2010 Tax Rebate Application - Penn Manor School District
ADVERTISEMENT
1PROPERTY TAX REBATE CLAIM FORM
PENN MANOR SCHOOL DISTRICT
For 2011-2012 Penn Manor School District Property Taxes
Bills Issued July 1, 2010
FILING INSTRUCTIONS
1)
Complete PART A – Personal Information
2)
Complete PART B – Property Tax Rebate Information from Form PA-1000 2008
3)
Assemble required documentation listed in Part C
4)
Mail COMPLETED claim form AND required documentation to
Penn Manor School District
Tax Rebate Claims
P.O. Box 1001
Millersville, PA 17551
NOTE – must be filed after July 1, 2011, but before June 30, 2012
Three Items are required for PMSD to process your claim:
1.
This Form
2.
A copy of the PA-1000 for 2010
3.
Proof of receipt of the State Property Tax Rebate
PART A – Personal Information
(a-1) Name of Claimant:
(a-2) Address of Claimant:
(a-3) Tax Bill Number:
(a-4) Total property taxes paid to School District for 2010-2011:
(a-5) Birth date of Claimant:
(a-6) Social Security Number of Claimant:
PART B – Property Tax Rebate from the Commonwealth of Pennsylvania
(b-1) Insert amount from Line 12 on Form PA-1000-2010 (Property Tax or Rent Rebate Claim)
$
(b-2) Insert amount from Line 14 on Form PA-1000-2010 (Property Tax or Rent Rebate Claim)
$
PART C – Required Information
(a)
Copy of Form PA-1000-2010 (Property Tax or Rent Rebate Claim) filed with the PA Dept. of Revenue
(b)
Evidence of receipt of amount set forth in Part B
I declare that this form is true, correct and complete, that the documents required and attached
hereto are true and correct copies of those documents, and that to the best of my knowledge and
belief this is the only claim filed by members of my household.
________________________________________
__________________________________________
Claimant's Signature
Signature of Preparer (if other than Claimant)
_________________/___________/___________
__________________________________________
Date
Telephone Number
00441673.1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal