NOTE: Applicants can exclude one-half of all Social Security income.

Transcription

1 11 The Property Tax/Rent Rebate program benefit eligible Pennylvanian age 65 and older; widow and widower age 50 and older; and people with diabilitie age 18 and older. The deadline to apply for a rebate on property taxe or rent paid in 2011 i June 30, Revenue will begin mailing and depoiting rebate on July 1, 2012, a pecified by law. Pleae ee Page 3 for eligibility requirement and Page 10 for a ample form. ARRISBURG PA omeowner: INCOME 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 Renter: INCOME MAXIMUM REBATE $0 to $8,000 $650 $8,001 to $15,000 $500 NOTE: Applicant can exclude one-half of all Social Security income. Some homeowner may receive larger rebate than requeted. Baed on where you live, income and/or property taxe, you may qualify for a upplemental property tax rebate, automatically calculated for you. See Page 13 for more information. For more information on property tax relief, viit For aitance regarding your rebate claim, call, toll-free, DIRECT DEPOSIT Eliminate trip to the bank and receive your rebate payment fater by enrolling in direct depoit. Mot enior already receive Social Security payment through thi afe, ecure and convenient payment method. See Page 12 for detail. PRSRT STD U.S. POSTAGE PAID COMMONWEALT OF PENNSYLVANIA DEPARTMENT OF REVENUE PA-1000 BOOKLET PRINTING AND MAILING COST REDUCTIONS In order to reduce printing and mailing cot aociated with the Property Tax/Rent Rebate program application booklet, beginning thi year the Department of Revenue will no longer mail PA-1000 booklet to any claimant whoe claim from the prior year wa filed uing a computer oftware-prepared form.

2 BEFORE YOU BEGIN STATE SUPPLEMENTARY PAYMENT RECIPIENTS The State Supplementary Payment (SSP) i not included on your SSA-1099 form. The Department of Public Welfare will iue annual tatement to verify your SSP benefit. SSP i till conidered reportable income. A with other Social Security income, only half of the SSP income need to be included on Line 4 of the Property Tax/Rent Rebate claim form. SOCIAL SECURITY RECIPIENTS WIT PA ADDRESSES If you were a Pennylvania reident for all of 2011, you do not have to ubmit proof of your Social Security income including Social Security retirement and Supplemental Security benefit. The Social Security Adminitration provide Social Security income information to the PA Department of Revenue. The PA Department of Public Welfare will provide State Supplementary Payment information to the department. owever, you or the peron who prepare your claim will need thee tatement to correctly calculate the amount of your rebate. If none of thee document are available, you or your preparer will need to etimate the amount you received during the year. If the dollar amount you provide i not correct, the department will adjut the amount of your rebate baed upon income amount reported directly to the department by the Social Security Adminitration or the Department of Public Welfare. SOCIAL SECURITY RECIPIENTS WITOUT PA ADDRESSES If your addre in Social Security Adminitration record wa not a Pennylvania addre for 2011, you mut ubmit a copy of one of the following document a proof of your 2011 Social Security income: Form SSA-1099 reporting your 2011 Social Security benefit, a tatement from Social Security that report the monthly or yearly Social Security/Supplemental Security Income benefit you received during 2011, or a bank tatement howing the amount of Social Security/Supplemental Security Income benefit depoited into your account during PILADELPIA RESIDENTS Pleae read the pecial filing intruction on Page 9. 2 PA-1000 Pennylvania Property Tax or Rent Rebate Program

3 ELIGIBILITY REQUIREMENTS You are eligible for a Property Tax/Rent Rebate for claim year 2011, if you meet the requirement in each of the three categorie below: CATEGORY 1 TYPE OF FILER a. You were 65 or older a of Dec. 31, 2011; b. You were not 65, but your poue who lived with you wa 65 a of Dec. 31, 2011; c. You were a widow or widower during all or part of 2011 and were 50 or older a of Dec. 31, 2011; or d. You were permanently diabled and 18 or older during all or part of 2011, you were unable to work becaue of your medically determined phyical or mental diability, and your diability i expected to continue indefinitely. If you received Supplemental Security Income (SSI) payment, you are eligible for a rebate if you meet all other requirement. NOTE: If you applied for Social Security diability benefit and the Social Security Adminitration did not rule in your favor, you are not eligible for a Property Tax/Rent Rebate a a diabled claimant. CATEGORY 2 ELIGIBILITY INCOME a. Property Owner - Your total eligible annual houehold income, including the income that your poue earned and received while reiding with you, wa $35,000 or le in b. Renter - Your total eligible annual houehold income, including the income that your poue earned and received while reiding with you, wa $15,000 or le in You mut report all item of income, except the nonreportable type of income lited on Page 7 and 8, whether or not the income i taxable for federal or PA income tax purpoe. NOTE: There may be difference between eligibility income and PA-taxable income. Pleae ee pecific line intruction for each category of income. When calculating your total eligible annual houehold income, exclude one-half of your Social Security benefit a hown in Box 5 of your SSA-1099 tatement, one-half of your Supplemental Security Income benefit, one-half of your State Supplementary Payment benefit, and one-half of any Railroad Retirement Tier 1 benefit a hown on Form RRB CATEGORY 3 OWNER, RENTER, OR OWNER/RENTER To file a a property owner, renter, or owner/renter, you mut meet all requirement for one of the following categorie: OWNER a. You owned and occupied your home, a evidenced by a contract of ale, deed, trut, or life etate held by a grantee; b. You occupied your home (rebate are for your primary reidence only); and c. You or omeone on your behalf paid the 2011 property taxe on your home. RENTER a. You rented and occupied a home, apartment, nuring home, boarding home, or imilar reidence in Pennylvania; b. Your landlord paid property taxe or agreed to make a payment in lieu of property taxe on your rental property for 2011 (ee Page 11); and c. You or omeone on your behalf paid the rent on your reidence for OWNER/RENTER a. You owned, occupied, and paid property taxe for part of the year and were a renter for part of the year; b. You owned and occupied your home and paid property taxe and paid rent for the land upon which your home i ituated; or c. You paid rent for the home you occupied, and paid property taxe on the land upon which your home i ituated. CAUTION: A a renter, if you received cah public aitance during 2011, you are not eligible for any rebate for thoe month you received cah public aitance. Pleae complete a PA-1000 Schedule D (encloed in thi booklet). PROOF DOCUMENTS TAT FIRST TIME FILERS MUST SUBMIT IMPORTANT: Pleae end photocopie, ince the department cannot return original document. Print your Social Security Number (SSN) on each Proof Document that you ubmit with your claim form. If you are age 65 or older, provide proof of your age. If you are under age 65 and your poue i age 65 or older, provide proof of your poue age. If you are a widow or widower age 50 to 64, provide proof of your age and a photocopy of your poue death certificate. PA-1000 Pennylvania Property Tax or Rent Rebate Program 3

