Form Ptr-2a - Homeowners Verification Of 2016 Property Taxes printable pdf download

Homeowners

Form PTR-2A

Verification of 2016 Property Taxes

(Use blue or black ink. See instructions for completion on back.)

Part I — To Be Completed by Applicant (Part II to be completed by tax collector)

Social Security #

–

Spouse’s/CU Partner’s Social Security #

–

Name

________________________________________________________________________________________

Last Name, First Name, and Initial (Joint filers, enter first name and initial of each - Enter spouse’s/CU partner’s last name ONLY if different)

Address ________________________________________________________________________________________

Street

City

State

Zip Code

Block

_____________________

Lot _________________________

Qualifier ________________________

A. Did you own this property with someone who was not your spouse/CU partner?

Yes

B. If yes, indicate the share (percentage) of the property that you (and your spouse/CU partner) owned.

C. Did this property consist of multiple units?

Yes

D. If yes, indicate the share (percentage) of the property used as your principal residence.

Part II — To Be Completed by Tax Collector

2016 Property Taxes

Check box if property had a tax appeal for 2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Check box if property had an added assessment for 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1. Assessed Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________

2. Tax Rate (including fire and other special tax rates). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________ %

3. Total Property Taxes (Multiply Line 1 by Line 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________

4. REAP Credit (if any) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ __________

5. Enter amount from Line 3. If applicant answered “Yes” to Questions A and/or C

above, you must apportion the amount on Line 3 when completing this line.

(See instructions on back.)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________

Homeowners, enter this amount on Line 9 of your Form PTR-2

Under the penalties of perjury, I certify that I am the local tax collector of __________________________________,

where the above property is located. I further certify that the above-stated amounts of property taxes due were paid

for calendar year 2016 and are true and accurate to the best of my knowledge. I have placed my stamp below for

verification.

(Name)

(Date)

(Title)

(If you complete this form, be sure to enclose it with your Form PTR-2 application.)

Form Ptr-2a - Homeowners Verification Of 2016 Property Taxes

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