Form 104 Ptc - Colorado Property Tax/rent/heat Rebate Application - 2016 Page 12

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STATE OF COLORADO

PRSRT STD

DEPARTMENT OF REVENUE

Denver, CO 80261-0005

U.S. POSTAGE

PAID

COLORADO DEPT

OF REVENUE

Do Not Mail Return Until After January 1.

Evidence of Lawful Presence

The Colorado Property Tax/Rent/Heat (PTC) Rebate is a public benefit. Under Colorado law, individuals who are age 18

years or older and are applying for a public benefit must establish lawful presence in the United States. PTC applicants

must complete and sign the form “Affidavit — Restrictions on Public Benefits,” which is part of the Form 104PTC in this

booklet. Applicants must include on the Form 104PTC a valid Colorado driver license number or Colorado identification

number, if available. On the Form 104PTC application, the following may be written in the boxes for driver license/ID

number if the applicant does not have those forms of ID:

• “Military” — U.S. military card or military dependent’s ID card

• “Coast” — U.S. Coast Guard Merchant Mariner Card

• “Tribal” — Native American Tribal Document

• “Other” — Other forms of ID are accepted. See the information below.

• “Waiver” — In some circumstances an identification waiver may be obtained.

Applicants may obtain additional information regarding Accepted Forms of Identification and the Waiver Process

either online at or by phone by calling 303-238-7378. PTC applicants who do not have a

Colorado driver license or ID card number must include with their Form 104PTC a photo-quality color copy of any one

of the other accepted forms of identification. Documents that are business card size must be enlarged to 200% or twice

their original size. Valid driver licenses from other states will not be accepted because PTC applicants must be full-year

Colorado residents. Note: If you have already obtained a waiver from the identification requirements, you do not need to

obtain another waiver. The waiver is already on file with the Colorado Department of Revenue.

PTC applications will be denied until the required identification information is submitted and/or the affidavit is

completed and submitted.

Forms and Information are available at these Taxpayer Service Centers:

Colorado Springs

Grand Junction

2447 N. Union Blvd.

222 S. 6th St., Room 208

Denver

Fort Collins

1375 Sherman St.

Pueblo

3030 S. College Ave.

827 W. 4th St., Suite A

Department of Revenue Phone Numbers

Taxpayer Assistance .................................................................................................................303-238-SERV (7378)

Driver License/ID Card Info .................................................................................................................. 303-205-5600

TTY/TTD Service .................................................................................................................................. 800-659-2656

Have you applied for LEAP?

You may receive up to $700 in extra help with your heating bills through LEAP. You may also be

eligible to receive free home energy saving services like window caulking and attic insulation.

Please call toll free 1-866-HEAT-HELP for more information.