4 If you are permanently diabled, age 18 to 64, you mut provide proof of your age and proof of your permanent diability. PROOF OF AGE NOTE: If you receive Social Security or SSI benefit and have proven your age with the Social Security Adminitration, you do not need to ubmit proof of age. IMPORTANT: The department accept photocopie of the following document a proof of your age. Do not end your original document ince the department cannot return original document. Birth certificate Blue Cro or Blue Shield 65 Special Card Church baptimal record Driver licene or PA identification card opital birth record Naturalization/immigration paper, if age i hown Military dicharge paper, if age i hown Medicare card PACE/PACENET card Paport The department will not accept a Social Security card or hunting or fihing licene a proof of age. If you have quetion on other type of acceptable document, pleae call the department at PROOF OF DISABILITY For Social Security diability, SSI permanent and total diability, Railroad Retirement permanent and total diability, or Black Lung diability, provide a copy of your award letter. For Veteran Adminitration diability, provide a letter from the Veteran Adminitration tating that you are 100 percent diabled. For Federal Civil Service diability, provide a letter from Civil Service tating that you are 100 percent diabled. If you do not qualify under any of the diability program mentioned above, did not apply for Social Security benefit, or do not have a letter from the Veteran Adminitration or Civil Service Adminitration, you mut ubmit a Phyician Statement of Permanent Diability (PA-1000 PS), encloed in thi booklet. The form mut decribe your diability a permanent and your phyician mut ign the tatement to certify that the information i true and accurate to the bet of hi/her knowledge and belief. IMPORTANT: The Phyician Statement of Permanent Diability cannot be ued if you were denied Social Security diability. The Department of Revenue ha the legal authority to require additional evidence that you are permanently diabled and eligible for a rebate. OUSEOLDS WIT MORE TAN ONE QUALIFIED CLAIMANT Only one member of your houehold may file a claim even if more than one peron qualifie for a rebate. If omeone other than your poue appear on the deed or the leae, pleae complete a PA-1000 Schedule F (encloed in thi booklet). You may apply for only one rebate each year. DECEASED CLAIMANT To be eligible for a rebate, the claimant mut have lived during all of If a claimant died on or after Jan. 1, 2012, the department will pay the rebate to the claimant poue, etate, or peronal repreentative. Pleae follow the rule explained in the following ection entitled SUR- VIVING SPOUSE, AN ESTATE, and PERSONAL REPRE- SENTATIVE. SURVIVING SPOUSE The urviving poue can file the completed claim and include a copy of the death certificate and a letter tating that he/he wa the poue of the claimant at the time of death. The urviving poue may ign on the claimant ignature line. OR If the urviving poue i eligible to file a claim, he/he can file under hi/her own name intead of ubmitting a claim uing the deceaed individual claim form. The urviving poue hould print hi/her name, addre, and Social Security Number (SSN) in Part A, and follow the filing intruction. The urviving poue hould anwer NO to Quetion 3 in Part B, and furnih proof required for a firt time filer. Do not ue the label the department ent to the decedent in the booklet. The urviving poue hould enter the deceaed poue SSN and name in the poue information area, and fill in the oval if Spoue i Deceaed, located in the area next to the Spoue SSN on the claim form. AN ESTATE The executor or the court-appointed repreentative of the claimant etate may file the claim and ubmit a Short Certificate howing the will wa regitered or probated. When there i no will and there are aet (an etate), ubmit a copy of the court order appointing omeone to receive the deceaed peron aet, known a a Decree of Ditribution. A Short Certificate or Decree of Ditribution can be obtained from the county courthoue where the death i recorded. The peron filing the claim form on behalf of the deceaed peron may ign on the claimant ignature line. 4 PA-1000 Pennylvania Property Tax or Rent Rebate Program

5 PERSONAL REPRESENTATIVE If a peron die after filing a claim and there i no will; or if the will ha not been regitered or probated; or if there i no etate, then a peronal repreentative can requet that the department change the rebate to be iued into hi/her name. In cae where the rebate check ha been received but cannot be cahed, the check mut be returned with a requet to have the rebate reiued in the name of the peronal repreentative. The decedent peronal repreentative mut ubmit a copy of the decedent death certificate, and a receipted copy of the claimant funeral bill howing that he or he peronally paid the funeral expene in an amount that i equal to or greater than the amount of Property Tax/Rent Rebate the claimant i entitled. If you have any quetion regarding the filing of a claim on behalf of a deceaed claimant, pleae call the department at PRIVACY NOTIFICATION By law, (42 U.S.C. 405(c)(2)(C)(i); 61 Pa. Code ) the Pennylvania Department of Revenue ha the authority to ue the Social Security Number (SSN) to adminiter the Property Tax or Rent Rebate Program, the Pennylvania Peronal Income Tax, and other Commonwealth of Pennylvania tax law. The department ue the SSN to identify individual and verify their income. The department alo ue the SSN to adminiter a number of tax-offet and child-upport program federal and Pennylvania law require. The Commonwealth may alo ue the SSN in exchange-of-tax-information agreement with governmental authoritie. Pennylvania law prohibit the Commonwealth from dicloing information that individual provide on income tax return and rebate claim, including the SSN(), except for official purpoe. PA FILING INSTRUCTIONS PART A - SOCIAL SECURITY NUMBER, NAME, ADDRESS AND RESIDENCE INFORMATION You mut fill in your Social Security Number and enter your county and chool ditrict code even if uing the preprinted label. If you are not uing oftware to prepare your claim and your label i correct, place your label in Part A. If you or your preparer are uing oftware to prepare your claim, or if any information on the preprinted label i incorrect, dicard the label. If not uing a label, follow the intruction below for printing letter and number and completing your name and addre. If your poue lived in a nuring home the entire year do not include hi/her Social Security Number on the claim form. e or he may qualify for a eparate rebate on the rent paid to the nuring home. IMPORTANT TIPS: There are two line to enter your addre. On the firt line, enter the potal format for an apartment number (APT), uite (STE), room number (RM), rural route (RR), box number (PO BOX), floor (FL), etc. Then on the econd line, enter your treet addre. If you have only a treet addre, you may enter it on either line. Ue black ink. Another color uch a red ink will delay the proceing of your rebate claim. Do not ue pencil. Print all information on your claim neatly inide the boxe. Ue upper cae (capital) letter. Ue a blank box to eparate word. Print one letter or number in each box when entering your Social Security Number, name, addre, dollar amount, and other information. If your name, addre, or city begin with Mc, Van, O, etc., do not enter a pace or a punctuation mark. Completely fill in all the appropriate oval on your claim form. Sample M C D O E A P T A N Y S T J O N A R R I S B U R G P A J A N E A a claimant, you mut provide your birth date, telephone number, county code, chool ditrict code, and, if applicable, your poue Social Security Number, birth date, and name. If your poue i deceaed, completely fill in the oval If Spoue i Deceaed in Part A of the form. IMPORTANT: County & School Code - You mut enter the two-digit county code and five-digit chool ditrict code for where you lived on Dec. 31, 2011, even if you moved after Dec. 31, Uing incorrect code may affect your property tax rebate. The lit of county and chool ditrict name and the repective code are on Page 14, 15 and 16. If you do not know the name of the county or chool ditrict where you reide, you can either 1) check the county and chool property tax bill ued to complete thi claim if you are a property owner, or 2) obtain thi information from the Online Cutomer Service Center at PART B - FILING STATUS CATEGORIES Line 1 - Pleae fill in the oval that how your correct filing tatu. Fill in only one oval. Filling in more than one oval may reduce the amount of your rebate. A PA-1000 Pennylvania Property Tax or Rent Rebate Program 5

6 (P) Property Owner: Fill in thi oval if you owned and occupied your home for all or part of 2011 and did not rent for any part of the year. If your deceaed poue name i on your deed or tax bill, include the decedent Social Security Number and name. (R) Renter: Fill in thi oval if you rented and occupied your reidence for all or part of (B) Owner/Renter: Fill in thi oval if you owned and occupied your reidence for part of 2011, and alo rented and occupied another reidence for the ret of 2011, or if you owned your reidence and rented the land where your reidence i located. EXAMPLE: John pay property taxe on a mobile home that he own and occupie. i mobile home i on land that he leae. John may claim a Property Tax rebate on the mobile home and a Rent Rebate on the land. See Page 8, 9 and 11 for document you mut end a proof of property taxe or rent paid. Line 2 - Certification. Pleae read each decription and elect the type of filer that applie bet to your ituation a of Dec. 31, If you are a urviving poue or filing a claim for a claimant who died prior to Dec. 31, 2011, the deceaed i not eligible for a rebate. If you are eligible under another category, pleae complete the claim form uing your Social Security Number, name and addre, and upply all appropriate documentation. a. Claimant age 65 or older b. Claimant under age 65, with a poue age 65 or older who reided in the ame houehold (You mut ubmit proof of your poue age the firt time you file.) c. Widow or widower, age 50 to 65 (If your mot recent marriage ended in divorce, you do not qualify a a widow/widower.) d. Permanently diabled and age 18 to 64 See Page 4 for acceptable proof of age document. Line 3 - If you have received a rebate before, completely fill in the oval for Ye. If you have not received a rebate before, or if your deceaed poue received rebate in the pat, completely fill in the oval for No. See Page 3 and 4 for acceptable proof document for firt time filer. PART C - LINES 4 TROUG 18 You mut report the total houehold income you earned and/or received during 2011 for each category, which include your poue income earned and/or received while reiding with you. All claimant mut ubmit proof of annual income. IMPORTANT: The department reerve the right to requet additional information or make adjutment to federal data if credit or deduction were taken to reduce income. CAUTION: Spoue may not offet each other income and loe. The department ha the legal authority to require evidence of the income you report on your claim. The following lit the kind of income you mut report and the document you mut ubmit a proof of the reported income. You mut include the income that your poue received while reiding with you. See Page 7 and 8 for a lit of the kind of income that you do not need to report. NOTE: Print your Social Security Number on each Proof Document that you ubmit with your claim form. Line 4 - Include one-half of your 2011 Social Security Benefit a hown in Box 5 of your benefit tatement SSA- 1099, one-half of your 2011 SSI, one-half of your 2011 Social Security Diability Income, and one-half of your 2011 State Supplementary Payment. No documentation i required, if uing a PA addre. Line 5 - Include one-half of your Railroad Retirement Tier 1 Benefit. Submit a copy of form RRB CAUTION: The total income from old age benefit program from other countrie, uch a Service Canada Old Age Security, mut be converted into U.S. dollar and reported on Line 6. Line 6 - Include the gro amount (not the taxable amount) of penion, annuitie, Individual Retirement Account ditribution, Tier 2 Railroad Retirement Benefit, Veteran Diability Benefit, and Civil Service Diability Benefit. Do not include Black Lung Benefit. Submit photocopie of penion/annuity benefit tatement along with other form 1099 howing income for IMPORTANT: Do not include rollover from Individual Retirement Account and employer penion. owever, proof mut be provided. Proof include, but i not limited to, a federal Form 1099-R howing a rollover or other documentation indicating that the ditribution wa rolled into a new account. Line 7 - Report interet and dividend received or credited during the year, whether or not you actually received the cah. If you received dividend and capital gain ditribution from mutual fund, report the capital gain ditribution portion of the income a dividend, not a gain from the ale or exchange of property. Include interet received from government entitie. You mut alo include all taxexempt interet income from direct obligation of the U.S. government, any tate government, or any political ubdiviion thereof in the amount hown on Line 7. SUBMIT TE FOLLOWING: A copy of your federal Form 1040 Schedule B or your PA-40 Schedule A and/or B; or copie of any federal Form 1099 you received; OR A copy of the front page of your PA or federal income tax return verifying the income reported on Line 7. 6 PA-1000 Pennylvania Property Tax or Rent Rebate Program

