2015 PA Property Tax or Rent Rebate Program … PA-1000 Pennsylvania Property Tax or Rent Rebate...

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201520152015The Property Tax/Rent Rebate program benefits eligiblePennsylvanians age 65 and older; widows and widowers age50 and older; and people with disabilities age 18 and older.

The deadline to apply for a rebate on property taxes or rentpaid in 2015 is June 30, 2016. Revenue will begin mailing and depositing rebates on July 1, 2016, as specified by law.Please see Page 3 for eligibility requirements and 0 fora sample form.

ATTENTION:As a result of Act 156 of 2014, income increases due solely toSocial Security cost-of-living adjustments will not automaticallydisqualify claimants from receiving rebates. See the IncomeEligibility Section on Page 3 for more information.

DIRECT DEPOSITTo eliminate an extra trip to the bank and receive your rebatefaster, claimants are encouraged to opt for direct deposit ofrebate payments. See Page 12 for details. Most seniors alreadyreceive Social Security payments through this safe, secure andconvenient payment method.

NEW THIS YEARThe department may pursue automated phone calls to rebaterecipients in 2016 notifying them of approval of their rebateclaims. Each rebate claimant is encouraged to include his or hertelephone number on the application form to facilitate these calls.

Homeowners: 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

Renters: INCOME MAXIMUM REBATE$0 to $8,000 $650

$8,001 to $15,000 $500

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

2 PA-1000 Pennsylvania Property Tax or Rent Rebate Program

STATE SUPPLEMENTARY PAYMENT RECIPIENTSThe State Supplementary Payment (SSP) is not includedon your SSA-1099 form. The Department of HumanServices will issue annual statements to verify your SSPbenefit. SSP is still considered reportable income. Aswith other Social Security income, only half of the SSPincome needs to be included on Line 4 of the PropertyTax/Rent Rebate claim form.

SOCIAL SECURITY RECIPIENTS WITH PA ADDRESSESIf you were a Pennsylvania resident for all of 2015, youdo not have to submit proof of your Social Securityincome including Social Security retirement andSupplemental Security benefits. The Social SecurityAdministration provides Social Security income informa-tion to the PA Department of Revenue. The PADepartment of Human Services will provide StateSupplementary Payment information to the department.

However, you or the person who prepares your claim willneed these statements to correctly calculate the amountof your rebate. If none of these documents are available,you or your preparer will need to estimate the amountyou received during the year. If the dollar amount youprovide is not correct, the department will adjust theamount of your rebate based upon income amountsreported directly to the department by the Social SecurityAdministration or the Department of Human Services.

SOCIAL SECURITY RECIPIENTS WITHOUT PAADDRESSESIf your address in Social Security Administration recordswas not a Pennsylvania address for 2015, you must sub-mit a copy of one of the following documents as proof ofyour 2015 Social Security income: Form SSA-1099reporting your 2015 Social Security benefits, a state-ment from Social Security that reports the monthly oryearly Social Security/Supplemental Security Incomebenefits you received during 2015, or a bank statementshowing the amount of Social Security/SupplementalSecurity Income benefits deposited into your accountduring 2015.

PHILADELPHIA RESIDENTSPlease read the special filing instructions on Page 9.

BEFORE YOU BEGIN

You are eligible for a Property Tax/Rent Rebate for claimyear 2015, if you meet the requirements in each of the threecategories below:

a. You were 65 or older as of Dec. 31, 2015;b. You were not 65, but your spouse who lived with you was

65 or older as of Dec. 31, 2015;c. You were a widow or widower during all or part of 2015 and

were 50 or older as of Dec. 31, 2015; ord. You were permanently disabled and 18 or older during all

or part of 2015, you were unable to work because of yourmedically determined physical or mental disability, andyour disability is expected to continue indefinitely. If youreceived Supplemental Security Income (SSI) payments, youare eligible for a rebate if you meet all other requirements.

NOTE: If you applied for Social Security disability benefits andthe Social Security Administration did not rule in your favor, youare not eligible for a Property Tax/Rent Rebate as a disabledclaimant.

When calculating your total eligible annual household income,exclude one-half of your Social Security benefits as shown inBox 5 of your SSA-1099 statement, one-half of yourSupplemental Security Income benefits, one-half of your StateSupplementary Payment benefits and one-half of any RailroadRetirement Tier 1 benefits as shown on Form RRB-1099.

a. Property Owners - Your total eligible annual householdincome, including the income that your spouse earned andreceived while residing with you, was $35,000 or less in2015. See Important below. (addition to a and b)

b. Renters - Your total eligible annual household income,including the income that your spouse earned andreceived while residing with you, was $15,000 or less in2015. See Important below. (addition to a and b)

You must report all items of income, except the nonreportabletypes of income listed on Pages 7 and 8, whether or not theincome is taxable for federal or PA income tax purposes.

NOTE: There may be differences between eligibility income andPA-taxable income. Please see specific line instructions for eachcategory of income.

IMPORTANT: Homeowners and renters who collected SocialSecurity benefits and received a property tax or rent rebate in2013 for claim year 2012 may be eligible for a property tax orrent rebate even if their eligibility income is greater than $35,000as a homeowner or $15,000 as a renter. Claimants whoseeligibility income is greater than these maximum householdincome limits may be eligible for claim year 2015 if their eligibili-ty income is not greater than $36,663 for a property owner or$15,713 for a renter if the department can determine that the

increase in the income is due solely to Social Security cost-of-livingadjustments in 2013, 2014 and 2015.

To file as a property owner, renter, or owner/renter, you mustmeet all requirements for one of the following categories:OWNER

a. You owned and occupied your home, as evidenced by acontract of sale, deed, trust, or life estate held by agrantee;

b. You occupied your home (rebates are for your primaryresidence only); and

c. You or someone on your behalf paid the 2015 propertytaxes on your home.

RENTERa. You rented and occupied a home, apartment, nursing

home, boarding home, or similar residence inPennsylvania;

b. Your landlord paid property taxes or agreed to make apayment in lieu of property taxes on your rental propertyfor 2015 (see Page 11); and

c. You or someone on your behalf paid the rent on yourresidence for 2015.

OWNER/RENTERa. You owned, occupied, and paid property taxes for part of

the year and were a renter for part of the year;b. You owned and occupied your home and paid property

taxes and paid rent for the land upon which your home issituated; or

c. You paid rent for the home you occupied, and paid propertytaxes on the land upon which your home is situated.

CAUTION: As a renter, if you received cash public assistanceduring 2015, you are not eligible for any rebate for those monthsyou received cash public assistance. Please complete aPA-1000 Schedule D (enclosed in this booklet).

IMPORTANT: Please send photocopies, since the departmentcannot return original documents. Print your Social SecurityNumber (SSN) on each proof document that you submit withyour claim form.• If you are age 65 or older, provide proof of your age.• If you are under age 65 and your spouse is age 65 or older,

provide proof of your spouse’s age.• If you are a widow or widower age 50 to 64, provide proof of

your age and a photocopy of your spouse’s death certificate.• If you are permanently disabled, age 18 to 64, you must

provide proof of your age and proof of your permanentdisability.

ELIGIBILITY REQUIREMENTS

CATEGORY 2 – ELIGIBILITY INCOME

PROOF DOCUMENTS THAT FIRST TIME FILERS MUST SUBMIT

CATEGORY 1 – TYPE OF FILER

CATEGORY 3 – OWNER, RENTER OROWNER/RENTER

PA-1000 Pennsylvania Property Tax or Rent Rebate Program 3

PROOF OF AGENOTE: If you receive Social Security or SSI benefits and haveproven your age with the Social Security Administration, you donot need to submit proof of age.

IMPORTANT: The department accepts photocopies of thefollowing documents as proof of your age. Do not send youroriginal documents since the department cannot return originaldocuments.• Birth certificate• Blue Cross or Blue Shield 65 Special Card• Church baptismal record• Driver’s license or PA identification card• Hospital birth record• Naturalization/immigration paper, if age is shown• Military discharge paper, if age is shown• Medicare card• PACE/PACENET card• Passport

The department will not accept a Social Security card or huntingor fishing license as proof of age.If you have questions on other types of acceptable documents,please call the department at 1-888-222-9190.

PROOF OF DISABILITY• For Social Security disability, SSI permanent and total

disability, Railroad Retirement permanent and total disability,or Black Lung disability, provide a copy of your award letter.

• For Veterans Administration disability, provide a letter fromthe Veterans Administration stating that you are 100 percentdisabled.

• For Federal Civil Service disability, provide a letter from CivilService stating that you are 100 percent disabled.

• If you do not qualify under any of the disability programsmentioned above, did not apply for Social Security benefits,or do not have a letter from the Veterans Administration orCivil Service Administration, you must submit a Physician’sStatement of Permanent Disability (PA-1000 PS), enclosedin this booklet. The form must describe your disability aspermanent and your physician must sign the statement tocertify that the information is true and accurate to the best ofhis/her knowledge and belief.

IMPORTANT: The Physician’s Statement of Permanent Disabilitycannot be used if you were denied Social Security disability. The Department of Revenue has the legal authority to requireadditional evidence that you are permanently disabled and eligible for a rebate.

HOUSEHOLDS WITH MORE THAN ONE QUALIFIEDCLAIMANTOnly one member of your household may file a claim even ifmore than one person qualifies for a rebate. If someone otherthan your spouse appears on the deed or the lease, pleasecomplete a PA-1000 Schedule F (enclosed in this booklet). Youmay apply for only one rebate each year.

