Form Ptax 340 is an Indiana state tax form that is used to report various types of income. The form can be filed electronically or by mail, and must be submitted by the April filing deadline. Taxpayers are required to include their Social Security number on the form, and should ensure that all information is accurate and complete. Penalties may apply for inaccurate or incomplete filings. For more information, consult the instructions provided with the form.
| Question | Answer |
|---|---|
| Form Name | Form Ptax 340 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | ST., ptax-, EAV, COUNTY |
Last date to apply: ______________________________________
Part 1: Applicant information (Please type or print.)
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____________________________________________________________ |
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____________________________________________ |
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First name |
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Last name |
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Tax ID number |
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____________________________________________________________ |
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____ ____ /____ ____ /____ ____ ____ ____ |
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Mailing address |
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Date of birth (month, day, year) |
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____________________________________________________________ |
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_____________________ |
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______________________ |
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City |
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State |
ZIP |
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Area code and phone number |
Email address |
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Part 2: Property information
1_____________________________________________________________________________________________________________
Street address of property for which this exemption application is filedTownship
__________________________________________ |
IL ______________________________________________________________ |
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City |
ZIP |
County |
2____________________________________________________________
Property (parcel) index number (PIN)
Note: The PIN is shown on your property tax bill. You also may obtain it from your chief county assessment officer (CCAO). If you cannot obtain the PIN, attach a copy of the legal description.
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Have you or your spouse received this exemption for this property previously? |
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Yes |
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No |
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If you answered “Yes”, write the base year, if known. |
____ ____ ____ ____ |
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If your spouse maintains a separate residence, has he or she applied for this exemption? |
____ Yes |
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No |
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Part 3: Household income for 2012
You must include the income of you, your spouse, and all other individuals who live in your household.
1 |
Social Security and SSI benefits. Include Medicare deductions in this total. |
1 |
__________________|______ |
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Railroad Retirement benefits. Include Medicare deductions in this total. |
2 |
__________________|______ |
3 |
Civil Service benefits |
3 |
__________________|______ |
4 |
Annuities, federally taxable pensions and retirement plan distributions. |
4 |
__________________|______ |
5 |
Human Services and other governmental cash public assistance benefits |
5 |
__________________|______ |
6 |
Wages, salaries, and tips from work |
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__________________|______ |
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Interest and dividends received |
7 |
__________________|______ |
8 |
Net rental, farm, and business income or (loss). (See instructions for Line 8.) |
8 |
__________________|______ |
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Net capital gain or (loss). (See instructions for Line 9.) |
9 |
__________________|______ |
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Other income or (loss). (See instructions for Line 10.) |
10 __________________|______ |
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11 |
Add Lines 1 through 10. |
11 __________________|______ |
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12Certain subtractions. You may subtract only the reported adjustments to income from U.S. 1040, Line 36, or U.S. 1040A, Line 20.
Subtraction item |
Amount |
12a _______________________________________________ __________________|______ |
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12b_______________________________________________ __________________|______ |
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Add the amounts on Lines 12a and 12b, and write the result. |
12 __________________|______ |
13Subtract Line 12 from Line 11, and write the result. This is your total household income
for 2012. If the amount is greater than $55,000, STOP. You do not qualify for this exemption.13__________________|______
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Do not write in this space. |
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Date received |
___________________ |
Income verified |
___ Yes ___ No |
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Application number |
___________________ |
Base year EAV |
$__________________ |
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Base year |
___ ___ ___ ___ |
Revised base year EAV |
$__________________ |
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Revised base year |
___ ___ ___ ___ |
EAV of added improvements |
$__________________ |
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Approved |
___ Yes |
___ No |
Base amount |
$__________________ |
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Part 4: Affidavit
Sworn under oath, I state the following:
1(Mark the statement that applies.)
On January 1, 2013, the property identified in Part 2, Line 1, was improved with a permanent structure a ____ that I used as my principal residence.
b ____ for which I received this exemption previously and is either unoccupied or used as my spouse’s principal residence. I am now a resident of a facility licensed under the Assisted Living and Shared Housing Act, Nursing Home Care Act, ID/DD (intellectually disabled/developmentally disabled) Community Care Act, or Specialized Mental Health Rehabili- tation Act.
