Property Tax/rent/heat Rebate Booklet - 2012 (Page 8 of 8) in pdf

STATE OF COLORADO

PRSRT STD

Please Read All Instructions Before Completing The Forms.

DEPARTMENT OF REVENUE

Denver CO 80261-0005

U.S. POSTAGE

PAID

COLORADO DEPT

OF REVENUE

Do Not Mail Return Until After January 1st.

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 DR 4679 PTC “Affidavit — Restrictions on Public Benefits,” which is on the back of the

104PTC form in this booklet. Applicants must include on the 104PTC form a valid Colorado driver’s license number or

Colorado identification number, if available. On the 104PTC application, the following may be written in the boxes for driver’s

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 by clicking on PTC or by telephone by calling 303-238-7378. PTC applicants who do not

have a Colorado driver’s license or ID card number must include with their 104PTC form 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’s 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

(DR 4679 PTC) is completed and submitted.

Click on the PTC button at the top of the

page.

Forms and Information are Available at these Service Centers:

Colorado Springs

Grand Junction

2447 N. Union Blvd.

222 S. 6th Street, Room 208

Denver

1375 Sherman Street

Fort Collins

Pueblo

3030 S. College Ave.

827 W. 4th St., Suite A

Department of Revenue Telephone Numbers

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

Driver's 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.

104PTC Booklet Page 8