DECEASED CLAIMANTTo be eligible for a rebate, the claimant must have lived at leastone day of a claim year, owned and occupied and paid taxes orrented and occupied and paid rent for the claim year during thetime period the claimant was alive. The property tax paid for adeceased claimant will be prorated based upon the number ofdays the claimant lived during the claim year. See Schedule A forthe calculation of the prorated property tax rebate.

To determine if a deceased claimant is eligible for a rebate, adeceased claimant’s claim form must also include an annualizedincome amount in the calculation of total household income. SeeSchedule G, specifically the instructions for Line 11g, forinformation on the calculation of annualized income to beincluded in household income. A copy of the death certificatemust also be included with the claim form.

A surviving spouse, estate or personal representative may file aclaim on behalf of a deceased claimant. A personalrepresentative can also have a previously filed rebate issued inhis or her name, instead of the name of the decedent, in certaincircumstances. Please see sections entitled SURVIVINGSPOUSE, AN ESTATE, and PERSONAL REPRESENTATIVE for details.

SURVIVING SPOUSEThe surviving spouse can file the completed claim and include acopy of the death certificate and a letter stating that he/she wasthe spouse of the claimant at the time of death. The survivingspouse may sign on the claimant’s signature line.

ORIf the surviving spouse is eligible to file a claim, he/she can fileunder his/her own name instead of submitting a claim using thedeceased individual’s claim form.The surviving spouse should print his/her name, address, andSocial Security Number (SSN) in Part A, and follow the filinginstructions. The surviving spouse should answer NO toQuestion 3 in Part B, and furnish proof required for a first timefiler. Do not use the label the department sent to the decedent inthe booklet. The surviving spouse should enter the deceasedspouse’s SSN and name in the spouse information area, and fillin the oval “if Spouse is Deceased”, located in the area next tothe Spouse’s SSN on the claim form.

AN ESTATEThe executor or the administrator of the claimant’s estate mayfile the claim and submit a Short Certificate showing the will wasregistered or probated. When there is no will and there areassets (an estate), submit a copy of the Letters ofAdministration. A Short Certificate or Letters of Administrationcan be obtained from the county courthouse where the deathis recorded. The person filing the claim form on behalf of thedeceased person may sign on the claimant’s signature line.

PERSONAL REPRESENTATIVEIf a person dies and there is no will, the will has not beenregistered or probated or there is no estate, then a personalrepresentative may file a claim on behalf of an eligible decedent.A decedent’s personal representative must submit a copy ofthe decedent’s death certificate and a receipted copy of the


decedent’s funeral bill showing that the personal representativepersonally paid the decedent’s funeral expenses in an amountthat is greater than or equal to the amount of the propertytax/rent rebate to which the decedent is entitled.If a person dies after filing a claim and there is no will, or if thewill has not been registered or probated, or there is no estate,then a personal representative can also request that thedepartment change the rebate to be issued into his/her name. Incases where the rebate check has been received but cannot becashed, the check must be returned with a request to have therebate issued in the name of the personal representative. Thedecedent’s personal representative must submit a copy of thedecedent’s death certificate, and a receipted copy of theclaimant’s funeral bill showing that the personal representativepersonally paid the funeral expenses in an amount that isgreater than or equal to the amount of the property tax/rentrebate to the claimant is entitled.If you have any questions regarding the filing of a claim on behalf of a deceased claimant, please call the department at1-888-222-9190.

PRIVACY NOTIFICATIONBy law, (42 U.S.C. § 405(c)(2)(C)(i); 61 Pa. Code §117.16) thePennsylvania Department of Revenue has the authority to usethe Social Security Number (SSN) to administer the Property Taxor Rent Rebate Program, the Pennsylvania personal incometax and other Commonwealth of Pennsylvania tax laws. Thedepartment uses the SSN to identify individuals and verify theirincomes. The department also uses the SSN to administer anumber of tax-offset and child-support programs federal andPennsylvania laws require. The commonwealth may also usethe SSN in exchange-of-tax-information agreements withgovernmental authorities.Pennsylvania law prohibits the commonwealth from disclosinginformation that individuals provide on income tax returns andrebate claims, including the SSN(s), except for official purposes.

You must fill in your Social Security Number and enter yourcounty and school district codes even if using the preprintedlabel. If you are not using software to prepare your claim andyour label is correct, place your label in Part A. If you or yourpreparer are using software to prepare your claim, or if anyinformation on the preprinted label is incorrect, discard the label.If not using a label, follow the instructions for printing lettersand numbers and completing your name and address.If your spouse lived in a nursing home the entire year do notinclude his/her Social Security Number on the claim form. He orshe may qualify for a separate rebate on the rent paid to thenursing home.

IMPORTANT TIPS: There are two lines to enter your address.For the First Line of Address, enter the street address. If theaddress has an apartment number (APT), suite (STE), floor (FL)

or rural route number (RR), enter it after the street address. If thestreet address and the apartment number, suite, etc. do not fit onthe First Line of Address, enter the street address on the SecondLine of Address and the apartment number, suite, etc. on theFirst Line of Address. For the Second Line of Address, enter thepost office box, if applicable. If there is no post office box, leavethe Second Line of Address blank.

The U.S. Postal Service prefers that the actual delivery addressappears on the line immediately above the city, state and ZIPcode. Do not include any punctuation such as apostrophes,commas, periods and hyphens.

• Use black ink. Another color such as red ink will delay theprocessing of your rebate claim.

• Do not use pencil or pens labeled as gel pens or any red ink.

• Print all information on your claim neatly inside the boxes.

• Use upper case (capital) letters. Use a blank box to separatewords.

• Print one letter or number in each box when entering yourSocial Security Number, name, address, dollar amounts, andother information. If your name, address, or city begins withMc, Van, O’, etc., do not enter a space or a punctuation mark.

• Completely fill in all the appropriate ovals on your claim form.

As a claimant, you must provide your birth date, telephonenumber, county code, school district code, and, if applicable,your spouse’s Social Security Number, birth date, and name. If your spouse is deceased, completely fill in the oval “If Spouseis Deceased” in Part A of the form.

IMPORTANT: County & School Codes - You must enter the two-digit county code and five-digit school district code for where youlived on Dec. 31, 2015, even if you moved after Dec. 31, 2015.Using incorrect codes may affect your property tax rebate. Thelists of county and school district names and the respectivecodes are on Pages 14, 15 and 16. If you do not know the nameof the county or school district where you reside, you can either1) check the county and school property tax bills used tocomplete this claim if you are a property owner, or 2) obtain thisinformation from the Online Customer Service Center atwww.revenue.pa.gov.

Line 1 - Please fill in the oval that shows your correct filingstatus. Fill in only one oval. Filling in more than one oval mayreduce the amount of your rebate.

PA - 1000 FILING INSTRUCTIONS

PART A - SOCIAL SECURITY NUMBER, NAME,ADDRESS AND RESIDENCE INFORMATION

SampleM C D O E J O H N

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1 2 3 A N Y S T

H A R R I S B U R G P A

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1 7 1 2 8

J A N E 2 2 2 7 5

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PART B - FILING STATUS CATEGORIES


(P) Property Owners: Fill in this oval if you owned and occupiedyour home for all or part of 2015 and did not rent for any part ofthe year. If your deceased spouse’s name is on your deed or taxbills, include the decedent’s Social Security Number and name.

(R) Renters: Fill in this oval if you rented and occupied yourresidence for all or part of 2015.

(B) Owner/Renter: Fill in this oval if you owned and occupiedyour residence for part of 2015, and also rented and occupiedanother residence for the rest of 2015, or if you owned yourresidence and rented the land where your residence is located.

EXAMPLE: John pays property taxes on a mobile home that heowns and occupies. His mobile home is on land that he leases.John may claim a property tax rebate on the mobile home and arent rebate on the land. See Pages 8, 9 and 11 for documentsyou must send as proof of property taxes or rents paid.

Line 2 - Certification. Please read each description and selectthe type of filer that applies best to your situation as of Dec. 31,2015. A surviving spouse age 50 to 64 is eligible for a rebate asa widow or widower, while a surviving spouse who is 65 or oldercan file as a claimant. A surviving spouse under 50 may be ableto file a claim for a deceased claimant if the deceased was 65or older. Please complete the claim form using your SocialSecurity Number, name and address, and supply all appropriatedocumentation.

a. Claimant age 65 or olderb. Claimant under age 65, with a spouse age 65 or older who

resided in the same household (You must submit proof of your spouse’s age the first time you file.)

c. Widow or widower, age 50 to 65 (If your most recentmarriage ended in divorce, you do not qualify as awidow/widower.)

d. Permanently disabled and age 18 to 64See Pages 3 and 4 for acceptable proof of age documents.

Line 3 - If you are filing on behalf of a decedent (a claimant whodied during the claim year who otherwise would have been aneligible claimant under a, b, c or d for Line 2 above), completelyfill in the oval. The type of claimant under which the decedentqualifies under Line 2 above must also be included. A copy of thedeath certificate must be submitted and Schedule G must becompleted.

You must report the total household income you earned and/orreceived during 2015 for each category, which includes yourspouse’s income earned and/or received while residing with you. All claimants must submit proof of annual income.

IMPORTANT: The department reserves the right to requestadditional information or make adjustments to federal data ifcredits or deductions were taken to reduce income.

