Form Pa-1000 - Instructions For Completing Your Claim Form - Property Tax Or Rent Rebate Program Page 4
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4GENERAL INSTRUCTIONS
Line 15. The result is your 1999 Rent Rebate. Enter this amount on
grants the Department of Revenue the authority to access the
Line 16 of your claim form. The Department will not pay a rebate for
claimant’s PA Personal Income Tax records to verify the truth, accu-
less than $10. The maximum rebate is $500.
racy, and completeness of information reported in the claim. If
someone other than the claimant signs the claim form, a copy of the
Power of Attorney, guardianship papers or other documents entitling
FOR OWNER-RENTERS ONLY
that person to sign must accompany the claim form. If the claimant
makes a mark instead of a signature, two people must sign the form as
If you were both a property owner and a renter in 1999, you must
witnesses to the claimant’s mark.
calculate your Property Tax Rebate separately from your Rent
Rebate. Complete Lines 11 through 13 to calculate your Property
Please provide the name, address, and telephone number of the
Tax Rebate. Complete Lines 14 through 16 to calculate your Rent
claimant’s nearest relative. This helps the Department locate
Rebate.
claimants if the Post Office returns a rebate check as undeliverable.
Line 17. Add Lines 13 and 16. The result is your 1999 Property
Tax/Rent Rebate. Enter this amount on Line 17 of your claim form.
MAILING INSTRUCTIONS
The Department will not pay a rebate for less than $10. The maxi-
Please mail your completed claim form and other necessary docu-
mum rebate is $500.
ments in the envelope provided for your convenience. If you do not
have a preaddressed envelope, mail the form to:
IMPORTANT:
Mailing of the 1999 rebate checks will begin July 1, 2000, as spec-
PA DEPARTMENT OF REVENUE
ified by law. Please withhold inquiries on your Property Tax or Rent
PROPERTY TAX OR RENT REBATE PROGRAM
Rebate check until August 2000.
DEPT 280503
HARRISBURG PA 17128-0503
PART D: OATH AND SIGNATURES
Please read the oath. Sign and date the claim form in the space
If you need further help or information, please contact the Department
provided.
of Revenue district office nearest you. See page 11 for the list of Rev-
The signature(s) must match the name(s) listed on the label or print-
enue district offices. You must file your claim form by July 1, 2000,
unless the Department of Revenue officially extends the filing date.
ed on the name line. Submission of the signed and dated claim form
REBATE PERCENTAGE TABLES
TABLE A - OWNERS ONLY
TABLE B - RENTERS ONLY
TOTAL INCOME
Your
TOTAL INCOME
Your
From Line 10 of your claim form
percentage
From Line 10 of your claim form
percentage
factor is:
factor is:
0
to
$ 5,499
1.00
0
to
$ 5,499
.20
$5,500
to
$ 5,999
.90
$5,500
to
$ 5,999
.18
$6,000
to
$ 6,499
.80
$6,000
to
$ 6,499
.16
$6,500
to
$ 6,999
.70
$6,500
to
$ 6,999
.14
$7,000
to
$ 7,499
.60
$7,000
to
$ 7,499
.12
$7,500
to
$ 7,999
.50
$7,500
to
$ 7,999
.10
$8,000
to
$ 8,499
.40
$8,000
to
$ 8,499
.08
$8,500
to
$ 8,999
.35
$8,500
to
$ 8,999
.07
$9,000
to
$ 9,999
.25
$9,000
to
$ 9,999
.05
$10,000
to
$11,999
.20
$10,000
to
$11,999
.04
$12,000
to
$12,999
.15
$12,000
to
$12,999
.03
$13,000
to
$15,000
.10
$13,000
to
$15,000
.02
$15,001
or over
$15,001
or over
NOT ELIGIBLE
NOT ELIGIBLE
Please Note:
THE MAXIMUM REBATE EACH HOUSEHOLD CAN RECEIVE IS $500
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