Form 8914 Exemption Amount for Taxpayers Housing Midwestern Displa

Form

8914

Exemption Amount for Taxpayers Housing
Midwestern Displaced Individuals

Department of the Treasury
Internal Revenue Service
Name(s) shown on your return

Part I

© Attach

OMB No. 1545-0074

2009

Attachment
Sequence No. 55
Your social security number

to Form 1040, Form 1040A, or Form 1040NR.

Information on Midwestern Displaced Individuals for Whom You Provided Housing in Your Main
Home for at Least 60 Consecutive Days

Do not enter information for more than four individuals, for anyone included on line 6d of Form 1040 or 1040A (line 7d of
Form 1040NR), or for anyone included on a Form 8914 you filed for 2008.
1

(a) First and last name

Part II
2
3

4
5
6
7
8
9

(b) Social security number
(see instructions)

(c) Former address in disaster area
(number and street, city or town, state, and ZIP code)

(d) Number of
consecutive days housed
in your main home

Exemption Amount

Maximum exemption amount. Enter $2,000 (see instructions if married filing separately)
Did you file Form 8914 for 2008?
Yes. Enter the amount from your 2008 Form 8914, line 2.
. . . . . . .
No. Enter -0Subtract line 3 from line 2 . . . . . . . . . . . . . . . . . . . . .
Multiply $500 by the total number of individuals listed in Part I above . . . . . . .
Enter the smaller of line 4 or line 5 . . . . . . . . . . . . . . . . . . .
Multiply $3,650 by the total number of exemptions claimed on line 6d of Form 1040
1040A (line 7d of Form 1040NR) . . . . . . . . . . . . . . . . . . .
Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . .

}

.

.

.

2

.

.

.

3

. .
. .
. .
Form
. .
. .

4
5
6

.
.
.
or
.
.

7
8

Is the amount on Form 1040, line 38 (Form 1040A, line 22; or
Form 1040NR, line 36), more than the amount shown on line 10 below
for your filing status?
No.

Enter the amount from line 8 above on Form 1040,

line 42 (Form 1040A, line 26; or Form 1040NR, line 39).

10

Yes. Enter the amount from Form 1040, line 38 (Form 1040A,
line 22; or Form 1040NR, line 36) . . . . . . . . . . . .
Enter the amount shown below for your filing status.
• Single—$166,800
• Married filing jointly or Qualifying widow(er)—$250,200
. . . .
• Married filing separately—$125,100
• Head of household—$208,500
Form 1040NR filers, see instructions
Subtract line 10 from line 9 . . . . . . . . . . . . . . .
Is line 11 more than $122,500 ($61,250 if married filing separately)?
No. Skip line 13; go to line 14.
Yes. Multiply $2,433 by the total number of exemptions claimed on
line 6d of Form 1040 or Form 1040A (line 7d of Form 1040NR) . .

}

11
12

13

14

15
16
17
18

Add lines 6 and 12. Enter the result here and on Form 1040, line 42;
Form 1040A, line 26; or Form 1040NR, line 39. Do not complete the
rest of this form . . . . . . . . . . . . . . . . . . .

9

10

11

12

13

Divide line 11 by $2,500 ($1,250 if married filing separately). If the result
is not a whole number, increase it to the next higher whole number (for
14
example, increase .0004 to 1) . . . . . . . . . . . . . .
Multiply line 14 by 2% (.02) and enter the result as a decimal rounded
.
15
to at least three places . . . . . . . . . . . . . . . .
16
Multiply line 7 by line 15 . . . . . . . . . . . . . . . .
Divide line 16 by 3.0 . . . . . . . . . . . . . . . . . . . . . . . . . .
Exemption amount. Subtract line 17 from line 8. Enter the result here and on Form 1040, line 42;
Form 1040A, line 26; or Form 1040NR, line 39 . . . . . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see page 3.