CAUTION: Spouses may not offset each other’s income and losses.

The department has the legal authority to require evidence of theincome you report on your claim. The following lists the kinds of

income you must report and the documents you must submit asproof of the reported income. You must include the income thatyour spouse received while residing with you. See Pages 7 and8 for a list of the kinds of income that you do not need to report.

NOTE: Print your Social Security Number on each ProofDocument that you submit with your claim form.

Line 4 - Include one-half of your 2015 Social Security Benefitsas shown in Box 5 of your benefit statement SSA-1099, one-halfof your 2015 SSI, one-half of your 2015 Social Security DisabilityIncome, and one-half of your 2015 State SupplementaryPayment. No documentation is required, if using a PA address.

Line 5 - Include one-half of your Railroad Retirement Tier 1Benefits. Submit a copy of form RRB-1099.

CAUTION: The total income from old age benefit programs fromother countries, such as Service Canada Old Age Security, mustbe converted into U.S. dollars and reported on Line 6.

Line 6 - Include the gross amount (not the taxable amount) ofpensions, annuities, Individual Retirement Account distributions,Tier 2 Railroad Retirement Benefits, Veterans’ DisabilityBenefits, and Civil Service Disability Benefits. Do not includeBlack Lung Benefits. Submit photocopies of pension/annuitybenefits statements along with other forms 1099 showingincome for 2015.

IMPORTANT: Do not include rollovers from IndividualRetirement Accounts and employer pensions. However, proofmust be provided. Proof includes, but is not limited to, a federalForm 1099-R showing a rollover or other documentationindicating that the distribution was rolled into a new account.

Line 7 - Report interest and dividends received or creditedduring the year, whether or not you actually received the cash. Ifyou received dividends and capital gains distributions frommutual funds, report the capital gains distributions portion of theincome as dividends, not as gains from the sale or exchange ofproperty. Include interest received from government entities. Youmust also include all tax-exempt interest income from directobligations of the U.S. government, any state government, orany political subdivision thereof in the amount shown on Line 7.SUBMIT THE FOLLOWING:• A copy of your federal Form 1040 Schedule B or your PA-40

Schedule A and/or B; or copies of any federal Forms 1099you received; OR

• A copy of the front page of your PA or federal income taxreturn verifying the income reported on Line 7.

IMPORTANT: If you received capital gains distributions from amutual fund, you must use PA Schedule B or the front page ofyour PA tax return to verify your income. If you have PA tax-exempt interest income, you must include federal Form 1040Schedule B along with a copy of the front page of your federaltax return.

Line 8 - Include gains or losses you realized from the sale ofstocks, bonds, and other tangible or intangible property as wellas any gains or losses realized as a partner in a partnership or

PART C - LINES 4 THROUGH 18


shareholder in a PA S corporation. Do not include capital gainsdistributions from mutual funds required to be reported on Line 7.

NOTE: The nontaxable gain on the sale of your principalresidence must also be reported on this line. If you realized aloss from the sale of your principal residence, this loss may beused to offset any other gains you realized from the sale oftangible or intangible property. However, any net loss reportedon this line cannot be deducted from any other income. You mayalso submit photocopies of each PA Schedule RK-1, PASchedule NRK-1 or federal Schedule K-1 that shows your gainsor losses for each partnership or PA S corporation.

Submit a copy of your federal Form 1040 Schedule D, a copy ofyour PA-40 Schedule D, or copies of any federal Forms 1099you received which will verify any gains or losses you realized. Ifyou received capital gains distributions from mutual funds, donot include a copy of federal Form 1040 Schedule D. You mustinclude a copy of your PA-40 Schedule D.

If you sold your personal residence during this claim year, submita statement showing the sale price less selling expenses, minusthe sum of the original cost and permanent improvements.

CAUTION: You may only use losses from the sale or exchangeof property to offset gains from the sale or exchange of property.

Line 9 - Include net rental, royalty, and copyright income orloss realized during 2015 from property owned and rented toothers, oil and gas mineral rights royalties or income receivedfrom a copyright as well as any net income or loss realized asa partner in a partnership or shareholder in a PA S corporation.

CAUTION: You may only use rental losses to offset rental income.

IMPORTANT: If you receive income from the rental of a portionof your own home, you must complete and submit a PA-1000Schedule E (enclosed in this booklet). Submit a copy of your federal Form 1040 Schedule E, Part I, or PA-40 Schedule E from your income tax return. You may also submit photocopiesof each PA Schedule RK-1, PA Schedule NRK-1 or federalSchedule K-1 that shows your net income or loss from rents, royalties, patents and copyrights for each partnership or PA S corporation.

Line 10 - Include net income or loss from a business,profession, or farm, and net income or loss you realized as apartner in a partnership or a shareholder in a PA S corporation.

CAUTION: You may only use business losses to offset business income.

IMPORTANT: If you operate your business or profession at yourresidence, you must complete and submit a PA-1000 Schedule E(enclosed in this 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 mayalso submit photocopies of each PA Schedule RK-1, PASchedule NRK-1, or federal Schedule K-1 that shows yourincome or loss for each business.

Lines 11a - 11g - Other Income - Complete Lines 11athrough 11g to report all other income that you and your spouseearned, received, and realized.For each category of income on Lines 11a through 11g, you mustsubmit proof, such as photocopies of Forms W-2, Department ofHuman Services cash assistance statements, your federal or PAincome tax returns, and any other documents verifying income.

Line 11a. - Gross salaries, wages, bonuses, commissions,and estate or trust income not included in business, profession,or farm income.

Line 11b. - Gambling and lottery winnings, including PALottery, Powerball and Mega Millions winnings, prize winnings,and the value of other prizes and awards. (A PA-40 Schedule Tmust be submitted to verify these winnings, as well as a W-2Gto document PA Lottery winnings.)

Line 11c. - Value of inheritance, alimony, and spousalsupport money.

Line 11d. - Cash public assistance/relief, unemploymentcompensation, and workers’ compensation benefits, exceptSection 306(c) benefits.

Line 11e. - Gross amount of loss of time insurance benefits, disability insurance benefits, long-term care insurance benefits (if received directly by the claimant), and life insurance benefits and proceeds, except the first $5,000 ofthe total death benefit payments.

Line 11f. - Gifts of cash or property totaling more than $300,except gifts between members of a household.

Line 11g. - Miscellaneous income and annualized incomeamount. Include any income not identified above prior to thecalculation of annualized income. If a claimant died during the claim year, an annualized income amount must also beincluded. To calculate the annualized income amount, completeSchedule G. When adding amounts for Line 3 of Schedule G, donot add any negative amounts reported on Lines 8, 9 or 10.

Do not report the following income:• Medicare or health insurance reimbursements;• Food stamps, surplus foods, or other such non-cash relief

supplied by a governmental agency;• Property Tax/Rent Rebate received in 2015;• The amount of any damages due to personal injuries or

sickness. Damages include Black Lung benefits and benefitsgranted under Section 306(c) of the Workers’ CompensationSecurity Fund Act (relating to Schedule of Compensation fordisability from permanent injuries of certain classes);

• Payments provided to eligible low-income households underthe commonwealth’s Low Income Home Energy AssistanceProgram;

• Payments received by home providers of the domiciliary careprogram administered by the Department of Aging, exceptthose payments in excess of the actual expenses of the care;

• Disability income received by disabled children in thehousehold;


• The difference between the purchase price of your residenceand its selling price, if you used the proceeds from the sale topurchase a new residence. This new residence must be yourprincipal residence;

• Federal or state tax refunds;• Spouse’s income earned or received while not living with you;• Public Assistance benefits received by children in the house-

hold, even though the check is issued in claimant’s name;• Child support; and• Individual Retirement Account and employer pension

rollovers (must provide a copy of federal Form 1099-R indicating rollover or other supporting documentation).

CAUTION: If a claimant had significant income that is nottypically received in equal amounts throughout the claim year, orif the number-of-days method does not accurately calculate theannualized income, the claim may be filed using an alternativemethod for determining the annualized income amount to beincluded on Line 11g. A worksheet must be included to show howthe amount of annualized income was determined in thoseinstances. The worksheet must clearly show how the incomewas determined and an explanation of the reason for deviatingfrom the Schedule G method. Examples of when the claim wouldbe filed using an alternative method would include instanceswhere there is income from a one-time event such as a gain onthe sale of stock, lump sum payments from an IRA or annuity, anamount is reported as an inheritance or a payment is receivedas a beneficiary on a life insurance policy. Proof of the deviationfrom the number-of-days method may be required by thedepartment. The department will accept reasonable methods ofcalculating the annualized income amount.

Line 12 - Add the positive income figures reported on Lines 4through 11g and enter the total. Do not include losses. Enter thetotal income on Line 12 and also Line 22.

IMPORTANT: If you have over $35,000 of income claimed onLine 12, you are not eligible for either Property Tax or RentRebate relief under this program unless a Social Security COLAis the only reason your income is greater than $35,000. SeePage 3 for additional information.

Line 13 - For Property Owners OnlyBefore completing Line 13 of the claim form, complete anyschedules listed in the instructions for this line. If you must com-plete more than one schedule, you must complete them inalphabetical order. If one schedule does not apply to you, skip it,and go to the next schedule. You must carry forward, as the totaltax paid, the last amount shown on the previous schedule youcomplete to the next schedule you complete. Enter the total amount of the property taxes paid for your primaryresidence, or the amount shown as eligible property taxes paidon the last schedule completed.

