Real Estate Tax Installment Plan Application - City Of Philadelphia - 2008

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MAKE NO MARKS IN THIS AREA
Filing Deadline: February 29, 2008
City of Philadelphia
7 1 0 8
Year 2008
Real Estate Tax
NEW APPLICANTS ONLY
Installment Plan Application
2007 Program Participants Do Not Need to File this Application
Primary Address
Real Estate Tax Account Number
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-
Print Applicant's Name
Applicant's Social Security Number
Payment Plan
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-
Low Income
Applicant's Birth Date
(Choose up to 8 payments)
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-
Low Income Senior Citizen
Print Spouse's Name
(Choose up to 20 payments)
Total Members of Household
Spouse's Social Security Number
(To determine eligibility,
compare total income to
-
-
members of household
per chart on reverse.)
Spouse's Birth Date
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-
Household Income
1. Total 2006 Gross Social Security and Supplemental Security Income
,
. 0 0
(Medicare premiums must be included)..............................................................................................1.
2. Total 2006 Gross Pensions, Annuities, Veterans' & Railroad Retirement Benefits,
,
. 0 0
and taxable portion of Individual Retirement Accounts (IRAs).............................................................2.
3. Total 2006 Salary, Wages, Bonuses, Commissions, Income from Self-Employment
,
. 0 0
and Partnership Income (Do not subtract losses)...............................................................................3.
,
. 0 0
4. Total 2006 Interest, Dividends, Capital Gains, Prizes (Do not subtract losses)...................................4.
5. Total 2006 Net Rental Income and Net Business Income (Do not include rent you pay;
,
. 0 0
do not subtract rental or business losses from your total income).......................................................5.
6. Total 2006 Other Income (Cash Public Assistance, Unemployment and Workers'
Compensation, Alimony, Support Money, Gifts totaling more than $500, Life Insurance
,
. 0 0
Death Benefit Payments exceeding $10,000 per person)....................................................................6.
,
. 0 0
7. TOTAL HOUSEHOLD INCOME (Add Lines 1 through 6)...................................................................7.
Under penalties of perjury, as set forth in 18 PA C.S. §§ 4902-4903 as amended, I swear that I have reviewed this return
and accompanying statements and schedules, and to the best of my knowledge and belief, they are true and complete.
Taxpayer Signature________________________________________ Date_______________________Phone #_________________________
Preparer Signature_________________________________________ Date_______________________Phone #_________________________
MAIL TO: PHILADELPHIA DEPARTMENT OF REVENUE
P.O. BOX 53190
PHILADELPHIA, PA 19105
Rev 9-17-2007 15:42
QUESTIONS: 215-686-6442 E-MAIL revenue@phila.gov

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