Ptax 343 A Form PDF Details

If you are a Canadian taxpayer and want to know more about the Ptax 343 A Form, then you have come to the right place. In this article, we'll explain what this form is used for, who typically needs to file it, how to navigate through it step-by-step, and any tips and tricks for filing Ptax 343 A correctly. This guide will help make sure that your tax returns run smoothly. Get ready to learn what makes up Ptax 343 A and become an informed taxpayer!

QuestionAnswer
Form NamePtax 343 A Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform ptax 343 a, ptax 343 a homestead exemption, ptax 343 application, ptax 343

Form Preview Example

PTAX-343-A Physician’s Statement for Disabled Persons’ Homestead Exemption

Read this first

To qualify for the Disabled Persons’ Homestead Exemption (DPHE), proof of a disability is required. The acceptable proof of disabil- ity is listed on the back of this Form. If you are unable to provide any of these as proof of your disability, you and an Illinois licensed physician must complete Form PTAX-343-A. You are responsible for any physicians’ costs.

Step 1: Applicant - Complete the following information

1________________________________________________

Property owner’s name

________________________________________________

Street address of homestead property

3Write the property index number (PIN) of the property for which you are fi ling this form. Your PIN can be found on your property tax bill or you may obtain it from your Chief County Assessment Officer (CCAO). If you are unable to obtain your PIN, write the legal description on Line b.

__________________________________IL_____________

City

ZIP

(___ ___ ___)___ ___ ___ - ___ ___ ___ ___

Daytime phone

2Write the assessment year for which you

are requesting the DPHE:

___ ___ ___ ___

 

Year

aPIN __ __ - __ __ - __ __ __ - __ __ __ - __ __ __ __

bAttach a separate sheet if needed.

_____________________________________________

_____________________________________________

Step 2: Physician - Complete the following information

Part A: Patient information - Please print.

The patient must meet the disability criteria established by the Social Security Administration.

Note: Alcoholism or drug abuse is not included in the Social Security Administration’s guidelines as a qualification for disability status.

4Patient’s name: ____________________________________

5Date patient became disabled ___ ___/___ ___/___ ___ ___ ___

6

Can the patient do the same type of work as prior to their disability?

Yes

 

6a Was the patient able to work for a living after this date?

Yes

7

Has the disability lasted or is it expected to continue for 12 months or more?

Yes

8Check all major body systems, disorders, and diseases of the patient’s disability:

No No

No

1.00Musculoskeletal

2.00Special Senses and Speech

3.00Respiratory

4.00Cardiovascular

5.00Digestive

6.00Genitourinary

7.00Hematological

8.00Skin

9.00Endocrine

10.00Impairments that Affect Multiple Body

11.00Neurological

12.00Mental

13.00Malignant Neoplastic

14.00Immune

9What is the nature of the disability? __________________________________________________________________________

Part B: Physician information

10Name: __________________________________________

11Your Illinois physician’s license number issued by the

Illinois Department of Financial and Professional Regulations: 0 3 6 - ___ ___ ___ ___ ___ ___

12Sign below:

I have examined this patient and based on the Social Security Administration’s criteria for disability, I state that the information contained in Step 2 is true, correct and complete to the best of my knowledge.

Physician’s signature: ___________________________________________________ Date: _____/_____/_____

PTAX-343-A (N-03//08) IL-492-4547

General Information

To qualify for the Disabled Persons’ Homestead Exemption (DPHE), proof of a disability is required. The acceptable proof of disability is listed below. If you are unable to provide any of these as proof of your disability, you and an Illinois licensed physician must complete Form PTAX-343-A.

You are responsible for any physicians’ costs.

What is considered proof of disability?

1A Class 2 Illinois Disabled Person Identification Card from the Illinois Secretary of State’s Office. Class 2 or Class 2A qualifies, Class 1 or 1A does not qualify.

2Proof of Social Security Administration (SSA) disability benefits which includes an award letter, verification letter or annual Cost of Living Adjustment (COLA) letter

(only Form SSA-4926-SM-DI). If you are under the age of 65 receiving Supplemental Security Income (SSI) disability benefits, proof includes a letter indicating SSI payments (SSA-L8151, SSA-L8155, or SSA-L8156).

3Proof of Veterans Administration disability benefits which includes an award letter or verification letter indicating you are receiving a pension for a non-service connected disability.

4Proof of Railroad or Civil Service disability benefits which includes an award letter or verification letter of total (100%) disability.

When and where must I file this Form PTAX-343-A?

You must fi le Form PTAX-343- A with your Chief County Assessment Officer (CCAO) at the address shown below prior to your county’s due date for the Disabled Persons’ Homestead Exemption (DPHE). Contact your CCAO at the telephone number or address below for assistance.

File or mail your completed Form PTAX-343-A:

_______________________________________ County, CCAO

____________________________________________________

Mailing address

 

IL

City

ZIP

If you have any questions, please call: (____)_____-________

Social Security Administration’s Listing of Impairments

The Listing of Impairments describes, for each major body system, impairments that are considered severe enough to prevent a person from doing any gainful activity. Most of the listed impairments are permanent or expected to result in death, or a specific state- ment of duration is made. For all others, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months. The criteria in the listing of impairments are applicable to evaluation of claims for disability benefits from the Social Security Administration (SSA). Visit SSA web site for more specific information.

1.00

Musculoskeletal System

8.00

Skin Disorders

2.00

Special Senses and Speech

9.00

Endocrine System

3.00

Respiratory System

10.00

Impairments that Affect Multiple Body Systems

4.00

Cardiovascular System

11.00

Neurological

5.00

Digestive System

12.00

Mental Disorders

6.00

Genitourinary System

13.00

Malignant Neoplastic Diseases

7.00

Hematological Disorders

14.00

Immune System

 

 

 

Offi cial use. Do not write in this space.

 

 

Date received: ___ ___/___ ___/___ ___ ___ ___

DFPR license verifi ed: ___ ___/___ ___/___ ___ ___ ___

Month

Day

Year

Month

Day

Year

 

 

 

Comments:______________________________________________

_______________________________________________________

_______________________________________________________

PTAX-343-A (N-03//08)

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Filling in section 1 in form ptax 343 a

2. Given that this section is finished, it's time to add the essential specifics in Musculoskeletal, Special Senses and Speech, Skin, Endocrine, Respiratory, Cardiovascular, Digestive, Genitourinary, Hematological, Impairments that Affect Multiple, Neurological, Mental, Malignant Neoplastic, Immune, and What is the nature of the allowing you to move on further.

Tips to complete form ptax 343 a portion 2

3. Completing To qualify for the Disabled, When and where must I fi le this, What is considered proof of, County CCAO, Mailing address, City If you have any questions, ZIP, A Class Illinois Disabled Person, Illinois Secretary of States Offi, Proof of Social Security, SSAL SSAL or SSAL, Proof of Veterans Administration, includes an award letter or verifi, Proof of Railroad or Civil, and includes an award letter or verifi is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

When and where must I fi le this, What is considered proof of, and Proof of Veterans Administration inside form ptax 343 a

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Filling out part 4 of form ptax 343 a

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