IMPORTANT: If you do not enter the amount of all taxes paid on the primary residence, you will limit the department’s ability to determine your eligibility for and amount of a supplementalrebate. See Page 13 for more information on supplementalrebates.

You must deduct interest or penalty payments, municipalassessments, per capita taxes, or occupation taxes included inyour payment. If you paid early and received a discount, youenter the amount you actually paid on Line 13. You must alsodeduct other charges included in your tax bills. See taxes thatare not acceptable on Page 9.If your name does not appear on the receipted tax bills, you mustsubmit proof of ownership. Examples of proper proof are: acopy of the deed or a copy of the trust agreement, will, or decreeof distribution if you inherited your property. If your address is noton your receipted property tax bill or mortgage statement, youalso must submit a letter from your tax collector or mortgagecompany verifying your home address.

NOTE: If your tax bills include a name and/or names other thanyours and your spouse’s, you must complete PA-1000 ScheduleF or submit proof that you are the sole owner of the property.Include only the property tax on the amount of land that isnecessary for your personal use.

PA-1000 Schedule A - If you owned and occupied your homefor less than the entire year of 2015 or a claim is being filed onbehalf of a deceased owner who died during 2015.

PA-1000 Schedule B - If you were a widow or widower age 50to 64 who remarried in 2015.

PA-1000 Schedule E - If you used part of your residence for apurpose other than living quarters in 2015.

PA-1000 Schedule F - If your deed shows owners other thanyour spouse.

As proof of property tax paid, homeowners must providephotocopies of one of the following real estate documents:• All 2015 real estate tax bills that have been marked “paid” by

the tax collector (see the instructions beginning on this pagefor the proper calculation of the amount on Line 13). If youpaid your taxes in quarterly installments, a tax bill must besubmitted for each period. For tax bills that are not markedpaid by the tax collector, the department will accept aphotocopy of both sides of the cancelled check along with acopy of the tax bill;

• Your year-end mortgage statement showing the amount ofreal estate taxes paid;

• A letter signed by the tax collector certifying that you paidyour 2015 real estate taxes. The letter should also declarethe total tax does not include nuisance taxes or penalty; OR

• A receipted copy of your tax billing from your owner’sassociation or corporation. Resident stockholders of acooperative housing corporation, such as a condominium,may qualify as property owners based on their pro rata share of the property taxes paid to the corporation fortheir residence.

The following types of receipted real estate tax bills areacceptable:• County• School district


• City

• Borough

• Township

Taxes/charges that are not acceptable (even if based onmillage):• Flat rate charges

• Footage charges

• Personal property tax

• Per capita tax

• Occupational privilege tax

• Sewer rent

• Garbage collection charges

• Municipal assessments such as, or including, road,institution, street, library, light, water, fire, debt, and sinkingfund taxes

• Interest or penalty payments

If your tax bills contain any of these charges, you must deductthem when completing Line 13.

Line 14 - To determine the amount for Line 14, start with theamount of your total income on Line 22. In Table A, find theincome range that includes your Line 22 amount and circle thecorresponding maximum standard rebate amount. Compareyour maximum standard rebate amount to the amount on Line 13and enter the lesser amount on Line 14. The department will notpay a rebate for less than $10. The maximum standard rebatecannot exceed $650.

Line 15 - For Renters OnlyIMPORTANT: If you have over $15,000 of income on Line 12, youare not eligible for the rent rebate relief portion of this programunless a Social Security COLA is the only reason your income isgreater than $15,000. See Page 3 for additional information.

PA-1000 Schedule RC - You must always complete this sched-ule before completing Line 15 or the additional schedules notedlater in the instructions for this line. If none of the additionalschedules apply, report the amount from Line 8 of Schedule RCon Line 15 of your claim form.You may claim a rebate only if you pay rent to a property ownerfor a dwelling that you rent for use as a home that is a self-con-tained unit.

NOTE: A landlord-tenant relationship exists when the landlord(lessor) provides the claimant (lessee) with a lease for a self-contained unit. This usually means a separate kitchen, bath andbedroom.

The landlord (lessor) must maintain a lease agreement, haveseparate utility bills, have other evidence of a self-contained unitand report the rental income on federal and PA tax returns. If thelandlord (lessor) also claims a Property Tax/Rent Rebate, theymust submit a PA-1000 Schedule E (enclosed in this booklet),and provide their federal or PA tax return. You, as the claimantfor a rebate, are responsible to prove a landlord-tenant relation-ship. Self-contained dwellings for rent eligible for rent rebatescan include:• Apartment in a house• Apartment building• Boarding home• Mobile home• Mobile home lot• Nursing home• Private home• Personal care home• Assisted living• Domiciliary care• Foster care

Rent Payment Subsidies - For the purpose of this rebate claim,subtract rent payment subsidies provided by or through a gov-ernmental agency from the total rent you paid. See Line 5 of thePA Rent Certificate.

Renters must provide one of the following proof documents:1. A PA Rent Certificate for each place you rented during the

year. Keep copies for your records. Your landlord orhis/her authorized agent should complete Lines 1 through8 and sign the PA Rent Certificate.

2. If you cannot get your landlord’s signature, you mustcomplete and submit the PA Rent Certificate and thenotarized Occupancy Affidavit that is below the PA RentCertificate. Complete the Occupancy Affidavit in itsentirety and write the reason the landlord did not sign thePA Rent Certificate.

3. Rent receipts signed by your landlord or his/her agent foreach month for which you are claiming a rebate that showyour name and rental address, the amount of rent paid andthe period for which you paid rent.

ATTENTION PHILADELPHIA RESIDENTS:The City of Philadelphia has provided the department withelectronic records of all receipted 2015 property tax bills forPhiladelphia that were paid by Dec. 31, 2015. If you live inthe City of Philadelphia and paid your 2015 property taxesby Dec. 31, 2015, do not include a copy of your receiptedproperty tax bills. If you live in Philadelphia and paid your2015 property taxes in 2016, please submit proof of paymentas outlined in the preceding information.

NOTE: You or the person who prepares your claim will needto know the amount of tax you paid in order to correctlycalculate your rebate. If you do not have a copy of your orig-inal tax bill or a copy of your tax payment, you or your pre-parer will need to estimate the amount of taxes you paid. Ifthe tax amount you provide is not correct, the department willadjust the amount of your rebate based upon the paid taxesreported to the department by the City of Philadelphia.


�

�

�

�

�

�

�

�

�

OFFICIAL USE ONLY

Spouse’s Social Security NumberYour Social Security Number

Claimant’s Birthdate

M M D D Y Y

Spouse’s Birthdate

M M D D Y Y

Spouse’s First Name County Code School District CodeMI

PLEASE WRITE IN YOUR SOCIAL SECURITY NUMBER(S) ABOVE

Last Name First Name MI

First Line of Address

Second Line of Address

State ZIP CodeCity or Post OfficeP

LA

CE

L

AB

EL

H

ER

E

Daytime Telephone Number

Check your label for accuracy. If incorrect, do not use the label. Complete Part A. Fill in only one oval in eachsection.

A

C

BIf Spouse is Deceased, fill in the oval. 1. I am filing for a rebate as a:

P. Property Owner – See instructions

R. Renter – See instructionsB. Owner/Renter – See

instructions2. I Certify that as of Dec. 31, 2015,

I am (a):A. Claimant age 65 or olderB. Claimant under age 65,

with a spouse age 65 or older who resided in the same household

C. Widow or widower, age 50 to 64

D. Permanently disabled and age 18 to 64

3.Filing on behalf of a decedent

TOTAL INCOME received by you and your spouse during 2015 Dollars Cents

4.

5.

4. Social Security, SSI and SSP Income (Total benefits $ divided by 2) . . . . . . . . . .

5. Railroad Retirement Tier 1 Benefits (Total benefits $ divided by 2) . . . . . . . . . . .

PA-1000Property Tax or RentRebate ClaimPA-1000 (08-15)PA Department of RevenueHarrisburg PA 17128-0503 2015

8. Gain or Loss on the Sale or Exchange of Property. . . . . . . . . If a loss, fill in this oval. . . . .

7. Interest and Dividend Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

7.

8.

9.

10.

11a.

6. Total Benefits from Pension, Annuity, IRA Distributions, Veterans’ Disability and Railroad RetirementTier 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

12.12. TOTAL INCOME. Add only the positive income amounts from Lines 4 through 11g. See Page 3

for income limitations. Enter this amount on line 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

LOSS

9. Net Rental Income or Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . If a loss, fill in this oval. . . . .

10. Net Business Income or Loss . . . . . . . . . . . . . . . . . . . . . . . . . If a loss, fill in this oval. . . . .

LOSS

LOSS

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

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

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

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

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

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

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

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

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

�11g.11g. Miscellaneous income and annualized income amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other Income.

� REQUIRED �

1505010015

1505010015

Call 1-888-728-2937 to check the status of your claim or to update your address.Deadline - June 30, 2016.

13.

14.

15.

16.

18.

14. Property Tax Rebate. Enter the maximum standard rebate Compare this amount to line 13 and amount from Table A for your income level here: (_______) enter the lesser amount to the right.

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

OWNER – RENTER ONLY18. Property Tax/Rent Rebate. Enter the maximum Compare this amount to the sum of

rebate amount from Table A for your income Lines 14 and 17 and enter the lesser level here: (_______) amount to the right.

