Fillable Form Ptr-1 - Property Tax Reimbursement Application

Income Worksheet A

Income Worksheet B

2006 Total Income

2007 Total Income

If you were married as of December 31, 2006, you must combine

If you were married or in a civil union as of December 31, 2007,

your income with your spouse’s income.

you must combine your income with your spouse’s/CU partner’s

income.

a. Social Security Benefits . . . . . . . . . ____________________

(including Medicare Part B premiums)

b. Total Pension Income . . . . . . . . . . . ____________________

(including IRA and annuity income)

c. Salaries and Wages . . . . . . . . . . . . ____________________

d. Bonuses, Commissions & Fees . . . ____________________

e. Unemployment Benefits . . . . . . . . . ____________________

f. Disability Benefits (including

veterans’ and black lung benefits) . ____________________

g. Interest (taxable & exempt) . . . . . . ____________________

h. Dividends . . . . . . . . . . . . . . . . . . . . ____________________

i. Net Capital Gains . . . . . . . . . . . . . . ____________________

j. Net Rental Income . . . . . . . . . . . . . ____________________

k. Net Business Income . . . . . . . . . . . ____________________

l. Support Payments . . . . . . . . . . . . . ____________________

m. Inheritances . . . . . . . . . . . . . . . . . . ____________________

n. Royalties . . . . . . . . . . . . . . . . . . . . . ____________________

o. Gambling & Lottery Winnings . . . . . ____________________

(including New Jersey)

p. Bequests and Death Benefits . . . . . ____________________

q. All Other Income . . . . . . . . . . . . . . . ____________________

r. TOTAL . . . . . . . . . . . . . . . . . . . . . . . ____________________

Was your total 2006 income less than $43,693 if you were single,

Was your total 2007 income less than $45,135 if you were single,

OR less than $53,576 (combined income) if you were married?

OR less than $55,344 (combined income) if you were married or in

a civil union?

Yes. Enter the total amount on Line 7 and continue with

Yes. Enter the total amount on Line 8 and continue

Income Worksheet B.

completing the application.

No. STOP. You are not eligible for a property tax

reimbursement.

Note: Civil union couple status applies only for tax years

beginning on or after January 1, 2007. It does not apply

for tax year 2006.

Proof of Age or Disability for 2006 and 2007 Must Be Submitted With Application

Age 65 or Older. If you (or your spouse/CU partner) indicated at Line 4a and/or 4b that you were 65 or older, you must submit proof of

age with your application. Examples of acceptable documentation include copies of the following:

Birth Certificate

Driver’s License

Church Records

Receiving Federal Social Security Disability Benefits. If you (or your spouse/CU partner) were under 65 and indicated at Lines 4a

and/or 4b that you (or your spouse/CU partner) were receiving Federal Social Security Disability Benefits, you must submit with your

application a copy of the Social Security Award Letter indicating that you (or your spouse/CU partner) were receiving benefits for that

year(s) based on your own social security number.

PTR-1 WORKSHEET

Form Ptr-1 - Property Tax Reimbursement Application - 2007 Page 2

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