7 IMPORTANT: If you received capital gain ditribution from a mutual fund, you mut ue PA Schedule B or the front page of your PA tax return to verify your income. If you have PA tax-exempt interet income, you mut include federal Form 1040 Schedule B along with a copy of the front page of your federal tax return. Line 8 - Include gain or loe you realized from the ale of tock, bond, and other tangible or intangible property. Do not include capital gain ditribution from mutual fund required to be reported on Line 7. NOTE: The nontaxable gain on the ale of your principal reidence mut alo be reported on thi line. If you realized a lo from the ale of your principal reidence, thi lo may be ued to offet any other gain you realized from the ale of tangible or intangible property. owever, any net lo reported on thi line cannot be deducted from any other income. Submit a copy of your federal Form 1040 Schedule D, a copy of your PA-40 Schedule D, or copie of any federal Form 1099 you received which will verify any gain or loe you realized. If you received capital gain ditribution from mutual fund, do not include a copy of federal Form 1040 Schedule D. You mut include a copy of your PA-40 Schedule D. If you old your peronal reidence during thi claim year, ubmit a tatement howing the ale price le elling expene, minu the um of the original cot and permanent improvement. CAUTION: You may only ue loe from the ale or exchange of property to offet gain from the ale or exchange of property. Line 9 - Include net rental, royalty, and copyright income or lo realized during CAUTION: You may only ue rental loe to offet rental income. IMPORTANT: If you receive income from the rental of a portion of your own home, you mut complete and ubmit a PA-1000 Schedule E (encloed in thi booklet). Submit a copy of your federal Form 1040 Schedule E, Part I, or PA- 40 Schedule E from your income tax return. Line 10 - Include net income or lo from a buine, profeion, or farm, and net income or lo you realized a a partner in a partnerhip or a hareholder in a PA S corporation. CAUTION: You may only ue buine loe to offet buine income. IMPORTANT: If you operate your buine or profeion at your reidence, you mut complete and ubmit a PA-1000 Schedule E (encloed in thi booklet). Submit a photocopy of each federal Form 1040 Schedule C or F, or PA-40 Schedule C or F from your income tax return. You may alo ubmit photocopie of each PA Schedule RK-1, PA Schedule NRK-1, or federal Schedule K-1 that how your income or lo for each buine. Line 11a - 11g - Other Income - Complete Line 11a through 11g to report all other income that you and your poue earned, received, and realized. For each category of income hown below, you mut ubmit proof, uch a photocopie of Form W-2, Department of Public Welfare cah aitance tatement, your federal or PA income tax return, and any other document verifying income. Line 11a. - Gro alarie, wage, bonue, commiion, and etate or trut income not included in buine, profeion, or farm income Line 11b. - Gambling and lottery winning, including PA Lottery, Powerball and Mega Million winning, prize winning, and the value of other prize and award (a PA- 40 Schedule T mut be ubmitted to verify thee winning, a well a a W-2G to document PA Lottery winning) Line 11c. - Value of inheritance, alimony, and poual upport money Line 11d. - Cah public aitance/relief, unemployment compenation, and worker compenation benefit, except Section 306(c) benefit Line 11e. - Gro amount of lo of time inurance benefit, diability inurance benefit, long-term care inurance benefit (if received directly by the claimant), and life inurance benefit and proceed, except the firt $5,000 of the total death benefit payment Line 11f. - Gift of cah or property totaling more than $300, except gift between member of a houehold Line 11g. - Micellaneou income that i not lited above Do not report the following income: Medicare or health inurance reimburement Food tamp, urplu food, or other uch non-cah relief upplied by a governmental agency Property Tax/Rent Rebate received in 2011 The amount of any damage due to peronal injurie or ickne. Damage include Black Lung benefit and benefit granted under Section 306(c) of the Worker Compenation Security Fund Act (relating to Schedule of Compenation for diability from permanent injurie of certain clae) Payment provided to eligible low-income houehold under the Commonwealth Low Income ome Energy Aitance Program Payment received by home provider of the domiciliary care program adminitered by the Department of Aging, PA-1000 Pennylvania Property Tax or Rent Rebate Program 7

8 except thoe payment in exce of the actual expene of the care Diability income received by diabled children in the houehold The difference between the purchae price of your reidence and it elling price, if you ued the proceed from the ale to purchae a new reidence. Thi new reidence mut be your principal reidence. Federal or tate tax refund Spoue income earned or received while not living with you Public Aitance benefit received by children in the houehold, even though the check i iued in claimant name Child upport Individual Retirement Account and employer penion rollover (mut provide a copy of federal Form 1099-R indicating rollover or other upporting documentation) Line 12 - Add the poitive income figure reported on Line 4 through 11g and enter the total. Do not include loe. Enter the total income on Line 12 and alo Line 22. IMPORTANT: If you have over $35,000 of income claimed on Line 12, you are not eligible for either Property Tax or Rent Rebate relief under thi program. Line 13 - For Property Owner Only Enter the total amount of the property taxe paid for your primary reidence, or the amount hown a eligible property taxe paid on the lat chedule completed. IMPORTANT: If you do not enter the amount of all taxe paid on the primary reidence, you will limit the department ability to determine your eligibility for and amount of a upplemental rebate. See Page 13 for more information on upplemental rebate. You mut deduct interet or penalty payment, municipal aement, per capita taxe, or occupation taxe included in your payment. If you paid early and received a dicount, you enter the amount you actually paid on Line 13. You mut alo deduct other charge included in your tax bill. See taxe that are not acceptable on Page 9. If your name doe not appear on the receipted tax bill, you mut ubmit proof of ownerhip. Example of proper proof are: a copy of the deed or a copy of the trut agreement, will, or decree of ditribution if you inherited your property. If your addre i not on your receipted property tax bill or mortgage tatement, you alo mut ubmit a letter from your tax collector or mortgage company verifying your home addre. Before completing Line 13 of the claim form, complete any of the following chedule that apply to you. NOTE: If your tax bill include a name and/or name other than your and your poue, you mut complete PA-1000 Schedule F or ubmit proof that you are the ole owner of the property. Include only the property tax on the amount of land that i neceary for your peronal ue. If you mut complete more than one chedule, you mut complete them in alphabetical order. If one chedule doe not apply to you, kip it, and go to the next chedule. You mut carry forward, a the total tax paid, the lat amount hown on the firt chedule you complete to the next chedule you complete. Report the amount hown on the lat chedule that applie to you on Line 13 of the claim form. PA-1000 Schedule A - If you owned and occupied your home for le than the entire year of PA-1000 Schedule B - If you were a widow or widower age 50 to 64 who remarried in PA-1000 Schedule E - If you ued part of your reidence for a purpoe other than living quarter in PA-1000 Schedule F - If your deed how owner other than your poue. A proof of property tax paid, homeowner mut provide photocopie of one of the following real etate document: All 2011 real etate tax bill that have been marked paid by the tax collector (ee the intruction beginning on thi page for the proper calculation of the amount on Line 13). If you paid your taxe in quarterly intallment, a tax bill mut be ubmitted for each period. For tax bill that are not marked paid by the tax collector, the department will accept a photocopy of both ide of the cancelled check along with a copy of the tax bill; Your year-end mortgage tatement howing the amount of real etate taxe paid; A letter igned by the tax collector certifying that you paid your 2011 real etate taxe. The letter hould alo how your name, the addre of the property, and declare the total tax doe not include nuiance taxe or penalty; OR A receipted copy of your tax billing from your owner aociation or corporation. Reident tockholder of a cooperative houing corporation, uch a a condominium, may qualify a property owner baed on their pro rata hare of the property taxe paid to the corporation for their reidence. 8 PA-1000 Pennylvania Property Tax or Rent Rebate Program