RENTERS ONLY15. Total 2015 rent paid. Submit PA Rent Certificate and/or rent receipts . . . . . . . . . . . . . . . . . . . . . .

PROPERTY OWNERS ONLY13. Total 2015 property tax. Submit copies of receipted tax bills. . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

DIRECT DEPOSIT. Banking rules do not permit direct deposits to bank accounts outside the U.S. If your bank account is outside the U.S.,do not complete the direct deposit Lines 19, 20 and 21. The department will mail you a paper check. If your rebate will be going to a bankaccount within the U.S., you have the option to have your rebate directly deposited. If you want the department to directly deposit your rebateinto your checking or savings account, complete Lines 19, 20 and 21.

20.

21.

Checking

Savings

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

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

17. Rent Rebate. Enter the maximum rebate amount Compare this amount to line 16 and from Table B for your income level here: (_______) enter the lesser amount to the right. 17.

Your Social Security Number

PA-1000 2015

Your Name:

19.

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

Spouse’s Signature Date

PREPARER: I declare that I prepared this return, and that it is to the best of myknowledge and belief, true, correct and complete.

Preparer’s Signature, if other than the claimant Date

Preparer’s Name. Please print.

Preparer’s telephone number( )

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

1.

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

Telephone number of claimant’s power of attorney or nearest relative.( )Home address of claimant’s power of attorney or nearest relative. Please print.

City or Post Office State ZIP Code

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

D

TABLE A - OWNERS ONLYINCOME LEVEL Maximum Standard

Rebate$ 0 to $ 8,000 $650$ 8,001 to $15,000 $500$15,001 to $18,000 $300$18,001 to $35,000 $250

TABLE B - RENTERS ONLYINCOME LEVEL Maximum

Rebate$ 0 to $ 8,000 $650$ 8,001 to $15,000 $500

Enter the amount from Line 12 ofthe claim form on this line and circlethe corresponding Maximum Rebateamount for your income level.Owners use Table A and Rentersuse Table B.

22.

1505120012

1505120012

1505120012

Fill in this oval if your spouse is deceased.

If your label is correct,

place it here.

Discard label if it is not correct

and fill in all data in Part A.

If you were both a PropertyOwner and a Renter,

complete Lines 13 through 18.

Fill in your Social Security Number.

Fill in only one oval for Line 1.

Fill in only one oval for Line 2.

Samp l e

Samp l e

Report your total SocialSecurity, SSI, and SSP benefitshere. Divide the total by 2 and

enter the result on Line 4.

Enter the total of Lines 4through 11g.

Report your total RailroadRetirement Tier 1 benefits here.Divide the total by 2 and enter

the result on Line 5.

PA-1000 COMPLETION SAMPLE

Property Ownerscomplete Lines

13 and 14.

Renters completeLines 15, 16 and 17.

If you want yourrebate directly

deposited, completeLines 19,20 and 21.

Claimant signs here.

Fill in School District Code (see Pages 15 and 16). Fill inCounty Code (see Page 14).


Enter your Routing Numberhere (direct deposit only).

Enter your Account Numberhere (direct deposit only).

Fill in this oval on behalfof decedent.


NOTE: The department will not accept cancelled checks asproof of rent paid. Print your Social Security Number on eachproof document that you submit with your claim form.

IMPORTANT: If your landlord is a tax-exempt entity and is notrequired to pay property taxes on your rental property, you do notqualify for a rent rebate unless your landlord makes payments inlieu of taxes. In this situation, landlords agree to make reason-able cash payments in lieu of taxes to a local governmentauthority (county, municipality, school district, fire/police depart-ment, etc.) in order to allow their residents to claim rent rebates.

Before completing Line 15 of the claim form, complete anyschedules listed in the instructions for this line. If you must complete more than one schedule, you must complete them inalphabetical order.If one schedule does not apply to you, skip it, and go to the nextschedule. You must carry forward, as the total rent paid, the lastamount shown on the previous schedule you complete to thenext schedule you complete.Report the amount shown on the last schedule that applies toyou on Line 15 of the claim form.

PA-1000 Schedule B - If you were a widow or widower age 50to 64 who remarried in 2015.

PA-1000 Schedule D - If you were a renter who received cashpublic assistance in 2015.

PA-1000 Schedule E - If you used part of your residence for apurpose other than living quarters in 2015.

PA-1000 Schedule F - If your lease shows persons other thanyour spouse or minor children.If you were required to complete Schedules B, D, E, or F, enterthe lesser amount of the total rent paid in 2015 or the amountshown as eligible rents paid, on the last schedule completed.

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

Line 17 - To determine the amount for Line 17, start with the amount of your total income on Line 22. In Table B, find theincome range that includes your Line 22 amount and circle the corresponding maximum rebate amount. Compare your maximum rebate amount to the amount on Line 16 and enter thelesser amount on Line 17. The department will not pay a rebatefor less than $10. The maximum standard rebate cannot exceed$650.

Line 18 - For Owner/Renter OnlyIMPORTANT: If you have over $15,000 of income claimed onLine 12, you are not eligible for the rent rebate relief portion ofthis program unless a Social Security COLA is the only reasonyour income is greater than $15,000. See Page 3 for additionalinformation.

CAUTION: As 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. Fillingin other ovals may reduce your rebate amount. If you were botha property owner and a renter in 2015, you must calculate yourproperty tax rebate separately from your rent rebate. Complete

Lines 13 and 14 to calculate your property tax rebate andcomplete Lines 15 through 17 to calculate your rent rebate.

Add Lines 14 and 17 - To determine the amount for Line 18,start with the amount of your total income in Line 22. In Table A,find the income range that includes your Line 22 amount andcircle the corresponding maximum standard rebate amount.Compare your maximum standard rebate amount to the sum ofLines 14 and 17 and enter the lesser amount on Line 18. The department will not pay a rebate for less than $10. The maximum standard rebate cannot exceed $650.

Line 19 - In order to comply with banking rules, directdeposits are not available for rebates going to bank accountsoutside the U.S. If your bank account is outside the U.S., do notcomplete the direct deposit Lines 19, 20 and 21. The departmentwill send you a paper check.If your rebate will be going to a bank account within the U.S., youhave the option to have your rebate directly deposited.If you want the Department of Revenue to directly deposit your rebate into your checking or savings account at your bank,credit union, or other financial institution, place an X in theappropriate box on Line 19. Then complete Lines 20 and 21.

CAUTION: Be sure to enter the correct routing and accountnumbers. Please check with your financial institution to makesure your direct deposit will be accepted and to get the correctrouting and account numbers. The Department of Revenue isnot responsible for a lost rebate if you enter the wrongaccount information. The Department of Revenue cannotchange the banking information you enter in these spaces.If the information you entered is not accurate or up to date,the department will send a check instead of making a directdeposit into your account.By placing an X in either box on Line 19, you are authorizing thedepartment to directly deposit your rebate into your checking or savings account. Direct deposits cannot be made toSocial Security Direct Express ® cards.

IMPORTANT: Do not include a copy of a blank check withyour rebate application. The department cannot complete thisinformation on your application.

Line 20 - Routing Number Enter your bank or financial institution’s nine-digit routing number. The first two digits must be 01 through 12, or 21 through32. Do not use spaces or special characters when entering therouting number. EXAMPLE: The routing number on the samplecheck on Page 12 is 250250025. If you are attempting to complete this line using a deposit slip,please contact your financial institution to determine if the routing number is correct. Many times the number on the deposit slip is for internal use by the institution and using it may delay the payment of your rebate.

NOTE: This number must be nine digits. Otherwise, yourfinancial institution will reject the direct deposit, and the department will mail you a check.

DIRECT DEPOSIT


IMPORTANT: Your check may state that it is payable through a bank different from the financial institution where you haveyour account (i.e. your check may have two banks listed on the face). If so, do not use the routing number on your check.Instead, ask your financial institution for the correct routing number and enter it on Line 20.

Line 21 - Checking or Savings Account NumberEnter your checking or savings account number. Your accountnumber may be as many as 17 digits and may contain both numbers and letters.

Enter the numbers and letters from left to right. Do not use spaces or special characters when you enter your accountnumber and leave any unused boxes blank. EXAMPLE: Thechecking account number on the sample check below is20202086. Do not include the check number. The checknumber on the sample check is 0001. If you are attempting

to complete this line using a direct deposit slip, please contactyour financial institution to determine if the account number is correct. Many times the number on the deposit slip is for internal use by the institution and using it may delay the payment of your rebate.

CAUTION: If your bank has recently changed ownership, the routing and account numbers on your check may be incorrect. Please verify the routing and account numbers withyour bank before you enter them on Lines 20 and 21.

IMPORTANT: If you apply before the end of May and opt for direct deposit of your rebate, you may notice a zero dollartransaction on your April or May bank statement. This transaction is part of a security process conducted to verify your account information and ensure your rebate arrives quickly and accurately. If account information cannot be verifiedfor direct deposit, the department will send you a paper check.

Line 22 - Total IncomeLine 22 is used to determine the correct rebate amount. Enter the amount from Line 12 of the claim form on this lineand circle the corresponding Maximum Standard Rebate orMaximum Rebate amount for your income level. Owners useTable A and Renters use Table B.

Please read the following oath before signing the claim form.

