Form Pa 1000 PDF Details

In the heart of Pennsylvania's approach to reducing the financial burden on its older and disabled residents lies the PA-1000 form, a critical document for accessing the Property Tax or Rent Rebate Program. This form facilitates claims for rebates on property taxes or rent paid by eligible Pennsylvanians, underscoring the state's commitment to supporting its vulnerable populations. The form, updated for the 2011 fiscal year, serves a wide demographic, including individuals aged 65 or older, those under 65 with a spouse who is 65 or older, widowers aged 50 to 64, and permanently disabled individuals aged 18 to 64. Importantly, it asks claimants to document their income sources meticulously, ranging from social security and pensions to wages and miscellaneous income, ensuring rebates are targeted to those in need. The inclusion of sections tailored specifically to property owners, renters, or those who are both, alongside detailed instructions for direct deposit of the rebate, reflects a well-considered design aimed at streamlining the process for applicants. With a deadline for submission and strict eligibility criteria based on income levels, the PA-1000 form embodies a significant part of Pennsylvania's efforts to ease the cost-of-living pressures for its residents, promising financial relief through well-defined rebates.

QuestionAnswer
Form NameForm Pa 1000
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesptrr_applicatio n pa 1000 form

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PA-1000

 

 

 

 

 

 

 

1105010019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P E N N S Y L V A N I A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property Tax or Rent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOTTERY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rebate Claim

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PA-1000 (08-11)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PA Department of Revenue

2011

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICIAL USE ONLY

 

 

 

 

Harrisburg PA 17128-0503

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

Check your label for accuracy. If incorrect, do not use the label. Complete Part A.

If Spouse is

 

 

 

B

Fill in only one oval in each

 

Your Social Security Number

 

 

Spouse’s Social Security Number

Deceased, fill

 

 

section.

 

 

 

 

1.

I am filing for a rebate as a:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

in the oval.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P. Property Owner – See

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

instructions

 

 

 

 

PLEASE WRITE IN YOUR SOCIAL SECURITY NUMBER(S) ABOVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R. Renter – See instructions

 

Last Name

 

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Owner/Renter – See

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

instructions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

I Certify that as of Dec. 31, 2011,

 

First Line of Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am a:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Claimant age 65 or older

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Claimant under age 65,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Second Line of Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

with a spouse age 65 or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

older who resided in the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

same household

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Widow or widower, age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City or Post Office

 

 

 

 

 

 

 

 

 

 

 

 

State

 

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50 to 64

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Permanently disabled

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and age 18 to 64

 

Spouse’s First Name

 

 

 

MI

County Code

 

 

 

 

School District Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Have you received Property

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REQUIRED

 

 

 

 

 

 

 

 

 

 

 

 

Tax/Rent Rebates in the past?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Yes

2. No

 

Claimant’s Birthdate

Spouse’s Birthdate

 

 

 

Daytime Telephone Number

 

 

 

 

 

 

 

 

 

 

 

(See instructions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deadline - June 30, 2012.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

TOTAL INCOME received by you and your spouse during 2011

 

 

 

 

 

 

 

 

 

 

Dollars

Cents

 

4. Social Security, SSI and SSP Income (Total benefits $

 

 

 

 

divided by 2)

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Railroad Retirement Tier 1 Benefits (Total benefits $

 

 

 

 

 

 

 

 

divided by 2)

 

 

 

 

 

 

5.

 

 

 

 

 

 

 

 

 

 

 

 

 

.

. . .

. . .

. .

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6. Total Benefits from Pension, Annuity, IRA Distributions, Veterans’ Disabilityand Railroad Retirement

 

 

 

 

 

 

 

 

 

 

 

Tier 2

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6.

 

 

 

 

 

 

7. Interest and Dividend Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

 

 

 

 

 

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LOSS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. Gain or Loss on the Sale or Exchange of Property. . .

.

 

. .

.

. . If a loss, fill in this oval

8.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOSS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. Net Rental Income or Loss

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. .

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. . If a loss, fill in this oval

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOSS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. Net Business Income or Loss

. .

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. . If a loss, fill in this oval

10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Income.

11a. Salaries, wages, bonuses, commissions, and estate and trust income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11b. Gambling and Lottery winnings, including PA Lottery winnings, prize winnings and the value

of other prizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11c. Value of inheritances, alimony and spousal support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11d. Cash public assistance/relief. Unemployment compensation and workers’ compensation,

except Section 306(c) benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11e. Gross amount of loss of time insurance benefits and disability insurance benefits,

and life insurance benefits, except the first $5,000 of total death benefit payments. . . . . . . . . . . . . . . . . . . . . . . . . . . .

11f. Gifts of cash or property totaling more than $300, except gifts between

members of a household. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11g. Miscellaneous income that is not listed above. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. TOTAL INCOME.Add only the positive income amounts from Lines 4 through 11g.

If your total income exceeds $35,000, you may not claim a rebate. . . . . . . . . . . . . . . . . . . . .

Enter this amount on line 22.

11a.

11b.

11c.

11d.

11e.

11f.

11g.

12.

IMPORTANT: You must submit proof of the income you reported – See the instructions on Pages 6 and 7.

1105010019

1105010019

1105120016

PA-1000 2011

Your Social Security Number

Your Name:

PROPERTY OWNERS ONLY

13.Total 2011property tax. Submit copies of receipted tax bills.

14.Property Tax Rebate. Enter the maximum standard rebate amount from Table A for your income level here: (_______)

. . . . . . . . . . . . . . . . . . . . . . . . . . . 13.

Compare this amount to line 13 and enter the lesser amount to the right. 14.