Cat. No. 37724X

17
18
Form

8914 (2009)

[This page left blank intentionally]

Page 3

Form 8914 (2009)

General Instructions
Purpose of Form
Use Form 8914 to claim your personal exemptions, exemptions
for dependents, and the additional exemption amount for
providing housing in your main home to one or more
Midwestern displaced individuals.

Additional Exemption Amount
You can claim an additional exemption amount of $500 for each
Midwestern displaced individual (defined below). You can claim
an additional exemption amount only one time for a specific
individual. If you claimed an additional exemption amount for an
individual in 2008, you cannot claim that amount again for the
same individual in 2009.
The maximum additional exemption amount you can claim for
all displaced individuals is $2,000. Any additional exemption
amount you claimed for displaced individuals in 2008 will
reduce the $2,000 maximum for 2009. The $2,000 limit applies
to a husband and wife, whether the husband and wife file joint
returns or separate returns. If married filing separately, the
$2,000 can be divided in $500 increments between the
spouses. For example, if one spouse claims an additional
exemption amount for one displaced individual, the other
spouse, if otherwise eligible, can claim additional exemption
amounts for three different displaced individuals.
If two or more taxpayers share the same main home, only
one taxpayer in that main home can claim the additional
exemption amount for a specific displaced individual. In order
for you to be considered to have provided housing, you must
have a legal interest in the main home (that is, own or rent the
home).

Midwestern Displaced Individual
To qualify as a Midwestern displaced individual, an individual
must meet the following three conditions.
• The individual must have had his or her main home in one of
the counties listed in Table 1 or Table 2 on page 4 on an
applicable disaster date shown in the table for that county, and
he or she must have been displaced from that home. In
addition, if the individual’s main home was in a county listed in
Table 2, the home must have been damaged by the storms,
tornadoes, or flooding that gave rise to the disaster declaration
for that county, or the individual must have been evacuated
from the home because of the storms, tornadoes, or flooding.
• He or she must have been provided housing in your main
home free of charge for a period of at least 60 consecutive days
ending in 2009. See Compensation for Housing below.
• He or she cannot be your spouse or dependent.

Compensation for Housing
You cannot claim the additional exemption amount if you
received rent (or any other amount) from any source for
providing the housing. You are permitted to receive payments or
reimbursements that do not relate to normal housing costs,
including the following.
• Food, clothing, or personal items consumed or used by the
displaced individual.
• Reimbursement for the cost of any long distance telephone
calls made by the displaced individual.
• Reimbursement for the cost of gasoline for the displaced
individual’s use of your vehicle.

However, you cannot claim the additional exemption amount
if you received any reimbursement for the extra costs of heat,
electricity, or water used by the displaced individual.

Specific Instructions
Line 1, Column (a)
Enter the first and last names of up to four displaced individuals
who were provided housing in your main home for a period of at
least 60 consecutive days ending in 2009. If less than 60
consecutive days, you cannot claim an additional exemption
amount for this individual.
Do not enter the name of any individual you included on a
Form 8914 you filed for 2008.

Line 1, Column (b)
Enter the displaced individual’s social security number (SSN) or
individual taxpayer identification number (ITIN). You must
provide this information in column (b) to claim an exemption
amount. You can use Form W-9, Request for Taxpayer
Identification Number and Certification, to request an SSN or
ITIN from the displaced individual.

Line 1, Column (c)
Enter the street address where the displaced individual’s main
home was located on the applicable disaster date. That home
must have been located in a Midwestern disaster area on that
date. Include the number and street, city or town, state, and ZIP
code.

Line 1, Column (d)
Enter the number of consecutive days the displaced individual was
provided housing in your main home free of charge.

