Maine Residents Property Tax And Rent Refund Application Form

Tax and Rent Refund Application

(page 2)

*0803701*

This application must be ﬁ led no later than June 1, 2009

6. ANNUAL HOUSEHOLD INCOME FOR 2007 (Total amount for Applicant, Spouse, and Dependents)

a. Maine adjusted gross income (total for all household members. See instructions) ........... 6a. $

Note: If no member of the household ﬁ led a 2007 Maine income tax return, leave

this line blank and go to line 6c.

b. Loss Add-Back (see instructions on page 7) ................................................................... 6b. $

c. Additional income not included on line 6a above (See instructions on pages 7 through 9)

(1) Salaries, Wages ................................................................................. _____________

(2) Dividends, Interest - all sources ......................................................... _____________

(3) Social Security, Railroad Retirement, Annuities, Pensions,

Veterans Compensation, ROTH IRAs................................................ _____________

(4) Pension Income Deduction claimed on your Maine income tax return ... _____________

(5) Deferred Compensation and Employee Contributions to Pension,

Annuity or Retirement Plans .............................................................. _____________

(6) Cash Public Assistance, TANF .......................................................... _____________

(7) Child Support Payments .................................................................... _____________

(8) State Supplemental Income (This is not social security income) ..... _____________

(9) Any other income (see pages 8 and 9 for types of income to list) ..... _____________

Add lines (1) through (9) above ...................................................................................... 6c. $

d. Add lines 6a, 6b and 6c ..................................................................................................... 6d. $

e. Rollovers of IRA, Pension, or Annuities and Property Tax Program Refunds only if included

on line 6a above. (See instructions on page 9 before entering an amount on this line.) .. 6e. $

f. Total household income (subtract line 6e from line 6d) ..................................................... 6f. $

7. Direct Deposit Information — If you want your refund sent directly to your bank account, see instructions on page 9 and ﬁ ll in

the blocks below.

7a. Routing

7b. Account

7c. Type of

Checking

Number:

Account:

Savings

8. Third Party Designee (see instructions on page 9): Do you want to

allow another person to discuss this return with Maine Revenue Services? ........

Yes (complete the following).

No.

Designee’s

Phone

5-digit Personal identiﬁ cation

name: ______________________________________ number: _________________________ number:

Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief, it is true, correct,

and complete. Applications may be audited either before or after refunds are issued. Refunds may be applied to other outstanding

government debts you may owe.

Signature of Applicant

Date

Signature of Preparer other than Applicant

Date

If you I-File your application, you will receive a 9-digit conﬁ rmation number after you have successfully completed the application process.

You must write this number below and keep this application for your records. It is proof that you ﬁ led an application.

CONFIRMATION NUMBER:

NOTE: If you do not I-ﬁ le, leave this information blank and mail this application to Maine Revenue Services in the envelope provided.

Mail your application in the envelope provided.

Maine Revenue Services, PO Box 9116, Augusta, ME 04332-9116

Ofﬁ ce Use only:

Maine Residents Property Tax And Rent Refund Application Form - 2008 Page 2

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