_______________________________________ |
_________________________________________________ |
Name of facility |
Mailing address |
2(Mark the statement that applies.)
On January 1, 2013, I
a ____ was the owner of record of the property identified in Part 2, Line 1.
b ____ had a legal or equitable interest by a written instrument in the property listed in Part 2, Line 1.
c ____ had a leasehold interest in the property identified in Part 2, Line 1, that was used as a
3I am liable for paying real property taxes on the property identified in Part 2, Line 1.
Note: If I have not received this exemption for this property previously, I also met the eligibility requirements listed in Part 4, Lines 1, 2, and 3 for this property on January 1, 2012.
4(Mark the statement that applies.)
a ____ In 2013, I am, or will be, 65 years of age or older.
b ____ In 2013, my spouse, who died in 2013, would have been 65 years of age or older. (Complete the following information.)
_____________________________________________ |
__________________________________________________ |
Deceased spouse’s name |
Tax ID number |
____ ____ /____ ____ /____ ____ ____ ____ |
____ ____ /____ ____ /____ ____ ____ ____ |
Date of birth (month, day, year) |
Date of death (month, day, year) |
5The property identified in Part 2, Line 1, is the only property for which I am applying for a senior citizens assessment freeze homestead exemption for 2013.
6The amount reported in Part 3, Line 13, of this form includes the income of my spouse and all persons living in my household and the total household income for 2012 is $55,000 or less.
7On January 1, 2013, the following individuals also used the property identified in Part 2, Line 1, for their principal residence. My spouse is included if he or she used the property as his or her principal dwelling place on January 1, 2013. The total income of all individuals and my spouse (regardless of his or her principal residence) are included in Part 3. (Attach an ad- ditional sheet if necessary.)
a b
First and last name |
Tax ID number |
__________________________________________________ |
__________________________________________________ |
__________________________________________________ |
__________________________________________________ |
8 (Mark the statement that applies.) |
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On January 1, 2013, I was |
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a ____ single, widow(er), or divorced. |
b ____ married and living together. |
c ____ married, but not living together. |
My spouse’s name and address is _____________________________________________________________________________
First nameMILast name
_____________________________________________________________________________________________________________
Street Address |
City |
State |
ZIP |
Under penalties of perjury, I state that, to the best of my knowledge, the information contained in this affidavit is true, correct, and complete.
_______________________________________ ____ ____/____ ____/____ ____ ____ ____
Signature of applicantDate (month, day, year)
Subscribed and sworn to before me this
_______ day of ________________________________, 20_____. |
____________________________________________________ |
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Notary public |
Note: The CCAO may conduct an audit to verify that the taxpayer is eligible to receive this exemption.
Mail your completed Form |
If you have any questions, please call: |
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_________________Co. Chief County Assessment Officer |
(_________) |
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_______________________________________________________ |
Last date to apply ___ ___/___ ___/___ ___ ___ ___ |
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Mailing address |
Month |
Day |
Year |
____________________________________IL _________________
City |
ZIP |
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Form
What is the Senior Citizens Assessment Freeze Homestead Exemption (SCAFHE)?
The Senior Citizens Assessment Freeze Homestead Exemption (35 ILCS
Freezing your property’s EAV does not mean that your property taxes will not increase, however. Other factors also affect your tax bill. For example, your tax bill could increase if the tax rate, which is based on the amount of revenues taxing districts re- quest, increases. Your EAV and tax bill may also increase if you add improvements to your home. However, if your home’s EAV decreases in the future, you will benefit from any reduction.
Who is eligible?
The senior citizens assessment freeze homestead exemption quali- fications for the 2013 tax year (for the property taxes you will pay in 2014), are listed below.
•You will be 65 or older during 2013.
•Your total household income in 2012 was $55,000 or less.
•On January 1, 2012, and January 1, 2013, you
—used the property as your principal place of residence,
—owned the property, or had a legal or equitable interest in the property as evidenced by a written instrument, or had a leasehold interest in the property used as a
—were liable for the payment of property taxes.