Line 10
If you are filing Form 1040NR, enter the amount shown below
for your filing status.
• Filing status box 1 or 2 — $166,800
• Filing status box 3, 4, or 5 — $125,100
• Filing status box 6 — $250,200
Paperwork Reduction Act Notice. We ask for the information
on this form to carry out the Internal Revenue laws of the United
States. You are required to give us the information. We need it
to ensure that you are complying with these laws and to allow
us to figure and collect the right amount of tax.
You are not required to provide the information requested on
a form that is subject to the Paperwork Reduction Act unless
the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as
long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
Internal Revenue Code section 6103.
The average time and expenses required to complete and file
this form will vary depending on individual circumstances. For
the estimated averages, see the instructions for your income tax
return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for your
income tax return.

Page 4

Form 8914 (2009)

Table 1

Table 2

The counties listed in Table 1 below are Midwestern disaster
areas. You may be eligible for the additional $500 exemption for
housing a Midwestern displaced individual if that individual had
his or her main home in one of the counties listed in this table
on an applicable disaster date shown for that county and was
displaced from that home.

The counties listed in Table 2 below are Midwestern disaster
areas. You may be eligible for the additional $500 exemption for
housing a Midwestern displaced individual if that individual had
his or her main home in one of the counties listed in this table
on an applicable disaster date shown for that county and was
displaced from that home and either:
• That home was damaged by the storms, tornadoes, or
flooding that gave rise to the disaster declaration for that
county, or
• The individual was evacuated from that home because of the
storms, tornadoes, or flooding.

Applicable
Disaster Dates*

State

Affected Counties — Midwestern Disaster Areas

05/02/2008
through
05/12/2008

Arkansas

Arkansas, Benton, Cleburne, Conway, Crittenden,
Grant, Lonoke, Mississippi, Phillips, Pulaski,
Saline, and Van Buren

06/01/2008
through
07/22/2008

Illinois

Adams, Calhoun, Clark, Coles, Crawford,
Cumberland, Douglas, Edgar, Hancock,
Henderson, Jasper, Jersey, Lake, Lawrence,
Mercer, Rock Island, Whiteside, and Winnebago

05/30/2008
through
06/27/2008

Indiana

05/25/2008
through
08/13/2008

Iowa

Adams, Bartholomew, Brown, Clay, Daviess,
Dearborn, Decatur, Gibson, Grant, Greene,
Hamilton, Hancock, Hendricks, Henry, Huntington,
Jackson, Jefferson, Jennings, Johnson, Knox,
Lawrence, Madison, Marion, Monroe, Morgan,
Owen, Parke, Pike, Posey, Putnam, Randolph,
Ripley, Rush, Shelby, Sullivan, Tippecanoe,
Vermillion, Vigo, Washington, and Wayne
Adair, Adams, Allamakee, Appanoose, Audubon,
Benton, Black Hawk, Boone, Bremer, Buchanan,
Butler, Cass, Cedar, Cerro Gordo, Chickasaw,
Clarke, Clayton, Clinton, Crawford, Dallas, Davis,
Decatur, Delaware, Des Moines, Dubuque,
Fayette, Floyd, Franklin, Fremont, Greene,
Grundy, Guthrie, Hamilton, Hancock, Hardin,
Harrison, Henry, Howard, Humboldt, Iowa,
Jackson, Jasper, Johnson, Jones, Keokuk,
Kossuth, Lee, Linn, Louisa, Lucas, Madison,
Mahaska, Marion, Marshall, Mills, Mitchell,
Monona, Monroe, Montgomery, Muscatine, Page,
Polk, Pottawattamie, Poweshiek, Ringgold, Scott,
Story, Tama, Union, Van Buren, Wapello, Warren,
Washington, Webster, Winnebago, Winneshiek,
Worth, and Wright

05/10/2008
through
05/11/2008

Missouri

06/01/2008
through
08/13/2008

Missouri

Adair, Andrew, Callaway, Cass, Chariton, Clark,
Gentry, Greene, Harrison, Holt, Johnson, Lewis,
Lincoln, Linn, Livingston, Macon, Marion, Monroe,
Nodaway, Pike, Putnam, Ralls, St. Charles, Stone,
Taney, Vernon, and Webster