9 The following type of receipted real etate tax bill are acceptable: County School ditrict City Borough Townhip Taxe/charge that are not acceptable (even if baed on millage): Flat rate charge Footage charge Peronal Property Tax Per Capita Tax Occupational Privilege Tax Sewer rent Garbage collection charge Municipal aement uch a, or including, road, intitution, treet, library, light, water, fire, debt, and inking fund taxe Interet or penalty payment If your tax bill contain any of thee charge, you mut deduct them when completing Line 13. ATTENTION PILADELPIA RESIDENTS: The City of Philadelphia ha provided the department with electronic record of all receipted 2011 property tax bill for Philadelphia that were paid by Dec. 31, If you live in the City of Philadelphia and paid your 2011 property taxe by Dec. 31, 2011, do not include a copy of your receipted property tax bill. If you live in Philadelphia and paid your 2011 property taxe in 2012, pleae ubmit proof of payment a outlined in the preceding information. NOTE: You or the peron who prepare your claim will need to know the amount of tax you paid in order to correctly calculate your rebate. If you do not have a copy of your original tax bill or a copy of your tax payment, you or your preparer will need to etimate the amount of taxe you paid. If the tax amount you provide i not correct, the department will adjut the amount of your rebate baed upon the paid taxe reported to the department by the City of Philadelphia. Line 14 - To determine the amount for Line 14, tart with the amount of your total income on Line 22. In Table A, find the income range that include your Line 22 amount and circle the correponding maximum tandard rebate amount. Compare your maximum tandard rebate amount to the amount on Line 13 and enter the leer amount on Line 14. The department will not pay a rebate for le than $10. The maximum tandard rebate cannot exceed $650. Line 15 - For Renter Only IMPORTANT: If you have over $15,000 of income on Line 12, you are not eligible for the Rent Rebate relief portion of thi program. Before completing Line 15 of the claim form, complete any chedule lited in the intruction for thi line. If you mut complete more than one chedule, you mut complete them in alphabetical order. If one chedule doe not apply to you, kip it, and go to the next chedule. You mut carry forward, a the total rent paid, the lat amount hown on the previou chedule you complete to the next chedule you complete. Report the amount hown on the lat chedule that applie to you on Line 15 of the claim form. PA-1000 Schedule B - If you were a widow or widower age 50 to 64 who remarried in PA-1000 Schedule D - If you were a renter who received cah public aitance in PA-1000 Schedule E - If you ued part of your reidence for a purpoe other than living quarter in PA-1000 Schedule F - If your leae how peron other than your poue or minor children. If you were required to complete Schedule B, D, E, or F, enter the leer amount of the total rent paid in 2011 or the amount hown a eligible rent paid, on the lat chedule completed. Line 16 - Multiply Line 15 by 20 percent (0.20). Line 17 - To determine the amount for Line 17, tart with the amount of your total income on Line 22. In Table B, find the income range that include your Line 22 amount and circle the correponding maximum rebate amount. Compare your maximum rebate amount to the amount on Line 16 and enter the leer amount on Line 17. The department will not pay a rebate for le than $10. The maximum tandard rebate cannot exceed $650. You may claim a rebate only if you pay rent to a property owner for a hometead. A hometead i a dwelling that you rent for ue a a home that i a elf-contained unit. NOTE: A landlord-tenant relationhip exit when the landlord (leor) provide the claimant (leee) with a leae for a elf-contained unit. Thi uually mean a eparate kitchen, bath, and bedroom. The landlord (leor) mut maintain a leae agreement, have eparate utility bill, have other evidence of a elfcontained unit, and report the rental income on federal and PA tax return. If the landlord (leor) alo claim a Property Tax/Rent Rebate, they mut ubmit a PA-1000 Schedule E (encloed in thi booklet), and provide their federal or PA tax return. You, a the claimant for a rebate, PA-1000 Pennylvania Property Tax or Rent Rebate Program 9