You do not qualify for this exemption if your property is assessed under the mobile home privilege tax.
Surviving spouse — Even if you are not 65 or older during 2013, you are eligible for this exemption for 2013 (and possibly 2012) if your spouse died in 2013 and would have met all of the qualifica- tions.
Residents in a health facility — Even if you did not use the property as your principal place of residence on January 1, 2013, you qualify for this exemption if you are a resident of a facility licensed under the Assisted Living and Shared Housing Act, Nursing Home Care Act, ID/DD (intellectually disabled/develop- mentally disabled) Community Care Act, or Specialized Mental Health Rehabilitation Act and you meet all other requirements, have received this exemption previously, and your property is either unoccupied or is occupied by your spouse.
Residents of cooperatives — If you are a resident of a coop- erative apartment building or cooperative
What is a household?
A household includes you, your spouse, and all other per- sons who used your residence as a principal dwelling place on January 1, 2013.
What is included in household income?
Household income includes your income, your spouse’s income, and the income of all individuals living in the household. Examples of income that must be included in your household income are listed below. (For specific questions, see Part 3 on Page 4.)
•alimony or maintenance received
•annuities and other pensions
•Black Lung benefits
•business income
•capital gains
•cash assistance from the Illinois Department of Human Ser- vices and other governmental cash public assistance
•cash winnings from such sources as raffles and lotteries
•Civil Service benefits
•damages awarded in a lawsuit for nonphysical injury or sick- ness (for example, age discrimination or injury to reputation)
•dividends
•farm income
•Illinois Income Tax refund (only if you received Form
•interest
•interest received on life insurance policies
•long term care insurance (federally taxable portion only)
•lump sum Social Security payments
•miscellaneous income, such as from rummage sales, recy- cling aluminum, or baby sitting
•military retirement pay based on age or length of service
•monthly insurance benefits
•pension and IRA benefits (federally taxable portion only)
•Railroad Retirement benefits (including Medicare deductions)
•rental income
•Ilinois Cares Rx rebate (only if you took an itemized deduction for health insurance in the prior year on your federal income tax return)
•Social Security income (including Medicare deductions)
•Supplemental Security Income (SSI) benefits
•all unemployment compensation
•wages, salaries, and tips from work
•Workers’ Compensation Act income
•Workers’ Occupational Diseases Act income
What is not included in household income?
Some examples of income that are not included in household income are listed below. (For specific income questions, see Part 3 on Page 4.)
•cash gifts
•child support payments
•Circuit Breaker grants
•COBRA subsidy payments
•damages awarded in a lawsuit for a physical personal injury or sickness
•Energy Assistance payments
•federal income tax refunds
•IRA’s “rolled over” into other retirement accounts, unless “rolled over” into a Roth IRA
•lump sums from inheritances
•lump sums from insurance policies
•money borrowed against a life insurance policy or from any financial institution
• reverse mortgage payments
•spousal impoverishment payments
•stipends from Foster Parent and Foster Grandparent programs
•Veterans’ benefits
What if I have a net operating loss or capital loss carryover from a previous year?
You cannot include any carryover of net operating loss or capital loss from a previous year. You can include only a net operating loss or capital loss that occurred in 2012.
Will my information remain confidential?
All information received from your application is confidential and may be used only for official purposes.
When must I file?
File Form
Note: The CCAO may require additional documentation
(i.e., birth certificates, tax returns) to verify the information in this application.
What if I need additional assistance?
If you have questions about this form, please contact your CCAO, also known as the supervisor of assessments, or county assessor, at the address and phone number printed at the bottom of Page 2.
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Form
Part 1: Applicant information
Lines 1 through 5 — Type or print the requested information.
Part 2: Property information
Lines 1 and 2 — Identify the property for which this applica- tion is filed.
Lines 3 and 4 — Answer the questions by marking an “X” next to your statement. If you answered “Yes” to the question on Line 3 and you know the base year, write it in the space provided.
Part 3: Household income for 2012
“Income” for this exemption means 2012 federal adjusted gross income, plus certain items subtracted from or not included in your federal adjusted gross income (320 ILCS 25/3.07). These in- clude
The amounts written on each line must include the 2012 income for you, your spouse, and all the other individuals living in the household.
