Form Ptr-1a - Homeowners Verification Of 1999 And 2000 Property Taxes For Property Tax Reimbursement Applicants

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FORM PTR-1A
Homeowners
Verification of 1999 and 2000 Property Taxes for
Property Tax Reimbursement Applicants
Social Security Number
–
–
Spouse’s Social Security Number
–
–
First Name
__________________________ Last Name _______________________________
Address
____________________________________________________________________
____________________________________________________________________
Block
_______________
Lot___________
Qualifier ___________________________
1999 Property Taxes*
2000 Property Taxes*
Total Amount Due
$ ___________
Total Amount Due
$ ___________
Total Amount Paid
$ ___________
Total Amount Paid
$ ___________
*
Enter the amount of property taxes actually due and paid before senior citizen’s
and/or veteran’s deductions (if applicable) were subtracted.
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 1999 and 2000 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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