10 PENNSYLVANIA PA-1000 COMPLETION SAMPLE Fill in your Social Security Number. Fill in thi oval if your poue i deceaed. If your label i correct, place it here. Dicard label if it i not correct and fill in all data in Part A. PLACE LABEL ERE PA-1000 Property Tax or Rent LOTTERY Rebate Claim PA-1000 (08-11) PA Department of Revenue arriburg PA A Check your label for accuracy. If incorrect, do not ue the label. Complete Part A. Your Social Security Number Spoue Social Security Number PLEASE WRITE IN YOUR SOCIAL SECURITY NUMBER(S) ABOVE Lat Name Firt Name MI Firt Line of Addre Second Line of Addre City or Pot Office Spoue Firt Name MI County Code School Ditrict Code Claimant Birthdate Spoue Birthdate State ZIP Code REQUIRED Daytime Telephone Number If Spoue i Deceaed, fill in the oval OFFICIAL USE ONLY Fill in only one oval in each ection. M M D D Y Y M M D D Y Y Deadline - June 30, C TOTAL INCOME received by you and your poue during 2011 Dollar Cent 4. Social Security, SSI and SSP Income (Total benefit $ divided by 2) Railroad Retirement Tier 1 Benefit (Total benefit $ divided by 2) Total Benefit from Penion, Annuity, IRA Ditribution, Veteran Diability and Railroad Retirement Tier Interet and Dividend Income LOSS 8. Gain or Lo on the Sale or Exchange of Property If a lo, fill in thi oval LOSS 9. Net Rental Income or Lo If a lo, fill in thi oval LOSS 10. Net Buine Income or Lo If a lo, fill in thi oval Other Income. 11a. Salarie, wage, bonue, commiion, and etate and trut income b. Gambling and Lottery winning, including PA Lottery winning, prize winning and the value of other prize c. Value of inheritance, alimony and poual upport d. Cah public aitance/relief. Unemployment compenation and worker compenation, except Section 306(c) benefit e. Gro amount of lo of time inurance benefit and diability inurance benefit, and life inurance benefit, except the firt $5,000 of total death benefit payment Sample 11f. Gift of cah or property totaling more than $300, except gift between member of a houehold g. Micellaneou income that i not lited above TOTAL INCOME. Add only the poitive income amount from Line 4 through 11g. 12. If your total income exceed $35,000, you may not claim a rebate Enter thi amount on line 22. IMPORTANT: You mut ubmit proof of the income you reported See the intruction on Page 6 and a. 11b. 11c. 11d. 11e. 11f. 11g. B 1. I am filing for a rebate a a: P. Property Owner See intruction R. Renter See intruction B. Owner/Renter See intruction 2. I Certify that a of Dec. 31, 2011, I am a: A. Claimant age 65 or older B. Claimant under age 65, with a poue age 65 or older who reided in the ame houehold C. Widow or widower, age 50 to 64 D. Permanently diabled and age 18 to ave you received Property Tax/Rent Rebate in the pat? 1. Ye 2. No (See intruction) Fill in only one oval for Line 1. Fill in only one oval for Line 2. Fill in only one oval for Line 3. Fill in School Ditrict Code (ee Page 15 and 16). Fill in County Code (ee Page 14). Report your total Social Security, SSI, and SSP benefit here. Divide the total by 2 and enter the reult on Line 4. Report your total Railroad Retirement Tier 1 benefit here. Divide the total by 2 and enter the reult on Line 5. Enter the total of Line 4 through 11g. Property Owner complete Line 13 and 14. Renter complete Line 15, 16 and 17. If you want your rebate directly depoited, complete Line 19, 20 and 21. Claimant ign here. PA Your Social Security Number Your Name: PROPERTY OWNERS ONLY 13. Total 2011 property tax. Submit copie of receipted tax bill Property Tax Rebate. Enter the maximum tandard rebate Compare thi amount to line 13 and amount from Table A for your income level here: ( ) enter the leer amount to the right. RENTERS ONLY 15. Total 2011 rent paid. Submit PA Rent Certificate and/or rent receipt Multiply Line 15 by 20 percent (0.20) Rent Rebate. Enter the maximum rebate amount Compare thi amount to line 16 and from Table B for your income level here: ( ) enter the leer amount to the right. 17. OWNER RENTER ONLY 18. Property Tax/Rent Rebate. Enter the maximum Compare thi amount to the um of 18. rebate amount from Table A for your income Line 14 and 17 and enter the leer level here: ( ) amount to the right. DIRECT DEPOSIT. Banking rule do not permit direct depoit to bank account outide the U.S. If your bank account i outide the U.S., do not complete the direct depoit Line 19, 20 and 21. The department will mail you a paper check. If your rebate will be going to a bank account within the U.S., you have the option to have your rebate directly depoited. If you want the department to directly depoit your rebate into your checking or aving account, complete Line 19, 20 and Place an X in one box to authorize the Department of Revenue to directly depoit your rebate into your: Routing number. Enter in boxe to the right Account number. Enter in boxe to the right Enter the amount from Line 12 of the claim form on thi line and circle the correponding Maximum Rebate amount for your income level. Owner ue Table A and Renter ue Table B. D Sample 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 $ Checking Saving TABLE B - RENTERS ONLY INCOME LEVEL Maximum Rebate $ 0 to $ 8,000 $650 $ 8,001 to $15,000 $500 An exceive claim with intent to defraud i a midemeanor punihable by a maximum fine of $1,000, and/or imprionment for up to one year upon conviction. The claimant i alo ubject to a penalty of 25 percent of the entire amount claimed. CLAIMANT OAT: I declare that thi claim i true, correct and complete to the bet of my knowledge and belief, and thi i the only claim filed by member of my houehold. I authorize the PA Department of Revenue acce to my federal and tate Peronal Income Tax record, my PACE record, my Social Security Adminitration record and/or my Department of Public Welfare record. Thi acce i for verifying the truth, correctne and completene of the information reported in thi claim. Claimant Signature Date Witnee Signature: If the claimant cannot ign, but only make a mark. If you were both a Property Owner and a Renter, complete Line 13 through 18. Enter your Routing Number here (direct depoit only). Enter your Account Number here (direct depoit only). Spoue Signature Date 1. PREPARER: I declare that I prepared thi return, and that it i to the bet of my knowledge and belief, true, correct and complete. Preparer Signature, if other than the claimant Date Preparer Name. Pleae print. 2. Name of claimant power of attorney or nearet relative. Pleae print. Telephone number of claimant power of attorney or nearet relative. ( ) ome addre of claimant power of attorney or nearet relative. Pleae print. Preparer telephone number ( ) City or Pot Office State ZIP Code Call to check the tatu of your claim or to update your addre PA-1000 Pennylvania Property Tax or Rent Rebate Program

11 are reponible to prove a landlord-tenant relationhip. ometead can include: Apartment in a houe Apartment building Boarding home Mobile home Mobile home lot Nuring home Private home Peronal care home Aited living Domiciliary care Foter care Rent Payment Subidie - For the purpoe of thi rebate claim, ubtract rent payment ubidie provided by or through a governmental agency from the total rent you paid. See Line 5 of the PA Rent Certificate. Renter mut provide one of the following proof document: 1. A PA Rent Certificate for each place you rented during the year. Keep copie for your record. Your landlord or hi/her authorized agent hould complete Line 1 through 8 and ign the PA Rent Certificate; OR 2. If you cannot get your landlord ignature, you mut complete and ubmit the PA Rent Certificate and a notarized Occupancy Affidavit that i below the PA Rent Certificate. Complete the Occupancy Affidavit in it entirety, and write the reaon the landlord did not ign the PA Rent Certificate. The department will review the PA Rent Certificate and Occupancy Affidavit for accuracy; OR 3. Rent receipt igned by your landlord or hi/her agent for each month for which you are claiming a rebate that how your name and rental addre, the amount of rent paid, and the period for which you paid rent. NOTE: The department will not accept cancelled check a proof of rent paid. Print your Social Security Number on each Proof Document that you ubmit with your claim form. IMPORTANT: If your landlord i a tax-exempt entity and i not required to pay property taxe on your rental property, you do not qualify for a rent rebate unle your landlord make payment in lieu of taxe. In thi ituation, landlord agree to make reaonable cah payment in lieu of taxe to a local government authority (county, municipality, chool ditrict, fire/police department, etc.) in order to allow their reident to claim rent rebate. Line 18 - For Owner/Renter Only IMPORTANT: If you have over $15,000 of income claimed on Line 12, you are not eligible for the Rent Rebate relief portion of thi program. CAUTION: A an owner/renter, only fill in Oval B (Owner/Renter) in Section B of the claim form. Do not fill in Oval P or R. Filling in other oval may reduce your rebate amount. If you were both a property owner and a renter in 2011, you mut calculate your Property Tax Rebate eparately from your Rent Rebate. Complete Line 13 and 14 to calculate your Property Tax Rebate and complete Line 15 through 17 to calculate your Rent Rebate. Add Line 14 and 17 - To determine the amount for Line 18, tart with the amount of your total income in Line 22. In Table A, find the income range that include your Line 22 SAMPLE CECK Joe & Jane Taxpayer Drive Avenue 370 Nowhere, PA Date Pay To The Order Of: $ Your Bank Commonwealth Region arriburg, PA Routing Number Account Number Check Number Dollar Memo Signature I: :I 202III02III086 III0001 Pleae do not end a copy of a blank or voided check with your rebate application. PA-1000 Pennylvania Property Tax or Rent Rebate Program 11

12 amount and circle the correponding maximum tandard rebate amount. Compare your maximum tandard rebate amount to the um of Line 14 and 17 and enter the leer amount on Line 18. The department will not pay a rebate for le than $10. The maximum tandard rebate cannot exceed $650. DIRECT DEPOSIT Line 19 In order to comply with banking rule, direct depoit are not available for rebate going to bank account outide the U.S. If your bank account i outide the U.S., do not complete the direct depoit Line 19, 20 and 21. The department will end you a paper check. If your rebate will be going to a bank account within the U.S., you have the option to have your rebate directly depoited. If you want the Department of Revenue to directly depoit your rebate into your checking or aving account at your bank, credit union, or other financial intitution, place an X in the appropriate box on Line 19. Then complete Line 20 and 21. CAUTION: Be ure to enter the correct routing and account number. Pleae check with your financial intitution to make ure your direct depoit will be accepted and to get the correct routing and account number. The Department of Revenue i not reponible for a lot rebate if you enter the wrong account information. By placing an X in either box on Line 19, you are authorizing the department to directly depoit your rebate into your checking or aving account. Direct depoit cannot be made to Social Security Direct Expre card. IMPORTANT: Do not include a copy of a blank check with your rebate application. The department cannot complete thi information on your application. Line 20 - Routing Number Enter your bank or financial intitution nine-digit Routing Number. The firt two digit mut be 01 through 12, or 21 through 32. Do not ue pace or pecial character when entering the Routing Number. EXAMPLE: The Routing Number on the ample check on Page 11 i If you are attempting to complete thi line uing a depoit lip, pleae contact your financial intitution to determine if the routing number i correct. Many time the number on the depoit lip i for internal ue by the intitution and uing it may delay the payment of your rebate. NOTE: Thi number mut be nine digit. Otherwie, your financial intitution will reject the direct depoit, and the department will mail you a check. IMPORTANT: Your check may tate that it i payable through a bank different from the financial intitution where you have your account (i.e. your check may have two bank lited on the face). If o, do not ue the Routing Number on your check. Intead, ak your financial intitution for the correct Routing Number and enter it on Line PA-1000 Pennylvania Property Tax or Rent Rebate Program Line 21 - Checking or Saving Account Number Enter your checking or aving account number. Your account number may be a many a 17 digit and may contain both number and letter. Enter the number and letter from left to right. Do not ue pace or pecial character when you enter your account number and leave any unued boxe blank. EXAMPLE: The Checking Account Number on the ample check on Page 11 i Do not include the check number. The check number on the ample check i If you are attempting to complete thi line uing a direct depoit lip, pleae contact your financial intitution to determine if the account number i correct. Many time the number on the depoit lip i for internal ue by the intitution and uing it may delay the payment of your rebate. CAUTION: If your bank ha recently changed ownerhip, the routing and account number on your check may be incorrect. Pleae verify the routing and account number with your bank before you enter them on Line 20 and 21. IMPORTANT: If you apply before the end of May and opt for direct depoit of your rebate, you may notice a zero dollar tranaction on your April or May bank tatement. Thi tranaction i part of a ecurity proce conducted to verify your account information and enure your rebate arrive quickly and accurately. If account information cannot be verified for direct depoit, the department will end you a paper check. Line 22 - Total Income Line 22 i ued to determine the correct rebate amount. Enter the amount from Line 12 of the claim form on thi line and circle the correponding Maximum Standard Rebate or Maximum Rebate amount for your income level. Owner ue Table A and Renter ue Table B. PART D - OAT Pleae read the following oath before igning the claim form. CLAIMANT OAT: I declare that thi claim i true, correct, and complete to the bet of my knowledge and belief, and thi i the only claim filed by member of my houehold. I authorize the PA Department of Revenue acce to my federal and Pennylvania Peronal Income Tax record, my PACE record, my Social Security Adminitration record, and/or my Department of Public Welfare record. Thi acce i for verifying the truth, correctne, and completene of the information reported in thi claim. If you do not agree with the oath, do not ign the claim form. owever, the department will not proce the claim form or iue a rebate without a ignature. NOTE: The Property Tax or Rent Rebate program i a benefit provided to qualifying homeowner who apply. The Department of Revenue will not place a lien or judgment on your property becaue of a Property Tax/Rent Rebate paid to you.