RENTERS ONLY

15. Total 2011rent paid. Submit PA Rent Certificate and/or rent receipts . . . . . . . . . . . . . . . . . . . . . . . 15.

16. Multiply Line 15 by 20 percent (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.

17.Rent Rebate. Enter the maximum rebate amount from Table B for your income level here: (_______)

Compare this amount to line 16 and enter the lesser amount to the right. 17.

OWNER – RENTER ONLY

18.Property Tax/Rent Rebate. Enter the maximum rebate amount from Table A for your income level here: (_______)

Compare this amount to the sum of

18.

Lines 14 and 17 and enter the lesser

amount to the right.

DIRECTDEPOSIT.Banking rules do not permit direct deposits to bank accounts outside the U.S. If your bank account is outside the U.S., do not complete the direct deposit Lines 19, 20 and 21. The department will mail you a paper check. If your rebate will be going to a bank accountwithintheU.S.,youhavetheoptiontohaveyourrebatedirectlydeposited.Ifyouwantthedepartmenttodirectlydeposityourrebate into your checking or savings account, complete Lines 19, 20 and 21.

19. Place an X in one box to authorize the Department of Revenue to directly deposit your rebate

Checking

19.

into your:

 

Savings

20.Routing number. Enter in boxes to the right. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.

21.Account number. Enter in boxes to the right. . . . . . . . . . 21.

22.

Enter the amount from Line 12 of the claim form on this line and circle the corresponding Maximum Rebate amount for your income level. Owners use Table A and Renters use Table B.

TABLE A - OWNERS ONLY

 

INCOME LEVEL

Maximum Standard

 

 

 

 

Rebate

$

0

to

$ 8,000

$650

$

8,001

to

$15,000

$500

$

15,001

to

$18,000

$300

$

18,001

to

$35,000

$250

TABLE B - RENTERS ONLY

 

INCOME LEVEL

Maximum

 

 

 

 

Rebate

$

0

to $

8,000

$650

$

8,001

to $

15,000

$500

DAn excessive claim with intent to defraud is a misdemeanor punishable by a maximum fine of $1,000, and/or imprisonment for up to one year upon conviction. The claimant is also subject to a penalty of 25 percent of the entire amount claimed.

CLAIMANT OATH: I declare that this claim is true, correct and complete to the best of my knowledge and belief, and this is the only claim filed by members of my household. I authorize the PA Department of Revenue access to my federal and state Personal Income Tax records, my PACE records, my Social Security Administration records and/or my Department of Public Welfare records. This access is for verifying the truth, correctness and completeness of the information reported in this claim.

Claimant’s Signature

 

Date

Witnesses’Signatures: If the claimant cannot sign, but only makes a mark.

 

 

 

 

1.

 

Spouse’s Signature

 

Date

2.

 

 

 

 

 

 

 

PREPARER: I declare that I prepared this return, and that it is to the best of my

Name of claimant’s power of attorney or nearest relative. Please print.

knowledge and belief, true, correct and complete.

 

 

 

 

Preparer’s Signature, if other than the claimant

 

Date

 

 

 

Telephone number of claimant’s power of attorney or nearest relative.

 

 

 

 

 

 

 

 

Preparer’s Name. Please print.

Homeaddressofclaimant’spowerofattorneyornearestrelative.Pleaseprint.

Preparer’s telephone number

City or Post Office

State

ZIP Code

Call 1-888-728-2937 to check the status of your claim or to update your address.

1105120016

1105120016

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This PDF doc will require you to enter specific details; to guarantee consistency, be sure to heed the guidelines further on:

1. For starters, when filling out the Form Pa 1000, start with the page that features the next blanks:

Form Pa 1000 conclusion process described (stage 1)

2. Once this segment is done, it's time to insert the needed details in Net Rental Income or Loss, Net Business Income or Loss, LOSS, LOSS, Other Income, a Salaries wages bonuses, b Gambling and Lottery winnings, of other prizes, c Value of inheritances alimony, d Cash public assistancerelief, except Section c benefits, e Gross amount of loss of time, and life insurance benefits except, f Gifts of cash or property, and members of a household allowing you to go to the next stage.

How to fill out Form Pa 1000 step 2

3. This third part is generally simple - fill in every one of the empty fields in Your Social Security Number, Your Name, PROPERTY OWNERS ONLY Total, Property Tax Rebate Enter the, Compare this amount to line and, RENTERS ONLY Total rent paid, Multiply Line by percent, Compare this amount to line and, from Table B for your income level, OWNER RENTER ONLY Property, rebate amount from Table A for, Compare this amount to the sum of, DIRECT DEPOSIT Banking rules do, Place an X in one box to, and into your to conclude the current step.

Form Pa 1000 completion process detailed (step 3)

4. The form's fourth paragraph comes with these blank fields to fill out: Savings, Routing number Enter in boxes to, Account number Enter in boxes to, TABLE A OWNERS ONLY, TABLE B RENTERS ONLY, INCOME LEVEL, Maximum Standard, INCOME LEVEL, Enter the amount from Line of the, to to to to, Rebate, to to, Maximum, Rebate, and An excessive claim with intent to.

Find out how to fill in Form Pa 1000 step 4

5. To conclude your document, the particular part features a number of additional blanks. Completing Preparers Signature if other than, Date, Telephone number of claimants, Preparers Name Please print, Home address of claimants power of, Preparers telephone number, City or Post Office, State, ZIP Code, and Call to check the status of your will conclude everything and you will be done very quickly!

Filling out segment 5 of Form Pa 1000

People frequently make errors while filling out Telephone number of claimants in this section. Remember to re-examine whatever you enter here.

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