Form 8914

Department of the Treasury

Internal Revenue Service

Exemption Amount for Taxpayers Housing

Individuals Displaced by Hurricane Katrina

 Attach to Form 1040, Form 1040A, or Form 1040NR

OMB No. 1545-0074

Attachment

Sequence No. 55

Name(s) shown on your return Your social security number

Cat. No. 37724X Form 8914 (2005)

Part I

Part II

Information on Individuals Displaced by Hurricane Katrina for Whom You Provided Housing in Your

Main Home for at Least 60 Consecutive Days

Do not enter information for more than four individuals or for anyone included on line 6d of Form 1040 or 1040A

(line 7d of Form 1040NR).

1 (a) First and last name (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

2

3

4

5

6

7

8

9

10

11

Multiply $500 by the total number of individuals listed in Part I above. Do not enter more than

$2,000 ($1,000 if married filing separately)

Multiply $3,200 by the total number of exemptions claimed on line 6d of Form 1040 or 

Form 1040A (line 7d of Form 1040NR)

Add lines 2 and 3

Is the amount on Form 1040, line 38 (Form 1040A, line 22; or 

Form 1040NR, line 36), more than the amount shown on line 6 below

for your filing status?

No. Enter the amount from line 4 above on Form 1040,

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

STOP

Yes. Enter on line 5 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—$145,950

● Married filing jointly or Qualifying widow(er)—$218,950

● Married filing separately—$109,475

● Head of household—$182,450 

Subtract line 6 from line 5. Is the result more than $122,500 ($61,250

if married filing separately)?

Yes. Enter the amount from line 2 above on Form 1040,

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

STOP

No. Continue.

Divide line 7 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 example, increase 0.0004 to 1)

Multiply line 8 by 2% (.02) and enter the result as a decimal rounded

to at least three places

Multiply line 3 by line 9

Exemption amount. Subtract line 10 from line 4. Enter the result here and on Form 1040, line

42; Form 1040A, line 26; or Form 1040NR, line 39

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2005

.

For Paperwork Reduction Act Notice, see back of form.
Form 8914 (2005) Page 2

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 individuals displaced by Hurricane Katrina.

You can claim an additional exemption amount of $500 for

each displaced individual (defined below). The additional

exemption amount is allowable once for a specific individual.

The maximum additional exemption amount you can claim

for all displaced individuals is $2,000 ($1,000 if married filing

separately). The additional exemption amount you claim for

displaced individuals in 2005 will reduce the $2,000

maximum for 2006. 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. If married filing separately, only one spouse may

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).

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.

Additional Exemption Amount

Displaced Individual

For you to claim the additional exemption amount, a

displaced individual:

● Must have had his or her main home in the Hurricane

Katrina disaster area (for this purpose, the states of Alabama,

Florida, Louisiana, and Mississippi) on August 28, 2005, and

he or she must have been displaced from that home. If the

individual’s main home was located outside the core disaster

area (defined below), that home must have been damaged by

Hurricane Katrina or the individual must have been evacuated

from that home because of Hurricane Katrina.

● Must have been provided housing in your main home free

of charge for a period of at least 60 consecutive days ending

in the tax year in which the exemption is claimed. See

Compensation for Housing on this page.

● Cannot be your spouse or dependent.

Core Disaster Area

The following areas in three states are within the core

disaster area.

Alabama. The counties of Baldwin, Choctaw, Clarke,

Greene, Hale, Marengo, Mobile, Pickens, Sumter,

Tuscaloosa, and Washington.

Louisiana. The parishes of Acadia, Ascension,

Assumption, Calcasieu, Cameron, East Baton Rouge, East

Feliciana, Iberia, Iberville, Jefferson, Jefferson Davis,

Lafayette, Lafourche, Livingston, Orleans, Pointe Coupee,

Plaquemines, St. Bernard, St. Charles, St. Helena, St. James,

St. John, St. Mary, St. Martin, St. Tammany, Tangipahoa,

Terrebonne, Vermilion, Washington, West Baton Rouge, and

West Feliciana.

Mississippi. The counties of Adams, Amite, Attala,

Claiborne, Choctaw, Clarke, Copiah, Covington, Franklin,

Forrest, George, Greene, Hancock, Harrison, Hinds, Jackson,

Jasper, Jefferson, Jefferson Davis, Jones, Kemper, Lamar,

Lauderdale, Lawrence, Leake, Lincoln, Lowndes, Madison,

Marion, Neshoba, Newton, Noxubee, Oktibbeha, Pearl River,

Perry, Pike, Rankin, Scott, Simpson, Smith, Stone, Walthall,

Warren, Wayne, Wilkinson, Winston, and Yazoo.

● 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 individuals

displaced by Hurricane Katrina who were provided housing in

your main home for at least 60 consecutive days during

2005. If less than 60 consecutive days, you cannot claim an

additional exemption amount for this individual.

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 may 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 August 28, 2005. That home

must have been located in the Hurricane Katrina 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.

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.