CLAIMANT OATH: I declare that this claim is true, correct, andcomplete to the best of my knowledge and belief, and this is the only claim filed by members of my household. I authorize

the PA Department of Revenue access to my federal andPennsylvania personal income tax records, my PACE records,my Social Security Administration records, and/or myDepartment of Human Services records. This access is for veri-fying the truth, correctness, and completeness of the informa-tion reported in this claim.

If you do not agree with the oath, do not sign the claim form.However, the department will not process the claim form orissue a rebate without a signature.

NOTE: The Property Tax or Rent Rebate program is a benefitprovided to qualifying homeowners who apply. The Departmentof Revenue will not place a lien or judgment on your propertybecause of a Property Tax/Rent Rebate paid to you.

PART D - OATH

SAMPLE CHECK

Routing Number Account Number Check Number

Joe & Jane Taxpayer 50-42 0001123 Drive Avenue 370Nowhere, PA 78910 1234567890

Date

Pay To The Order Of:$

Dollars

Your Bank

Commonwealth Region

Harrisburg, PA

Memo Signature

I: 250250025 :I 202III02III086 III0001

Please do not send a copy of a blank or voided check with your rebate application.

REBATE TABLES

TABLE A - OWNERS ONLY

Maximum StandardRebate

TOTAL INCOMEFrom Line 12 of your claim form

$ 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

Maximum RebateTOTAL INCOMEFrom Line 12 of your claim form

$ 0 to $ 8,000 $ 650

$ 8,001 to $ 15,000 $ 500


SIGNATURES: Sign and date the claim form in the space provided. The signature must match the name listed on thelabel or printed on the name line. If someone other than theclaimant signs the claim form, a copy of the Power of Attorney, guardianship papers, or other documents entitling that person to sign must accompany the claim form. In the case ofdeceased claimant, see the instructions on Page 4.If the claimant makes a mark instead of a signature, two people must sign the form as witnesses to the claimant’s mark.Also please provide the name, address, and telephone numberof the claimant’s nearest relative. This helps the departmentlocate claimants if the Post Office returns a rebate check asundeliverable.

You must complete and submit one original claim form to the Department of Revenue. Do not submit a photocopy of theclaim form. For your convenience, the department provides two claim forms. If you need another claim form, visit www.revenue.pa.gov or call the Forms Ordering MessageService at 1-800-362-2050.

IMPORTANT: Do not use staples. Using staples delays theprocessing of your claim and damages your claim form andother documents.

Place your completed claim form and other necessary documents in the envelope provided. Use the checklist on the

back of the envelope to verify that your claim is complete.Incomplete claims will delay your rebate. If you do not have theenvelope the department provided, mail your completed claimform and necessary documents to:

PA DEPARTMENT OF REVENUEPROPERTY TAX OR RENT REBATE PROGRAMPO BOX 280503HARRISBURG PA 17128-0503

Revenue from slots gaming is providing general property taxrelief to all Pennsylvania homeowners. Supplemental propertytax rebates, equal to 50 percent of taxpayers’ base rebates, areavailable to provide extra relief to homeowners who need it themost.

Homeowners in Pittsburgh, Scranton and Philadelphia with eli-gibility income of $30,000 or less will receive additional pay-ments, as will homeowners in the rest of the state who meetthe same income-eligibility requirement and pay more than 15percent of their household income in property taxes.

IMPORTANT: If you are eligible for a supplemental paymentabove the maximum rebate, the department will calculate it for you. Please follow the instructions for Lines 13 and 14 on Pages 8 and 9 of this booklet to complete your rebate application; do not adjust the amounts on Line 14.

SUPPLEMENTAL PROPERTY TAX REBATES

MAILING INSTRUCTIONS

Adams . . . . . . . . . . . . . 01Allegheny . . . . . . . . . . 02

Armstrong . . . . . . . . . . 03

Beaver . . . . . . . . . . . . . 04

Bedford . . . . . . . . . . . . 05

Berks . . . . . . . . . . . . . . 06

Blair . . . . . . . . . . . . . . . 07

Bradford . . . . . . . . . . . 08

Bucks . . . . . . . . . . . . . 09

Butler . . . . . . . . . . . . . . 10

Cambria . . . . . . . . . . . . 11

Cameron . . . . . . . . . . . 12

Carbon . . . . . . . . . . . . 13

Centre . . . . . . . . . . . . . 14

Chester . . . . . . . . . . . . 15

Clarion . . . . . . . . . . . . . 16

Clearfield . . . . . . . . . . . 17

Clinton . . . . . . . . . . . . . 18

Columbia . . . . . . . . . . . 19

Crawford . . . . . . . . . . . 20

Cumberland . . . . . . . . . 21

Dauphin . . . . . . . . . . . . 22

Delaware . . . . . . . . . . . 23

Elk . . . . . . . . . . . . . . . 24

Erie . . . . . . . . . . . . . . . 25

Fayette . . . . . . . . . . . . 26

Forest . . . . . . . . . . . . . 27

Franklin . . . . . . . . . . . . 28

Fulton . . . . . . . . . . . . . 29

Greene . . . . . . . . . . . . 30

Huntingdon . . . . . . . . . 31

Indiana . . . . . . . . . . . . 32

Jefferson . . . . . . . . . . . 33

Juniata . . . . . . . . . . . . . 34

Lackawanna . . . . . . . . 35

Lancaster . . . . . . . . . . 36

Lawrence . . . . . . . . . . . 37

Lebanon . . . . . . . . . . . 38

Lehigh . . . . . . . . . . . . . 39

Luzerne . . . . . . . . . . . . 40

Lycoming . . . . . . . . . . . 41

McKean . . . . . . . . . . . . 42

Mercer . . . . . . . . . . . . . 43

Mifflin . . . . . . . . . . . . . . 44

Monroe . . . . . . . . . . . . 45

Montgomery . . . . . . . . 46

Montour . . . . . . . . . . . . 47

Northampton . . . . . . . . 48

Northumberland . . . . . 49

Perry . . . . . . . . . . . . . . 50

Philadelphia . . . . . . . . . 51

Pike . . . . . . . . . . . . . . . 52

Potter . . . . . . . . . . . . . . 53

Schuylkill . . . . . . . . . . . 54

Snyder . . . . . . . . . . . . . 55

Somerset . . . . . . . . . . . 56

Sullivan . . . . . . . . . . . . 57

Susquehanna . . . . . . . 58

Tioga . . . . . . . . . . . . . . 59

Union . . . . . . . . . . . . . . 60

Venango . . . . . . . . . . . 61

Warren . . . . . . . . . . . . . 62

Washington . . . . . . . . . 63

Wayne . . . . . . . . . . . . . 64

Westmoreland . . . . . . . 65

Wyoming . . . . . . . . . . . 66

York . . . . . . . . . . . . . . . 67

PENNSYLVANIA COUNTIES & CODES


CLEARFIELD


ADAMS

Bermudian Springs . . . . . . . . . . . . . .01110Conewago Valley . . . . . . . . . . . . . . .01160Fairfield Area . . . . . . . . . . . . . . . . . .01305Gettysburg Area . . . . . . . . . . . . . . . .01375Littlestown Area . . . . . . . . . . . . . . . .01520Upper Adams . . . . . . . . . . . . . . . . . .01852

ALLEGHENY

Allegheny Valley . . . . . . . . . . . . . . .02060Avonworth . . . . . . . . . . . . . . . . . . . .02075Baldwin Whitehall . . . . . . . . . . . . . . .02110Bethel Park . . . . . . . . . . . . . . . . . . .02125Brentwood Borough . . . . . . . . . . . . .02145Carlynton . . . . . . . . . . . . . . . . . . . .02160Chartiers Valley . . . . . . . . . . . . . . . .02175Clairton City . . . . . . . . . . . . . . . . . . .02190Cornell . . . . . . . . . . . . . . . . . . . . . . .02210Deer Lakes . . . . . . . . . . . . . . . . . . .02225Duquesne City . . . . . . . . . . . . . . . . .02250East Allegheny . . . . . . . . . . . . . . . . .02280Elizabeth Forward . . . . . . . . . . . . . .02315Fort Cherry . . . . . . . . . . . . . . . . . . . .63240Fox Chapel Area . . . . . . . . . . . . . . .02391Gateway . . . . . . . . . . . . . . . . . . . . . .02410Hampton Township . . . . . . . . . . . . .02460Highlands . . . . . . . . . . . . . . . . . . . . .02475Keystone Oaks . . . . . . . . . . . . . . . .02500McKeesport Area . . . . . . . . . . . . . . .02600Montour . . . . . . . . . . . . . . . . . . . . . .02630Moon Area . . . . . . . . . . . . . . . . . . . .02634Mount Lebanon . . . . . . . . . . . . . . . .02640North Allegheny . . . . . . . . . . . . . . . .02685Northgate . . . . . . . . . . . . . . . . . . . . .02687North Hills . . . . . . . . . . . . . . . . . . . .02690Penn Hills . . . . . . . . . . . . . . . . . . . . .02735Penn-Trafford . . . . . . . . . . . . . . . . . .65710Pine-Richland . . . . . . . . . . . . . . . . .02100Pittsburgh . . . . . . . . . . . . . . . . . . . . .02745Plum Borough . . . . . . . . . . . . . . . . .02750Quaker Valley . . . . . . . . . . . . . . . . .02775Riverview . . . . . . . . . . . . . . . . . . . . .02820Shaler Area . . . . . . . . . . . . . . . . . . .02830South Allegheny . . . . . . . . . . . . . . . .02865South Fayette Township . . . . . . . . .02870South Park . . . . . . . . . . . . . . . . . . . .02875Steel Valley . . . . . . . . . . . . . . . . . . .02883Sto-Rox . . . . . . . . . . . . . . . . . . . . . .02885Upper Saint Clair Township . . . . . . .02920West Allegheny . . . . . . . . . . . . . . . .02940West Jefferson Hills . . . . . . . . . . . . .02955West Mifflin Area . . . . . . . . . . . . . . .02960Wilkinsburg Borough . . . . . . . . . . . .02980Woodland Hills . . . . . . . . . . . . . . . . .02990

