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City of Lincoln
Low and Moderate Income Areas

Low Income, Owner-Occupied Exemption Refund Forms


Low Income, Owner-Occupied Exemption Refund Forms

Process Overview

Acrobat (PDF) Version of Process Overview (85 K) Acrobat Document

Filling Out Forms

Forms A, B, C and D are in Adobe Acrobat (PDF) Acrobat Document format. To fill out forms, please tab to each field, type contents and print form when complete.

Mail Completed Form To:

Public Works and Utilities Department
c/o Impact Fees Administrator
555 South 10th Street, Suite 203
Lincoln, Ne 68508-3994

Form What Do I Need? Who Completes This Form?
 Copy of Purchase Contract on House Builder
 Copy of the Previous tax year 1040 tax returns, signed and dated, from household members OR Self-Employment Documentation.Your Records
(Homebuyer)
Form ACompleted Family Income Worksheet Signed Purchaser Statement.Homebuyer
Form BSigned Builder/Developer Statement.Builder
Form CDocumentation Checklist with Supporting Document(s) attached.Homebuyer
Form DImpact Fee Refund Household Income Worksheet (If you are not required to file federal income taxes, recent statements of income will be required from all income recipients, over the age of 19, living in the household to determine gross income using this worksheet.)Homebuyer
 If Self Employed: 
 1099 for commissions for past 2 yearsYour Records
 1065 & K-1 tax returnsYour Records
 1120 tax formsYour Records
Validate

Low and Moderate Income Areas