Form Ptr-1 - Property Tax Reimbursement Application - 2001 Page 2
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2WORKSHEET A
WORKSHEET B
2000 TOTAL INCOME
2001 TOTAL INCOME
If you were married as of December 31, 2000, you must combine
Only complete Worksheet B if you answered “Yes” on Line 4 and
your income with your spouse’s income.
checked the box. If you were married as of December 31, 2001,
you must combine your income with your spouse’s income.
a. Social Security Benefits . . . . . . . __________________
a. Social Security Benefits . . . . . . . __________________
(including Medicare Part B premiums)
(including Medicare Part B premiums)
b. Total Pension Income . . . . . . . . . __________________
b. Total Pension Income . . . . . . . . . __________________
(including IRA and annuity income)
(including IRA and annuity income)
c. Salaries and Wages . . . . . . . . . . . __________________
c. Salaries and Wages . . . . . . . . . . . __________________
d. Bonuses, Commissions & Fees . . __________________
d. Bonuses, Commissions & Fees . . __________________
e. Unemployment Benefits . . . . . . . __________________
e. Unemployment Benefits . . . . . . . __________________
f. Interest (taxable & exempt) . . . . . __________________
f. Interest (taxable & exempt) . . . . . __________________
g. Dividends . . . . . . . . . . . . . . . . . . __________________
g. Dividends . . . . . . . . . . . . . . . . . . __________________
h. Net Capital Gains . . . . . . . . . . . . __________________
h. Net Capital Gains . . . . . . . . . . . . __________________
i. Net Rental Income . . . . . . . . . . . __________________
i. Net Rental Income . . . . . . . . . . . __________________
j. Net Business Income . . . . . . . . . __________________
j. Net Business Income . . . . . . . . . __________________
k. Support Payments . . . . . . . . . . . . __________________
k. Support Payments . . . . . . . . . . . . __________________
l. Inheritances . . . . . . . . . . . . . . . . __________________
l. Inheritances . . . . . . . . . . . . . . . . __________________
m. Royalties . . . . . . . . . . . . . . . . . . __________________
m. Royalties . . . . . . . . . . . . . . . . . . __________________
n. Gambling & Lottery Winnings . . __________________
n. Gambling & Lottery Winnings . . __________________
(including New Jersey)
(including New Jersey)
o. All Other Income . . . . . . . . . . . . __________________
o. All Other Income . . . . . . . . . . . . __________________
p. TOTAL . . . . . . . . . . . . . . . . . . . . __________________
p. TOTAL . . . . . . . . . . . . . . . . . . . . __________________
If you were SINGLE, and
If you were SINGLE, and
Ÿ Your total 2000 income was less than $37,174, enter the total
Ÿ Your total 2001 income was less than $38,475, enter the total
amount on Line 2 and continue completing the application.
amount on Line 5 and continue completing the application.
or
or
Ÿ Your total 2000 income was $37,174 or more, you are not eligible
Ÿ Your total 2001 income was $38,475 or more, you are not eligible
for the reimbursement and you should not file this application.
for the reimbursement and you should not file this application.
If you were MARRIED, and
If you were MARRIED, and
Ÿ Your total 2000 income was less than $45,582, enter the total
Ÿ Your total 2001 income was less than $47,177, enter the total
amount on Line 2 and continue completing the application.
amount on Line 5 and continue completing the application.
or
or
Ÿ Your total 2000 income was $45,582 or more, you are not eligible
Ÿ Your total 2001 income was $47,177 or more, you are not eligible
for the reimbursement and you should not file this application.
for the reimbursement and you should not file this application.
PTR-1 WORKSHEET
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