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Fill Out Your Wisconsin Rent Certificate Template

The Wisconsin Rent Certificate form is a document used by renters to report their rental payments for tax purposes, specifically when filing for homestead credit. This form must be completed by both the renter and the landlord, ensuring accurate reporting of rental amounts and occupancy details. Proper completion is essential, as any alterations or errors can invalidate the certificate.

Fill Out Your Wisconsin Rent Certificate Online

Fill Out Your Wisconsin Rent Certificate Template

Structure

The Wisconsin Rent Certificate form plays a crucial role in the state's tax system, particularly for renters seeking homestead credits. To properly utilize this form, renters must ensure that it is completed alongside Schedule H or H-EZ, which are essential for claiming these credits. It is important to note that any alterations or errors on the form can render it invalid, emphasizing the need for accuracy. Renters begin by providing their personal information, including their Social Security number, and the address of the rental property, which must be located in Wisconsin. The form requires the landlord's signature, confirming the details of the rental agreement, including the total rent collected for the year and any shared living expenses. Specific questions on the form determine whether the rental property is subject to property taxes or if it falls under particular categories, such as long-term care facilities. Furthermore, renters must report the number of occupants in the unit and the value of any food or services provided by the landlord. Completing the Rent Certificate accurately is essential, as it directly impacts the eligibility for tax credits and the overall rental experience.

Form Example

CAUTION:

Schedule H or H-EZ must be completed and filed with this rent certificate

A 2022 Schedule H or H-EZ may not be filed prior to January 1, 2023

Rent Certificate	2022
Wisconsin Department of Revenue

NOTE: • Attach to Schedule H or H-EZ

•Alterations (whiteouts, erasures, etc.) or errors void this rent certificate.

•Only attach rent certificate if filing a homestead credit claim

Renter (Claimant) – Enter Social Security Number AFTER your landlord fills in section below and signs.

Legal last name

Legal first name

M.I.

Social security number

Address of rental property (property must be in Wisconsin)

City

State Zip

Time you actually lived at this address in 2022 From

2022

M M

D D

M M D D

Do NOT sign your rent certificate.

If your landlord won’t sign, complete fields above and below and lines 1 to 8, attach rent verification (see instructions), and check here.

Landlord or Authorized Representative

Name of property owner

Telephone number

		(	)

Address	City	State	Zip

1	Is the rental property a long-term care facility, CBRF, or nursing home?	1
2a	Is the above rental property subject to property taxes?	2a

bIf 2a is “No” and you are a sec. 66.1201 municipal housing authority

that makes payments in lieu of taxes, check here . . . . . . . . . . . . . . . . . 2b

3 Is this certificate for rent of a mobile/manufactured: a Home?	3a
b Home site/Lot?	3b

Yes Yes

No No

c	Mobile or manufactured home taxes or municipal permit fees
	you collected from this renter for 2022	3c	.00
4a	Total rent collected for this rental unit for 2022 - do NOT include amounts received directly from a gov-
	ernmental agency, Wisconsin rental assistance program payments, security deposits, or late fees	4a	.00
b	If monthly rent paid didn’t change during 2022, enter monthly rent paid	4b	.00

cIf monthly rent changed during 2022, enter rent paid for each month below. Do not include security deposits or late fees.

Jan.	.00	Feb.	.00	Mar.	.00	Apr.	.00
May	.00	June	.00	July	.00	Aug.	.00
Sept.	.00	Oct.	.00	Nov.	.00	Dec.	.00
5a Number of occupants in this rental unit – do NOT count spouse or children under 18							. . .	. . . . . . . 5a

bRenters, if line 5a is more than 1, did each occupant pay an equal share of living

	expenses? (if no, complete shared living expenses schedule on page 2)	5b			Yes			No
6	This renter’s share of total 2022 rent	. . . .	6					.00
7	Value of food and services provided by landlord (this renter’s share) . . .	. . . .	7					.00
8a	Rent paid for occupancy only – Subtract line 7 from line 6	. . . .		. . .	. . . . . .	8a	.00
b Was heat included in the rent?		8b			Yes			No

I certify that the information shown on this rent certificate is true, correct, and complete to the best of my knowledge.

Signature (by hand) of landlord or authorized representative

Date

Print name (must match signature)

I-017i

2022 Rent Certificate	Renter’s	Renter’s
2022 Rent Certificate	name	SSN
	Address of rental property

Page 2 of 2

Shared Living Expenses Schedule – To be completed by renter only if line 5b on page one is “No.”

Step 1: List name(s) of other occupants:	Step 3: Using the amounts listed in Step 2, compute your allowable
	rent paid for occupancy only:

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:

Shared Living	Total Paid by			Amount
Expenses	All Occupants			You Paid

Rent	1a)	.00	1b)	.00
Food	2a)	.00	2b)	.00
Utilities	3a)	.00	3b)	.00
Other	4a)	.00	4b)	.00
Total	5a)	.00	5b)	.00

1 Total rent paid (line 1a)

.00

2Shared living expenses

	you paid (line 5b)	2	.00
3	Total shared living		.00
	expenses (line 5a)	3	.00
4	Divide line 2 by line 3. Fill
	in decimal amount	. . .	. . . . . . . . . 4 .

5	Multiply line 1 by line 4 . . .	. . .	. . . . . . . . . 5	.00

6Value of food and services provided by

landlord (line 7 of page 1)

.00

7Subtract line 6 from line 5. This is your allowable rent. Fill in here and on the applicable rent line of Schedule H or

Schedule H-EZ

.00

Instructions for Renter (Claimant)

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

If your landlord won’t sign, place a checkmark in the designated area. 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 veri- fied will not be allowed.

Note: Do NOT sign the rent certificate yourself. Rent certifi- cates signed by you or someone other than the landlord or his/ her authorized representative will not be accepted.

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 above Shared Living Expenses Schedule – see instructions below) on Schedule H or H-EZ, as appropriate.

Renter Instructions for Shared Living Expenses Schedule

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.

Instructions for Landlord/Authorized Representative

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

Line 4a Fill in the total rent collected from all occupants for this unit for the time occupied by this renter in 2022. 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).

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, 2022.

Line 5b Do not complete this line. This will be completed by the renter.

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.

Signature Review the rent certificate to be sure that all applicable fields and lines have an entry. Sign (by hand) and date, print your name, and return the rent certificate to the renter. Only an original signature is acceptable.

Applicable Laws and Rules

This document provides statements or interpretations of the following laws and regulations in effect as of July 27, 2022: ch. 71, Wis. Stats.

➤ PDF File

Document Specs

Fact Name	Details
Purpose	The Wisconsin Rent Certificate is used for claiming homestead credit by renters.
Governing Law	This form is governed by Chapter 71 of the Wisconsin Statutes.
Filing Requirement	It must be attached to Schedule H or H-EZ when filing for homestead credit.
Signature Requirement	The landlord or an authorized representative must sign the form for it to be valid.
Alterations	Any alterations, such as whiteouts or erasures, will void the rent certificate.
Social Security Number	The renter must enter their Social Security Number after the landlord completes their section.
Rental Property Location	The rental property must be located in Wisconsin to qualify for the certificate.
Rent Verification	Renters must provide verification of rent payments, such as canceled checks or bank money orders.
Occupant Count	Only adult occupants count towards the number reported on the form; spouses and children under 18 are excluded.
Shared Living Expenses	A separate schedule must be completed if multiple renters share living expenses and did not pay equally.

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