05/22/2008
through
06/24/2008

Nebraska

Buffalo, Butler, Colfax, Custer, Dawson, Douglas,
Gage, Hamilton, Holt, Jefferson, Kearney,
Lancaster, Platte, Richardson, Sarpy, and
Saunders

06/05/2008
through
07/25/2008

Wisconsin

Adams, Calumet, Columbia, Crawford, Dane,
Dodge, Fond du Lac, Grant, Green, Green Lake,
Iowa, Jefferson, Juneau, Kenosha, La Crosse,
Manitowoc, Marquette, Milwaukee, Monroe,
Ozaukee, Racine, Richland, Rock, Sauk,
Sheboygan, Vernon, Walworth, Washington,
Waukesha, and Winnebago

Applicable
Disaster Dates*

State

Affected Counties — Midwestern Disaster Areas

06/01/2008
through
07/22/2008

Illinois

Greene, Madison, Monroe, Pike, Randolph,
St. Clair, and Scott

05/30/2008
through
06/27/2008

Indiana

Benton, Boone, Fountain, Franklin, Jay,
Montgomery, Ohio, Switzerland, Union, and
Wabash

05/25/2008
through
08/13/2008

Iowa

Carroll, Cherokee, Lyon, Palo Alto, Pocahontas,
Taylor, and Wayne

05/22/2008
through
06/16/2008

Kansas

Barber, Barton, Bourbon, Brown, Butler,
Chautauqua, Cherokee, Clark, Clay, Comanche,
Cowley, Crawford, Decatur, Dickinson, Edwards,
Elk, Ellis, Ellsworth, Franklin, Gove, Graham,
Harper, Haskell, Hodgeman, Jackson, Jewell,
Kingman, Kiowa, Lane, Linn, Logan, Mitchell,
Montgomery, Ness, Norton, Osborne, Pawnee,
Phillips, Pratt, Reno, Republic, Riley, Rooks,
Rush, Saline, Seward, Sheridan, Smith, Stafford,
Sumner, Thomas, Trego, Wallace, and Wilson

06/06/2008
through
06/13/2008

Michigan

Allegan, Barry, Eaton, Ingham, Lake, Manistee,
Mason, Missaukee, Osceola, Ottawa, Saginaw, and
Wexford

06/06/2008
through
06/12/2008

Minnesota

Cook, Fillmore, Freeborn, Houston, Mower, and
Nobles

06/01/2008
through
08/13/2008

Missouri

Atchison, Audrain, Bates, Buchanan, Cape
Girardeau, Carroll, Christian, Daviess, Grundy,
Howard, Jefferson, Knox, Mercer, Miller,
Mississippi, Morgan, New Madrid, Pemiscot,
Perry, Pettis, Platte, Polk, Randolph, Ray, Saline,
Schuyler, Scotland, Shelby, St. Genevieve,
St. Louis, the Independent City of St. Louis,
Scott, Sullivan, and Worth

04/23/2008
through
04/26/2008

Nebraska

Gage, Johnson, Morrill, Nemaha, and Pawnee

05/22/2008
through
06/24/2008

Nebraska

Adams, Blaine, Boone, Boyd, Brown, Burt, Cass,
Chase, Cherry, Cuming, Dundy, Fillmore, Frontier,
Furnas, Garfield, Gosper, Greeley, Hall, Hayes,
Howard, Johnson, Keya Paha, Lincoln, Logan,
Loup, Merrick, McPherson, Morrill, Nance,
Nemaha, Otoe, Phelps, Polk, Red Willow, Rock,
Saline, Seward, Sherman, Stanton, Thayer,
Thomas, Thurston, Valley, Webster, Wheeler, and
York

06/27/2008

Nebraska

Dodge, Douglas, Sarpy, and Saunders

06/05/2008
through
07/25/2008

Wisconsin

Lafayette

Barry, Jasper, and Newton

* For more details, go to www.fema.gov.

* For more details, go to www.fema.gov.