ARMSTRONG

Allegheny Clarion Valley . . . . . . . . .16030Apollo-Ridge . . . . . . . . . . . . . . . . . .03060Armstrong . . . . . . . . . . . . . . . . . . . .03085Freeport Area . . . . . . . . . . . . . . . . . .03305Karns City Area . . . . . . . . . . . . . . . .10360Kiski Area . . . . . . . . . . . . . . . . . . . . .65440Leechburg Area . . . . . . . . . . . . . . . .03450Redbank Valley . . . . . . . . . . . . . . . .16800

BEAVER

Aliquippa Borough . . . . . . . . . . . . .04050Ambridge Area . . . . . . . . . . . . . . . . .04070Beaver Area . . . . . . . . . . . . . . . . . . .04120Big Beaver Falls Area . . . . . . . . . . .04150Blackhawk . . . . . . . . . . . . . . . . . . . .04160Central Valley . . . . . . . . . . . . . . . . . .04200Ellwood City Area . . . . . . . . . . . . . .37200Freedom Area . . . . . . . . . . . . . . . . .04285Hopewell Area . . . . . . . . . . . . . . . . .04410Midland Borough . . . . . . . . . . . . . . .04530New Brighton Area . . . . . . . . . . . . . .04565Riverside Beaver County . . . . . . . . .04585Rochester Area . . . . . . . . . . . . . . . .04690South Side Area . . . . . . . . . . . . . . . .04740Western Beaver County . . . . . . . . . .04930

BEDFORD

Bedford Area . . . . . . . . . . . . . . . . . .05100Chestnut Ridge . . . . . . . . . . . . . . . .05150Claysburg-Kimmel . . . . . . . . . . . . . .07150Everett Area . . . . . . . . . . . . . . . . . . .05300Northern Bedford County . . . . . . . . .05600Tussey Mountain . . . . . . . . . . . . . . .05800

SCHOOL DISTRICT CODE SCHOOL DISTRICT CODE SCHOOL DISTRICT CODE SCHOOL DISTRICT CODE

Palmerton Area . . . . . . . . . . . . . . . .13650Panther Valley . . . . . . . . . . . . . . . . .13660Weatherly Area . . . . . . . . . . . . . . . .13900

CENTRE

Bald Eagle Area . . . . . . . . . . . . . . . .14100Bellefonte Area . . . . . . . . . . . . . . . . .14110Keystone Central . . . . . . . . . . . . . . .18360Penns Valley Area . . . . . . . . . . . . . .14700Philipsburg-Osceola Area . . . . . . . .17700State College Area . . . . . . . . . . . . . .14800Tyrone Area . . . . . . . . . . . . . . . . . . .07800

CHESTER

Avon Grove . . . . . . . . . . . . . . . . . . .15050Coatesville Area . . . . . . . . . . . . . . . .15190Downingtown Area . . . . . . . . . . . . . .15200Great Valley . . . . . . . . . . . . . . . . . . .15350Kennett Consolidated . . . . . . . . . . .15400Octorara Area . . . . . . . . . . . . . . . . .15650Owen J. Roberts . . . . . . . . . . . . . . .15660Oxford Area . . . . . . . . . . . . . . . . . . .15670Phoenixville Area . . . . . . . . . . . . . . .15720Spring-Ford Area . . . . . . . . . . . . . . .46730Tredyffrin Easttown . . . . . . . . . . . . .15780Twin Valley . . . . . . . . . . . . . . . . . . . .06810Unionville-Chadds Ford . . . . . . . . . .15850West Chester Area . . . . . . . . . . . . . .15900

CLARION

Allegheny Clarion Valley . . . . . . . . .16030Armstrong . . . . . . . . . . . . . . . . . . . .03085Clarion Area . . . . . . . . . . . . . . . . . . .16120Clarion-Limestone Area . . . . . . . . . .16170Keystone . . . . . . . . . . . . . . . . . . . . .16650North Clarion County . . . . . . . . . . . .16750Redbank Valley . . . . . . . . . . . . . . . .16800Union . . . . . . . . . . . . . . . . . . . . . . . .16900

CLEARFIELD

Clearfield Area . . . . . . . . . . . . . . . . .17100Curwensville Area . . . . . . . . . . . . . .17180Dubois Area . . . . . . . . . . . . . . . . . . .17200Glendale . . . . . . . . . . . . . . . . . . . . .17300Harmony Area . . . . . . . . . . . . . . . . .17350Moshannon Valley . . . . . . . . . . . . .17500Philipsburg-Osceola Area . . . . . . . .17700Purchase Line . . . . . . . . . . . . . . . . .32730West Branch Area . . . . . . . . . . . . . .17900

CLINTON

Jersey Shore Area . . . . . . . . . . . . . .41400Keystone Central . . . . . . . . . . . . . . .18360West Branch Area . . . . . . . . . . . . . .17900

COLUMBIA

Benton Area . . . . . . . . . . . . . . . . . . .19100Berwick Area . . . . . . . . . . . . . . . . . .19110Bloomsburg Area . . . . . . . . . . . . . . .19120Central Columbia . . . . . . . . . . . . . . .19150Millville Area . . . . . . . . . . . . . . . . . . .19500Mount Carmel Area . . . . . . . . . . . . .49510North Schuylkill . . . . . . . . . . . . . . . .54500Southern Columbia Area . . . . . . . . .19750

CRAWFORD

Conneaut . . . . . . . . . . . . . . . . . . . . .20103Corry Area . . . . . . . . . . . . . . . . . . . .25145Crawford Central . . . . . . . . . . . . . . .20135Jamestown Area . . . . . . . . . . . . . . .43360Penncrest . . . . . . . . . . . . . . . . . . . . .20470Titusville Area . . . . . . . . . . . . . . . . . .61720Union City Area . . . . . . . . . . . . . . . .25910

CUMBERLAND

Big Spring . . . . . . . . . . . . . . . . . . . .21050Camp Hill . . . . . . . . . . . . . . . . . . . . .21100Carlisle Area . . . . . . . . . . . . . . . . . . .21110Cumberland Valley . . . . . . . . . . . . . .21160East Pennsboro Area . . . . . . . . . . . .21250Mechanicsburg Area . . . . . . . . . . . .21650Shippensburg Area . . . . . . . . . . . . .21800South Middleton . . . . . . . . . . . . . . . .21830West Shore . . . . . . . . . . . . . . . . . . .21900

DAUPHIN

Central Dauphin . . . . . . . . . . . . . . . .22140Derry Township . . . . . . . . . . . . . . . .22175Halifax Area . . . . . . . . . . . . . . . . . . .22250Harrisburg City . . . . . . . . . . . . . . . . .22275Lower Dauphin . . . . . . . . . . . . . . . . .22400

Middletown Area . . . . . . . . . . . . . . .22600Millersburg Area . . . . . . . . . . . . . . . .22610Steelton Highspire . . . . . . . . . . . . . .22800Susquehanna Township . . . . . . . . . .22830Susquenita . . . . . . . . . . . . . . . . . . . .50600Upper Dauphin Area . . . . . . . . . . . .22900Williams Valley . . . . . . . . . . . . . . . . .54880

DELAWARE

Chester Upland . . . . . . . . . . . . . . . .23123Chichester . . . . . . . . . . . . . . . . . . . .23130Garnet Valley . . . . . . . . . . . . . . . . . .23410Haverford Township . . . . . . . . . . . . .23450Interboro . . . . . . . . . . . . . . . . . . . . .23510Marple Newtown . . . . . . . . . . . . . . .23550Penn-Delco . . . . . . . . . . . . . . . . . . .23690Radnor Township . . . . . . . . . . . . . . .23760Ridley . . . . . . . . . . . . . . . . . . . . . . . .23770Rose Tree Media . . . . . . . . . . . . . . .23790Southeast Delco . . . . . . . . . . . . . . .23840Springfield . . . . . . . . . . . . . . . . . . . .23850Unionville-Chadds Ford . . . . . . . . . .15850Upper Darby . . . . . . . . . . . . . . . . . .23945Wallingford Swarthmore . . . . . . . . . .23960West Chester Area . . . . . . . . . . . . . .15900William Penn . . . . . . . . . . . . . . . . . .23965

ELK

Brockway Area . . . . . . . . . . . . . . . . .33070Forest Area . . . . . . . . . . . . . . . . . . .27200Johnsonburg Area . . . . . . . . . . . . . .24350Kane Area . . . . . . . . . . . . . . . . . . . .42230Ridgway Area . . . . . . . . . . . . . . . . . .24600Saint Marys Area . . . . . . . . . . . . . . .24800