13 SIGNATURES: Sign and date the claim form in the pace provided. The ignature mut match the name lited on the label or printed on the name line. If omeone other than the claimant ign the claim form, a copy of the Power of Attorney, guardianhip paper, or other document entitling that peron to ign mut accompany the claim form. In the cae of deceaed claimant, ee the intruction on Page 4. If the claimant make a mark intead of a ignature, two people mut ign the form a witnee to the claimant mark. Alo pleae provide the name, addre, and telephone number of the claimant nearet relative. Thi help the department locate claimant if the Pot Office return a rebate check a undeliverable. MAILING INSTRUCTIONS You mut complete and ubmit one original claim form to the Department of Revenue. Do not ubmit a photocopy of the claim form. For your convenience, the department provide two claim form. If you need another claim form, viit or call the Form Ordering Meage Service at IMPORTANT: Do not ue taple. Uing taple delay the proceing of your claim and damage your claim form and other document. Place your completed claim form and other neceary document in the envelope provided. Ue the checklit on the back of the envelope to verify that your claim i complete. Incomplete claim will delay your rebate. If you do not have the envelope the department provided, mail your completed claim form and neceary document to: PA DEPARTMENT OF REVENUE PROPERTY TAX OR RENT REBATE PROGRAM PO BOX ARRISBURG PA SUPPLEMENTAL PROPERTY TAX REBATES Revenue from lot gaming i providing general property tax relief to all Pennylvania homeowner. Supplemental property tax rebate, equal to 50 percent of taxpayer bae rebate, are available to provide extra relief to homeowner who need it the mot. omeowner in Pittburgh, Scranton and Philadelphia with eligibility income of $30,000 or le will receive additional payment, a will homeowner in the ret of the tate who meet the ame income-eligibility requirement and pay more than 15 percent of their houehold income in property taxe. IMPORTANT: If you are eligible for a upplemental payment above the maximum rebate, the department will calculate it for you. Pleae follow the intruction for Line 13 and 14 beginning on Page 8 of thi booklet to complete your rebate application; do not adjut the amount on Line 14. REBATE PERCENTAGE TABLES TABLE A - OWNERS ONLY TOTAL INCOME From Line 12 of your claim form 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 TOTAL INCOME From Line 12 of your claim form Maximum Rebate $ 0 to $ 8,000 $ 650 $ 8,001 to $ 15,000 $ 500 PA-1000 Pennylvania Property Tax or Rent Rebate Program 13

14 PENNSYLVANIA COUNTIES & CODES Adam Allegheny Armtrong Beaver Bedford Berk Blair Bradford Buck Butler Cambria Cameron Carbon Centre Cheter Clarion Clearfield Clinton Columbia Crawford Cumberland Dauphin Delaware Elk Erie Fayette Foret Franklin Fulton Greene untingdon Indiana Jefferon Juniata Lackawanna Lancater Lawrence Lebanon Lehigh Luzerne Lycoming McKean Mercer Mifflin Monroe Montgomery Montour Northampton Northumberland Perry Philadelphia Pike Potter Schuylkill Snyder Someret Sullivan Suquehanna Tioga Union Venango Warren Wahington Wayne Wetmoreland Wyoming York CLEARFIELD 14 PA-1000 Pennylvania Property Tax or Rent Rebate Program

15 PA-1000 Pennylvania Property Tax or Rent Rebate Program 15 ADAMS Bermudian Spring Conewago Valley Fairfield Area Gettyburg Area Littletown Area Upper Adam ALLEGENY Allegheny Valley Avonworth Baldwin Whitehall Bethel Park Brentwood Borough Carlynton Chartier Valley Clairton City Cornell Deer Lake Duquene City Eat Allegheny Elizabeth Forward Fort Cherry Fox Chapel Area Gateway ampton Townhip ighland Keytone Oak McKeeport Area Montour Moon Area Mount Lebanon North Allegheny Northgate North ill Penn ill Penn-Trafford Pine-Richland Pittburgh Plum Borough Quaker Valley Riverview Shaler Area South Allegheny South Fayette Townhip South Park Steel Valley Sto-Rox Upper Saint Clair Townhip Wet Allegheny Wet Jefferon ill Wet Mifflin Area Wilkinburg Borough Woodland ill ARMSTRONG Allegheny Clarion Valley Apollo-Ridge Armtrong Freeport Area Karn City Area Kiki Area Leechburg Area Redbank Valley BEAVER Aliquippa Borough Ambridge Area Beaver Area Big Beaver Fall Area Blackhawk Central Valley Ellwood City Area Freedom Area opewell Area Midland Borough New Brighton Area Riveride Beaver County Rocheter Area South Side Area Wetern Beaver County BEDFORD Bedford Area Chetnut Ridge Clayburg-Kimmel Everett Area Northern Bedford County Tuey Mountain SCOOL DISTRICT CODE SCOOL DISTRICT CODE SCOOL DISTRICT CODE SCOOL DISTRICT CODE Palmerton Area Panther Valley Weatherly Area CENTRE Bald Eagle Area Bellefonte Area Keytone Central Penn Valley Area Philipburg-Oceola Area State College Area Tyrone Area CESTER Avon Grove Coateville Area Downingtown Area Great Valley Kennett Conolidated Octorara Area Owen J. Robert Oxford Area Phoenixville Area Spring-Ford Area Tredyffrin Eattown Twin Valley Unionville-Chadd Ford Wet Cheter Area CLARION Allegheny Clarion Valley Armtrong Clarion Area Clarion-Limetone Area Keytone North Clarion County Redbank Valley Union CLEARFIELD Clearfield Area Curwenville Area Duboi Area Glendale armony Area Mohannon Valley Philipburg-Oceola Area Purchae Line Wet Branch Area CLINTON Jerey Shore Area Keytone Central Wet Branch Area COLUMBIA Benton Area Berwick Area Bloomburg Area Central Columbia Millville Area Mount Carmel Area North Schuylkill Southern Columbia Area CRAWFORD Conneaut Corry Area Crawford Central Jametown Area Penncret Tituville Area Union City Area CUMBERLAND Big Spring Camp ill Carlile Area Cumberland Valley Eat Pennboro Area Mechanicburg Area Shippenburg Area South Middleton Wet Shore DAUPIN Central Dauphin Derry Townhip alifax Area arriburg City Lower Dauphin Middletown Area Millerburg Area Steelton ighpire Suquehanna Townhip Suquenita Upper Dauphin Area William Valley DELAWARE Cheter Upland Chicheter Garnet Valley averford Townhip Interboro Marple Newtown Penn-Delco Radnor Townhip Ridley Roe Tree Media Southeat Delco Springfield Unionville-Chadd Ford Upper Darby Wallingford Swarthmore Wet Cheter Area William Penn ELK Brockway Area Foret Area Johnonburg Area Kane Area Ridgway Area Saint Mary Area ERIE Corry Area Erie City Fairview Fort Leboeuf General McLane Girard arbor Creek Iroquoi Millcreek Townhip North Eat Northwetern Union City Area Wattburg Area FAYETTE Albert Gallatin Area Belle Vernon Area Brownville Area Connellville Area Frazier Laurel ighland Southmoreland Uniontown Area FOREST Foret Area FRANKLIN Chamberburg Area Fannett-Metal Greencatle-Antrim Shippenburg Area Tucarora Wayneboro Area FULTON Central Fulton Forbe Road Southern Fulton GREENE Carmichael Area Central Greene Jefferon-Morgan Southeatern Greene Wet Greene UNTINGDON untingdon Area Juniata Valley Mount Union Area Southern untingdon County Tuey Mountain Tyrone Area BERKS Antietam Boyertown Area Brandywine eight Area Conrad Weier Area Daniel Boone Area Exeter Townhip Fleetwood Area Governor Mifflin amburg Area Kutztown Area Muhlenberg Townhip Oley Valley Reading Schuylkill Valley Tulpehocken Area Twin Valley Upper Perkiomen Wilon Wyomiing BLAIR Altoona Area Bellwood Anti Clayburg-Kimmel ollidayburg Area Spring Cove Tyrone Area Williamburg Community BRADFORD Athen Area Canton Area Northeat Bradford County Sayre Area Towanda Area Troy Area Wyaluing Area BUCKS Benalem Townhip Britol Borough Britol Townhip Centennial Central Buck Council Rock Eaton Area Morriville Borough Nehaminy New ope Solebury North Penn Paliade Pennridge Pennbury Quakertown Community Souderton Area BUTLER Allegheny Clarion Valley Butler Area Freeport Area Karn City Area Mar Area Moniteau Seneca Valley Slippery Rock Area South Butler County CAMBRIA Blacklick Valley Cambria eight Central Cambria Conemaugh Valley Ferndale Area Foret ill Glendale Greater Johntown Northern Cambria Penn Cambria Portage Area Richland Wetmont illtop Windber Area CAMERON Cameron County CARBON azleton Area Jim Thorpe Area Lehighton Area PA SCOOL DISTRICTS & CODES BY COUNTY

