Refund Allowable:
The law gives you the right to a refund of Utility Users' taxes
paid, but not more than $30.00 if you qualify.
Your Claim:
Your claim is to be filed with the City of Modesto Finance
Department, located at 1010 10th Street, Suite 2100, or
mailed to P.O. Box 642, Modesto, CA 95353, during the
period January 1, through April 15, for the Utility Users' Taxes
paid during the past twelve-month period ending on December 31. No
claim can be accepted if filed or postmarked later than April 15.
Answer all questions and fill in the blanks. PRINT clearly in ink.
Names of Other Household
Members:
List the name, relationship and age of every person who was a
member of your household during your last Federal or State income
tax reporting period. If none, so indicate. Household members
include your spouse (if living with you) and everyone qualified as
a dependent for income tax purposes. Be sure to include the
income of all of these household members with your income in Part
III of the claim form.
Part II: Answer Questions A
and B.
Part III: Household Income:
List all household income received during your last Federal or
State income tax reporting period. Household income is your income
and the income of all household members listed in Part I of the
claim form from salary or wages, tips, fees, charges, together
with the net income from all sources of all kinds,
including but not limited to alimony, support money, cash public
assistance and relief, pensions, annuities, social security,
interest on securities (including tax-free interest on
governmental securities), realized capital gains, workers'
compensation (not including medical benefits), unemployment
insurance income, insurance benefits of all kinds (other than
medical), and gifts, except that income shall not include Medicare
benefits, Medicaid benefits, gifts of food and gifts between
members of the household, the receipt of surplus food or other
relief in kind supplied by a governmental agency.
Proof of Payment:
The paid bills must support total utility users' taxes paid. Please
send the entire bill. If the name and address are missing,
payment will not be made. Utility companies have no obligation to
make or furnish, for refund purposes, proof of utility taxes due
or paid. When you bring or mail your claim to the Finance
Department, the receipts will be returned to you through the mail.
Questions regarding
eligibility, income, etc., should be directed to the Finance
Department/Utility Refund. The telephone number is (209) 577-5395.
Download
Utility Users' Tax Refund Claim Form in Adobe PDF Format:
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Utility
Users' Tax Refund Claim Form
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The Utility
Users' Tax Refund Claim Form is distributed in Adobe PDF Format. The free Adobe
Acrobat Reader is required for viewing or printing. |
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P.O. Box 642, Modesto, CA 95353