Form Ptr-1a - Homeowners Verification Of 2001 And 2002 Property Taxes
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1Homeowners
Form PTR-1A
Verification of 2001 and 2002 Property Taxes
(see instructions on back)
Part I — To Be Completed By Applicant
(Part II to be completed by tax collector)
–
–
–
–
Social Security Number
Spouse’s Social Security Number
Name
Last Name, First Name and Initial (Joint filers enter first name and initial of each - Enter spouse’s last name ONLY if different)
Address
Street
City
State
Zip Code
Block
Lot
Qualifier
2001
2002
A. Did you own your principal residence with someone who was not your spouse?
Yes
No
Yes
No
B. If yes, indicate the share (percentage) of the property that you (and your spouse) owned.
%
%
C. Does your principal residence have more than one dwelling unit?
Yes
No
Yes
No
D. If yes, indicate the share (percentage) of the property used as your principal residence.
%
%
Part II — To Be Completed By Tax Collector
2001 Property Taxes
2002 Property Taxes
1. Total Amount Levied by Municipality
1. Total Amount Levied by Municipality
(before Senior Citizen’s and Veteran’s
(before Senior Citizen’s and Veteran’s
Deductions are subtracted) .................... $
Deductions are subtracted)..................... $
2. Total Amount Paid
2. Total Amount Paid
by Homeowner(s) ........... $
by Homeowner(s) ........... $
3. Senior Citizen’s
3. Senior Citizen’s
Deduction......................... $
Deduction......................... $
4. Veteran’s
4. Veteran’s
Deduction ....................... $
Deduction........................ $
5. Total Credits
5. Total Credits
(Add Lines 2, 3, and 4) ........................... $
(Add Lines 2, 3, and 4) ........................... $
6. Amount for Line 14, Form PTR-1
6. Amount for Line 13, Form PTR-1
(Enter amount from Line 5 above. If
(Enter amount from Line 5 above. If
applicant answered “Yes” to Questions
applicant answered “Yes” to Questions
A or C above, see instructions on back.) $
A or C above, see instructions on back.) $
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 and paid for calendar years
2001 and 2002 are true and accurate to the best of my knowledge. I have placed my stamp below for verification.
__________________________________________
(Name)
__________________________________________
(Title)
(If you complete this form, be sure to enclose it with your Form PTR-1 application)
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