16 16 PA-1000 Pennylvania Property Tax or Rent Rebate Program UNION Lewiburg Area Mifflinburg Area Milton Area Warrior Run VENANGO Allegheny Clarion Valley Cranberry Area Foret Area Franklin Area Oil City Area Penncret Tituville Area Valley Grove WARREN Corry Area Tituville Area Warren County WASINGTON Avella Area Bentworth Bethlehem-Center Brownville Area Burgetttown Area California Area Canon-McMillan Charleroi Chartier-outon Fort Cherry McGuffey Peter Townhip Ringgold Trinity Area Wahington WAYNE Foret City Regional North Pocono Suquehanna Community Wallenpaupack Area Wayne ighland Wetern Wayne WESTMORELAND Belle Vernon Area Blairville-Saltburg Burrell Derry Area Franklin Regional Greater Latrobe Greenburg Salem empfield Area Jeannette City Kiki Area Leechburg Area Ligonier Valley Moneen City Mount Pleaant Area New Kenington-Arnold Norwin Penn-Trafford Southmoreland Yough WYOMING Elk Lake Lackawanna Trail Lake-Lehman Tunkhannock Area Wyaluing Area Wyoming Area YORK Central York Dallatown Area Dover Area Eatern York anover Public Northeatern Northern York County Red Lion Area South Eatern South Wetern Southern York County Spring Grove Area Wet Shore Wet York Area York City York Suburban SCOOL DISTRICT CODE SCOOL DISTRICT CODE SCOOL DISTRICT CODE SCOOL DISTRICT CODE INDIANA Apollo-Ridge Armtrong Blairville-Saltburg armony Area omer Center Indiana Area Marion Center Area Penn Manor Area Punxutawney Area Purchae Line United JEFFERSON Brockway Area Brookville Area Clarion-Limetone Area Duboi Area Punxutawney Area JUNIATA Greenwood Juniata County LACKAWANNA Abington eight Carbondale Area Dunmore Foret City Regional Lackawanna Trail Lakeland Mid Valley North Pocono Old Forge Riveride Scranton City Valley View LANCASTER Cocalico Columbia Borough Conetoga Valley Donegal Eatern Lancater County Elizabethtown Area Ephrata Area empfield Lampeter-Straburg Lancater Manheim Central Manheim Townhip Octorara Area Penn Manor Pequea Valley Solanco Warwick LAWRENCE Blackhawk Ellwood City Area Laurel Mohawk Area Nehannock Townhip New Catle Area Shenango Area Union Area Wilmington Area LEBANON Annville-Cleona Cornwall-Lebanon Eatern Lebanon County Lebanon Northern Lebanon Palmyra Area LEIG Allentown City Bethlehem Area Cataauqua Area Eat Penn Northern Lehigh Northwetern Lehigh Parkland Salibury Townhip Southern Lehigh Whitehall-Coplay LUZERNE Berwick Area Cretwood Dalla Greater Nanticoke Area anover Area azleton Area Lake-Lehman Northwet Area Pittton Area Wilke-Barre Area Wyoming Area Wyoming Valley Wet LYCOMING Canton Area Eat Lycoming Jerey Shore Area Loyalock Townhip Montgomery Area Montourville Area Muncy South Williamport Area Southern Tioga Wellboro Area Williamport Area MCKEAN Bradford Area Kane Area Owayo Valley Otto-Eldred Port Allegany Smethport Area MERCER Commodore Perry Crawford Central Farrell Area Greenville Area Grove City Area ermitage Jametown Area Lakeview Mercer Area Reynold Sharon City Sharpville Area Wet Middleex Area Wilmington Area MIFFLIN Mifflin County Mount Union Area MONROE Eat Stroudburg Area Pleaant Valley Pocono Mountain Stroudburg Area MONTGOMERY Abington Boyertown Area Bryn Athyn Borough Cheltenham Townhip Colonial atboro-orham Jenkintown Lower Merion Lower Moreland Townhip Methacton Norritown Area North Penn Perkiomen Valley Pottgrove Potttown Souderton Area Springfield Townhip Spring-Ford Area Upper Dublin Upper Merion Area Upper Moreland Townhip Upper Perkiomen Wiahickon MONTOUR Danville Area Warrior Run NORTAMPTON Bangor Area Bethlehem Area Cataauqua Area Eaton Area Nazareth Area Northampton Area Northern Lehigh Pen Argyl Area Saucon Valley Wilon Area NORTUMBERLAND Danville Area Line Mountain Milton Area Mount Carmel Area Shamokin Area Shikellamy Southern Columbia Area Warrior Run PERRY Fannett-Metal Greenwood Newport Suquenita Wet Perry PILADELPIA Philadelphia City PIKE Delaware Valley Eat Stroudburg Area Wallenpaupack Area POTTER Autin Area Couderport Area Galeton Area Keytone Central Northern Potter Owayo Valley Port Allegany SCUYLKILL Blue Mountain azleton Area Mahanoy Area Minerville Area North Schuylkill Panther Valley Pine Grove Area Pottville Area Saint Clair Area Shenandoah Valley Schuylkill aven Area Tamaqua Area Tri-Valley William Valley SNYDER Midd-Wet Selingrove Area SOMERSET Berlin Brothervalley Conemaugh Townhip Area Meyerdale Area North Star Rockwood Area Salibury-Elk Lick Shade-Central City Shankville-Stonycreek Someret Area Turkeyfoot Valley Area Windber Area SULLIVAN Sullivan County SUSQUEANNA Blue Ridge Elk Lake Foret City Regional Montroe Area Mountain View Suquehanna Community TIOGA Canton Area Galeton Area Northern Tioga Southern Tioga Wellboro Area PA SCOOL DISTRICTS & CODES BY COUNTY

