Supplemental Property Tax Rebate Claim Form - State College Area (Page 2 of 2) in pdf

Supplemental Property Tax Rebate Claim Form - State College Area Page 2

SUPPLEMENTAL PROPERTY TAX REBATE CLAIM FORM

STATE COLLEGE AREA SCHOOL DISTRICT

For 2014-15 State College Area School District Property Tax

Bills Issued July 2014

FILING INSTRUCTIONS

1. Complete PART A – Personal Information

2. Complete PART B – Property Tax Rebate Information from Form PA-1000

3. Assemble required documentation listed in Part C

4. Mail completed claim form and required documentation to

State College Area School District

Supplemental Property Tax Program

131 West Nittany Ave.

State College, PA 16801

NOTE – must be filed after July 1, 2015, but before June 30, 2016.

Three items are required for SCASD to process your claim:

1. This completed form

2. A copy of the PA-1000 for 2014

3. Proof of receipt of the Pennsylvania Property Tax Rebate

PART A – Personal Information

(a-1) Name of Claimant:

(a-2) Address of Claimant:

(a-3) Tax Parcel Number :

(a-4) Total property taxes paid to School District for 2014-15:

(a-5) Birth date of Claimant:

(a-6) Social Security Number of Claimant:

PART B – Property Tax Rebate from the Commonwealth of Pennsylvania

(b-1) Insert amount from Line 12 on Form PA-1000-2014 (Property Tax or Rent Rebate Claim)

(b-2) Insert amount from Line 14 on Form PA-1000-2014 (Property Tax or Rent Rebate Claim)

PART C – Required Documentation

(a) Copy of Form PA-1000-2014 (Property Tax or Rent Rebate Claim) filed with the PA Department of Revenue

(b) Evidence of receipt of amount set forth in Part B

I declare that this form is true, correct and complete, that the documents required and

attached hereto are true and correct copies of those documents, and that to the best of my

knowledge and belief this is the only claim filed by members of my household.

____________________________________

______________________________________

Claimant’s Signature

Signature of Preparer (if other than Claimant)

________/_______/_________

______________________________________

Date

Telephone Number

Note: claim forms will be processed on a first-come, first-served basis until June 30, 2016, or until

$200,000 of eligible rebates have been paid.

Supplemental Property Tax Rebate Claim Form - State College Area Page 2

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