Ppb-8 - Application For Property Tax Assistance Program Form Montana
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1MONTANA
PPB-8
Application For
Rev. 11-07
Property Tax Assistance Program
As Provided By 15-6-134 and 15-6-191, MCA
County
This form, including all supporting documentation, must be returned to your local DOR Office or postmarked by March 15th or no
.
reduction will be allowed
You will receive a follow up letter that will indicate if your application has been approved or denied.
- For Office Use Only -
Geocode:
Name:
School District:
Mailing Address:
City, State Zip:
Assessment Code:
Legal Description of Property:
(I) / (We) own a mobile/manufactured home or home that may include land up to 5 acres, and occupied that same residence for at
least 7 months a year; my tax filing status is: (Check one)
single ($19,257);
married ($25,676); or
head of household* ($25,676); and my total income from last
year, including otherwise tax exempt income of all types, does not exceed the amount listed next to the filing status I have checked
above. (*If claiming head of household, you must complete the information at the bottom of the form)
Total Annual Income From All Sources
Please list your total annual income from all sources including otherwise tax-exempt income of all types for the calendar year
preceding the year of application.
$____________ Employment Income
Pension Income
$____________ Net Business Income Before
$____________
Railroad
Depreciation and/or Depletion
$____________
Teachers
(Copy of IRS Schedule C, E or F must be attached)
$____________
Employment
$____________ Net Rental Income Before
$____________
Veterans
Depreciation and/or Depletion
$____________
Any Other
(Copy of IRS Schedule E must be attached)
$____________
Aid to Dependent Children
$____________ Social Security
)
(Gross from Federal Form 1099
$____________
Maintenance (Alimony)
Do not include social security paid directly to a nursing
home or social security for dependent children.
$____________
Child Support
$____________
Interest Income
$____________ Disability Income
(From all sources
such as bank, checking and investment accounts)
$____________ Unemployment Benefits
$____________ Any Other Income
(Lottery, etc.)
Total Income $_________________
Under penalty of law, I affirm that the information provided in this form is true and correct.
Signature
Social Security Number
Name of Spouse
Social Security Number
Phone ________________________________ Date__________________________________
Head of Household Information
For Department Use Only
Disapproved
Head of household information (to be completed
Approved
by the applicant)
Codes:
Income
Class Codes
Name of Dependent
SSN
Single
M/H
%
Land
IMP
MOB
___________________
______________
___________________
______________
$
0 - $ 7,703
$
0 - $ 10,270
20
2132
3137
6237
___________________
______________
$ 7,704 - $ 11,811
$10,271 - $ 17,973
50
2135
3140
6240
___________________
______________
459
$ 11,812 - $ 19,257
$ 17,974 - $ 25,676
70
2137
3142
6242
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