17 TE PENNSYLVANIA LOTTERY The Pennylvania Lottery wa etablihed by the Legilature in The primary purpoe of creating the Lottery wa, and remain, to generate fund to benefit program that benefit older Pennylvanian. Where doe the money go*? RETAILER AND BENEFIT VENDOR OPERATING PRIZES PROGRAMS COMMISSIONS EXPENSES cent cent cent cent *Profit baed on ale and interet income Since 1972 when it firt game went on ale, the Pennylvania Lottery ha inveted more than $21.5 billion in ervice for older Pennylvanian through Revenue Property Tax/Rent Rebate program; a free and reduced fare tranit program; the low-cot precription drug program PACE and PACENET; a Department of Public Welfare program providing long-term living ervice; and 52 Area Agencie on Aging throughout the commonwealth, including full- and part-time enior community center acro the tate. The Pennylvania Lottery remain the only lottery in the nation that excluively target all of it proceed to program for older reident. In fical year , the Lottery achieved ale of more than $3.2 billion; contribution to the Lottery Fund totaled more than $960 million. A an agency of tate government, the Pennylvania Lottery i a ucceful enterprie of which all Pennylvanian can be proud. PA-1000 Pennylvania Property Tax or Rent Rebate Program 17

18 CUSTOMER SERVICES AND ASSISTANCE ONLINE SERVICES Property Tax/Rent Rebate applicant may now check the tatu of rebate online through the Revenue e-service center, a well a by phone. To ue the online application, each applicant mut enter hi/her Social Security number, date of birth and the amount of the rebate requeted. If you have Internet acce, you can find anwer to commonly aked quetion by uing the department Online Cutomer Service Center. Ue the Find an Anwer feature to earch the databae of commonly aked quetion. If you do not find your anwer in thi area, you can ubmit your quetion to a cutomer ervice repreentative. TELEPONE SERVICES Property Tax/Rent Rebate Taxpayer Service and Information Center Call for peronal aitance during normal buine hour, 7:30 a.m. to 5 p.m PATAXES Touch-tone ervice i required for thi automated 24-hour toll-free line. Call to order form or check the tatu of a peronal income tax account, corporation tax account or property tax/rent rebate. arriburg-area reident may call Service for Taxpayer with Special earing and/or Speaking Need: (TTY) FORMS ORDERING SERVICES To obtain form, viit a Revenue ditrict office or ue one of the following ervice: Internet: Form, brochure, and other information are available on the department webite. If you do not have Internet acce, viit your local public library. Requet for Form: ra-form@pa.gov Automated 24-hour Form Ordering Meage Service: Thi line erve taxpayer without touch-tone telephone ervice. Written Requet: PA DEPARTMENT OF REVENUE TAX FORMS SERVICE UNIT 711 GIBSON BLVD ARRISBURG PA OTER PROGRAMS AND SERVICES Free Preparation Aitance You can receive free aitance in preparing your Property Tax/Rent Rebate form through the Volunteer Income Tax Aitance (VITA) and Tax Couneling for the Elderly (TCE) program. Viit the department webite or contact the nearet Revenue ditrict office for information. Revenue Ditrict Office If you need aitance preparing your claim form or have quetion, pleae contact your local Department of Revenue ditrict office. See Page 19 for a lit of office. PA Department of Aging ( The Department of Aging ha erved a an advocate for the interet of older Pennylvanian at all level of government ince Information on the following program and ervice can be found on it webite. Area Agencie on Aging Each Area Agency on Aging ha trained taff available to anwer quetion and make referral to other agencie in the community that provide the pecific ervice needed by the individual. Refer to the government page of your local phone directory to find the Area Agency on Aging office nearet you. PACE, PACENET and PACE Plu Medicare ( ) PACE, PACENET and PACE Plu Medicare are Pennylvania precription aitance program for older adult, offering low-cot precription medication to qualified reident age 65 and older. Long-Term Care Service ( ) Thi program, adminitered by the Department of Public Welfare and funded by the Pennylvania Lottery and federal Medical Aitance money, provide nuring facility and homeand community-baed ervice to qualifying low-income enior and individual with diabilitie. Free and Reduced-Fare Tranportation The Department of Tranportation ditribute Lottery funding to local tranit authoritie to provide free and reduced-fare ma tranit for older reident. Contact your local tranit authority for more information. APPRISE ( ) APPRISE i a free health inurance couneling program deigned to help older Pennylvanian with Medicare. Counelor are pecially trained volunteer who can anwer your quetion about Medicare and provide you with objective, eay-to-undertand information about Medicare, Medicare Supplemental Inurance, Medicaid and Long-Term Care Inurance. Report Elder Abue ( ) Any peron who believe an older adult i being abued, neglected, exploited or abandoned may call the tatewide elder abue hotline toll-free, 24 hour a day. 18 PA-1000 Pennylvania Property Tax or Rent Rebate Program

19 PA DEPARTMENT OF REVENUE DISTRICT OFFICES NOTE: Pleae call ahead to verify a ditrict office addre and it ervice or vit the department webite at for information. Taxpayer aitance hour are 9 a.m. to noon and from 1 to 4 p.m. ERIE SCRANTON NEW CASTLE PITTSBURG JONSTOWN GREENSBURG SUNBURY ARRISBURG BETLEEM READING NORRISTOWN CESTER p p PILADELPIA BETLEEM 44 E BROAD ST BETLEEM PA CESTER 6T FL STE AVENUE OF TE STATES CESTER PA ERIE 448 W 11T ST ERIE PA GREENSBURG SECOND FL 15 W TIRD ST GREENSBURG PA ARRISBURG LOBBY STRAWBERRY SQ ARRISBURG PA JONSTOWN 425 MAIN ST JONSTOWN PA NEW CASTLE 103 S MERCER ST NEW CASTLE PA NORRISTOWN SECOND FL STONY CREEK OFFICE CENTER 151 W MARSALL ST NORRISTOWN PA PILADELPIA STE 204A 110 N 8T ST PILADELPIA PA PILADELPIA ACDMY PLZ SPG CTR 3240 RED LION RD PILADELPIA PA PITTSBURG 411 7T AVE - ROOM 420 PITTSBURG PA READING STE CERRY ST READING PA SCRANTON RM 200 SAMTERS BLDG 101 PENN AVE SCRANTON PA SUNBURY 535 CESTNUT ST SUNBURY PA PA-1000 Pennylvania Property Tax or Rent Rebate Program 19

20 COMMONWEALT OF PENNSYLVANIA OFFICE OF TE GOVERNOR ARRISBURG My Fellow Citizen: The Property Tax/Rent Rebate program i one of many valuable program benefiting older reident funded by the Pennylvania Lottery. More than 600,000 older Pennylvanian and reident with diabilitie will benefit from rebate up to $975 thi year, and an etimated 120,000 homeowner will have property taxe completely eliminated thi year when general property tax relief from lot gaming combine with the Property Tax/Rent Rebate program. Further, thi pat ummer the General Aembly and my adminitration worked together to enact an amendment to the Taxpayer Relief Act that reform Pennylvania property tax ytem. With very limited exception, chool ditrict no longer have the authority to increae property taxe over the rate of inflation without voter approval. Thi reform prevent local government from overburdening their reident, and a uch i a victory for fical retraint and democracy. The Pennylvania Lottery, which ha funded property tax relief for enior ince the early 1970, remain the only lottery in the nation that devote all proceed to program that benefit older reident. Since it inception, the Lottery ha contributed more than $21.5 billion to program that have grown to include the Property Tax/Rent Rebate program, a free and reduced-fare public tranit program, the low-cot precription drug program PACE and PACENET, long-term care ervice and the 52 Area Agencie on Aging that erve all 67 countie, a well a full- and part-time enior community center acro the tate. All of thee program and ervice are part of Pennylvania commitment to enuring a healthier, happier life for it 2.5 million older reident. In fical year , on an average day, the Lottery helped provide enior with more than 32,200 precription, more than 111,200 tranit ride, more than $489,000 in long-term care ervice and more than 22,300 hot meal. The Property Tax/Rent Rebate program i available to qualified older Pennylvanian and permanently diabled reident. If you think a friend, neighbor or family member may qualify for a rebate, tell them about the program. It a benefit they deerve, and I don t want a ingle enior to mi out on the help they need. Sincerely, Tom Corbett Governor 20 PA-1000 Pennylvania Property Tax or Rent Rebate Program