Line 1 — Social Security and Supplemental Security Income (SSI) benefits
Write the total amount of retirement, disability, or survivor’s benefits (including Medicare deductions) the entire household received from the Social Security Administration (shown on Form
Note: The amount deducted for Medicare ($1,198.80 yearly or $99.90 per month, per person) is already included in the amount in box 3 of Form
Line 2 — Railroad Retirement benefits
Write the total amount of retirement, disability, or survivor’s bene- fits (including Medicare deductions) the entire household received under the Railroad Retirement Act (shown on Forms
Line 3 — Civil Service benefits
Write the total amount of retirement, disability, or survivor’s benefits the entire household received under any Civil Service retirement plan (shown on Form
Line 4 — Annuities and other retirement income
Write the total amount of income the entire household received as an annuity from any annuity, endowment, life insurance con- tract, or similar contract or agreement (shown on Form
Include only the federally taxable portion of pensions, IRAs, and IRAs converted to Roth IRAs (shown on U.S. 1040, Line 15b and 16b, or U.S. 1040A, Line 11b and 12b). IRA’s are not taxable when “rolled over,” unless “rolled over” into a Roth IRA.
Line 5 — Human Services and other governmental cash public assistance benefits
Write the total amount of Human Services and other governmen- tal cash public assistance benefits the entire household received. If the first two digits of any member’s Human Services case num- ber are the same as any of those in the following list, you must include the total amount of any of these benefits on Line 5.
01 |
aged |
04 and 06 temporary assistance to |
02 |
blind |
needy families (TANF) |
03 |
disabled |
07 general assistance |
To determine the total amount of the household benefits, multi- ply the monthly amount each person received by 12. You must adjust your figures accordingly if anyone in the household did not receive 12 equal checks during this period.
Food stamps, medical assistance, and Circuit Breaker benefits anyone in the household may have received are not considered income and should not be added to your total income.
Line 6 — Wages, salaries, and tips from work
Write the total amount of wages, salaries, and tips from work for every household member (shown in box 1 of Form
Line 7 — Interest and dividends received
Write the total amount of interest and dividends the entire house- hold received from all sources, including any government sources (shown on Forms
Line 8 — Net rental, farm, and business income or (loss)
Write the total amount of net income or loss from rental, farm, business sources, etc., the entire household received, as allowed on U.S. 1040, Lines 12, 17, and 18. You cannot use any net oper- ating loss (NOL) carryover in figuring income.
Line 9 — Net capital gain or (loss)
Write the total amount of taxable capital gain or loss the entire household received in 2012, as allowed on U.S. 1040, Lines 13 and 14, or U.S. 1040A, Line 10. You cannot use a net capital loss carryover in figuring income.
Line 10 — Other income or (loss)
Write the total amount of other income or loss not included in Lines 1 through 9, that is included in federal adjusted gross income, such as alimony received, unemployment compensation, taxes withheld from oil or gas well royalties. You cannot use any net operating loss (NOL) carryover in figuring income.
Line 11 — Add Lines 1 through 10.
Line 12 — Subtractions
You may subtract only the reported adjustments to income totaled on U.S. 1040, Line 36 or U.S. 1040A, Line 20. For example
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IRA deduction |
• Educator expenses |
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Archer MSA deduction |
• Tuition and fees |
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moving expenses |
• Domestic production |
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alimony or maintenance paid |
activities deduction |
• health savings account deduction
•student loan interest deduction
•jury duty pay you gave to your employer
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•penalty on early withdrawal of savings
Line 13 — Total household income
Subtract Line 12 from Line 11. If this amount is greater than $55,000, you do not qualify for this exemption. See Page 3.
Part 4: Affidavit
Lines 1 through 4 — Mark the item that applies. Read the af- fidavit carefully. The statements must apply.
Line 7 — Write the names and tax identification numbers of the individuals, other than yourself, who used the property for their principal residence on January 1, 2013. Attach an additional sheet if necessary.
Line 8 — Follow the instructions on the form. If your spouse does not reside at this property, be sure to write his or her name and address.
Note: You must sign your Form
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