Form Ptr-1 - Property Tax Reimbursement Application

WORKSHEET A

WORKSHEET B

1998 TOTAL INCOME

1999 TOTAL INCOME

If you were married as of 12/31/98, you must combine your

Only complete Worksheet B if you answered “Yes” on Line 4 and

income with your spouse’s income.

checked the box. If you were married as of 12/31/99, you must

combine your income with your spouse’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. Interest (taxable & exempt) . . . . . __________________

g. Dividends . . . . . . . . . . . . . . . . . . __________________

h. Capital Gains . . . . . . . . . . . . . . . __________________

i. Net Rental Income . . . . . . . . . . . __________________

j. Net Business Income . . . . . . . . . __________________

k. Support Payments . . . . . . . . . . . . __________________

l. Inheritances . . . . . . . . . . . . . . . . __________________

m. Royalties . . . . . . . . . . . . . . . . . . __________________

n. Gambling & Lottery Winnings . . __________________

(including New Jersey)

o. All Other Income . . . . . . . . . . . . __________________

o. All Other Income . . . . . . . . . . . . _________________

p. TOTAL . . . . . . . . . . . . . . . . . . . . __________________

If you were SINGLE, and

Your total 1998 income was less than $17,918, enter the total

Your total 1999 income was less than $18,151, enter the total

amount on Line 2 and continue completing the application.

amount on Line 5 and continue completing the application.

Your total 1998 income was $17,918 or more, you are not eligible

Your total 1999 income was $18,151 or more, you are not eligible

for the reimbursement and you should not file this application.

If you were MARRIED, and

Your total 1998 income was less than $21,970, enter the total

Your total 1999 income was less than $22,256, enter the total

amount on Line 2 and continue completing the application.

amount on Line 5 and continue completing the application.

Your total 1998 income was $21,970 or more, you are not eligible

Your total 1999 income was $22,256 or more, you are not eligible

for the reimbursement and you should not file this application.

PTR-1 WORKSHEET

Form Ptr-1 - Property Tax Reimbursement Application - 1999 Page 2

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