ERIE

Corry Area . . . . . . . . . . . . . . . . . . . .25145Erie City . . . . . . . . . . . . . . . . . . . . . .25260Fairview . . . . . . . . . . . . . . . . . . . . . .25330Fort Leboeuf . . . . . . . . . . . . . . . . . .25355General McLane . . . . . . . . . . . . . . .25390Girard . . . . . . . . . . . . . . . . . . . . . . . .25405Harbor Creek . . . . . . . . . . . . . . . . . .25435Iroquois . . . . . . . . . . . . . . . . . . . . . .25655Millcreek Township . . . . . . . . . . . . . .25760North East . . . . . . . . . . . . . . . . . . . .25830Northwestern . . . . . . . . . . . . . . . . . .25850Union City Area . . . . . . . . . . . . . . . .25910Wattsburg Area . . . . . . . . . . . . . . . .25970

FAYETTE

Albert Gallatin Area . . . . . . . . . . . . .26030Belle Vernon Area . . . . . . . . . . . . . .65060Brownsville Area . . . . . . . . . . . . . . .26080Connellsville Area . . . . . . . . . . . . . .26130Frazier . . . . . . . . . . . . . . . . . . . . . . .26290Laurel Highlands . . . . . . . . . . . . . . .26400Southmoreland . . . . . . . . . . . . . . . .65750Uniontown Area . . . . . . . . . . . . . . . .26800

FOREST

Forest Area . . . . . . . . . . . . . . . . . . .27200

FRANKLIN

Chambersburg Area . . . . . . . . . . . . .28130Fannett-Metal . . . . . . . . . . . . . . . . . .28200Greencastle-Antrim . . . . . . . . . . . . .28300Shippensburg Area . . . . . . . . . . . . .21800Tuscarora . . . . . . . . . . . . . . . . . . . . .28600Waynesboro Area . . . . . . . . . . . . . .28900

FULTON

Central Fulton . . . . . . . . . . . . . . . . .29130Forbes Road . . . . . . . . . . . . . . . . . .29230Southern Fulton . . . . . . . . . . . . . . . .29750

GREENE

Carmichaels Area . . . . . . . . . . . . . .30130Central Greene . . . . . . . . . . . . . . . .30140Jefferson-Morgan . . . . . . . . . . . . . . .30350Southeastern Greene . . . . . . . . . . .30650West Greene . . . . . . . . . . . . . . . . . .30850

HUNTINGDON

Huntingdon Area . . . . . . . . . . . . . . .31250Juniata Valley . . . . . . . . . . . . . . . . . .31280Mount Union Area . . . . . . . . . . . . . .31600Southern Huntingdon County . . . . .31750Tussey Mountain . . . . . . . . . . . . . . .05800Tyrone Area . . . . . . . . . . . . . . . . . . .07800

BERKS

Antietam . . . . . . . . . . . . . . . . . . . . . .06050Boyertown Area . . . . . . . . . . . . . . . .06075Brandywine Heights Area . . . . . . . .06085Conrad Weiser Area . . . . . . . . . . . . .06110Daniel Boone Area . . . . . . . . . . . . . .06150Exeter Township . . . . . . . . . . . . . . .06200Fleetwood Area . . . . . . . . . . . . . . . .06250Governor Mifflin . . . . . . . . . . . . . . . .06300Hamburg Area . . . . . . . . . . . . . . . . .06350Kutztown Area . . . . . . . . . . . . . . . . .06400Muhlenberg Township . . . . . . . . . . .06550Oley Valley . . . . . . . . . . . . . . . . . . . .06650Reading . . . . . . . . . . . . . . . . . . . . . .06700Schuylkill Valley . . . . . . . . . . . . . . . .06750Tulpehocken Area . . . . . . . . . . . . . .06800Twin Valley . . . . . . . . . . . . . . . . . . . .06810Upper Perkiomen . . . . . . . . . . . . . . .46860Wilson . . . . . . . . . . . . . . . . . . . . . . .06910Wyomissing . . . . . . . . . . . . . . . . . . .06935

BLAIR

Altoona Area . . . . . . . . . . . . . . . . . .07050Bellwood Antis . . . . . . . . . . . . . . . . .07100Claysburg-Kimmel . . . . . . . . . . . . . .07150Hollidaysburg Area . . . . . . . . . . . . . .07350Spring Cove . . . . . . . . . . . . . . . . . . .07750Tyrone Area . . . . . . . . . . . . . . . . . . .07800Williamsburg Community . . . . . . . . .07900

BRADFORD

Athens Area . . . . . . . . . . . . . . . . . . .08050Canton Area . . . . . . . . . . . . . . . . . . .08100Northeast Bradford County . . . . . . .08300Sayre Area . . . . . . . . . . . . . . . . . . . .08600Towanda Area . . . . . . . . . . . . . . . . .08650Troy Area . . . . . . . . . . . . . . . . . . . . .08665Wyalusing Area . . . . . . . . . . . . . . . .08900

BUCKS

Bensalem Township . . . . . . . . . . . . .09100Bristol Borough . . . . . . . . . . . . . . . .09130Bristol Township . . . . . . . . . . . . . . . .09135Centennial . . . . . . . . . . . . . . . . . . . .09200Central Bucks . . . . . . . . . . . . . . . . .09210Council Rock . . . . . . . . . . . . . . . . . .09235Easton Area . . . . . . . . . . . . . . . . . . .48330Morrisville Borough . . . . . . . . . . . . .09720Neshaminy . . . . . . . . . . . . . . . . . . . .09750New Hope Solebury . . . . . . . . . . . . .09760North Penn . . . . . . . . . . . . . . . . . . . .46570Palisades . . . . . . . . . . . . . . . . . . . . .09800Pennridge . . . . . . . . . . . . . . . . . . . .09810Pennsbury . . . . . . . . . . . . . . . . . . . .09820Quakertown Community . . . . . . . . .09840Souderton Area . . . . . . . . . . . . . . . .46710

BUTLER

Allegheny Clarion Valley . . . . . . . . .16030Butler Area . . . . . . . . . . . . . . . . . . . .10125Freeport Area . . . . . . . . . . . . . . . . . .03305Karns City Area . . . . . . . . . . . . . . . .10360Mars Area . . . . . . . . . . . . . . . . . . . .10500Moniteau . . . . . . . . . . . . . . . . . . . . .10535Seneca Valley . . . . . . . . . . . . . . . . .10790Slippery Rock Area . . . . . . . . . . . . .10750South Butler County . . . . . . . . . . . .10780

CAMBRIA

Blacklick Valley . . . . . . . . . . . . . . . . .11060Cambria Heights . . . . . . . . . . . . . . . .11120Central Cambria . . . . . . . . . . . . . . . .11130Conemaugh Valley . . . . . . . . . . . . . .11140Ferndale Area . . . . . . . . . . . . . . . . .11200Forest Hills . . . . . . . . . . . . . . . . . . . .11220Glendale . . . . . . . . . . . . . . . . . . . . .17300Greater Johnstown . . . . . . . . . . . . . .11250Northern Cambria . . . . . . . . . . . . . .11450Penn Cambria . . . . . . . . . . . . . . . . .11600Portage Area . . . . . . . . . . . . . . . . . .11630Richland . . . . . . . . . . . . . . . . . . . . . .11650Westmont Hilltop . . . . . . . . . . . . . . .11850Windber Area . . . . . . . . . . . . . . . . . .56910

CAMERON

Cameron County . . . . . . . . . . . . . . .12270

CARBON

Hazleton Area . . . . . . . . . . . . . . . . .40330Jim Thorpe Area . . . . . . . . . . . . . . .13500Lehighton Area . . . . . . . . . . . . . . . . .13550

PA SCHOOL DISTRICTS & CODES BY COUNTY


UNIONLewisburg Area . . . . . . . . . . . . . . . .60400Mifflinburg Area . . . . . . . . . . . . . . . .60500Milton Area . . . . . . . . . . . . . . . . . . . .49500Warrior Run . . . . . . . . . . . . . . . . . . .49800

VENANGOAllegheny Clarion Valley . . . . . . . . .16030Cranberry Area . . . . . . . . . . . . . . . . .61130Forest Area . . . . . . . . . . . . . . . . . . .27200Franklin Area . . . . . . . . . . . . . . . . . .61220Oil City Area . . . . . . . . . . . . . . . . . . .61620Penncrest . . . . . . . . . . . . . . . . . . . . .20470Titusville Area . . . . . . . . . . . . . . . . . .61720Valley Grove . . . . . . . . . . . . . . . . . .61860

WARRENCorry Area . . . . . . . . . . . . . . . . . . . .25145Titusville Area . . . . . . . . . . . . . . . . . .61720Warren County . . . . . . . . . . . . . . . . .62830

WASHINGTONAvella Area . . . . . . . . . . . . . . . . . . . .63050Bentworth . . . . . . . . . . . . . . . . . . . . .63090Bethlehem-Center . . . . . . . . . . . . . .63100Brownsville Area . . . . . . . . . . . . . . .26080Burgettstown Area . . . . . . . . . . . . . .63120California Area . . . . . . . . . . . . . . . . .63150Canon-McMillan . . . . . . . . . . . . . . . .63170Charleroi . . . . . . . . . . . . . . . . . . . . .63180Chartiers-Houston . . . . . . . . . . . . . .63190Fort Cherry . . . . . . . . . . . . . . . . . . . .63240McGuffey . . . . . . . . . . . . . . . . . . . . .63390Peters Township . . . . . . . . . . . . . . .63650Ringgold . . . . . . . . . . . . . . . . . . . . . .63700Trinity Area . . . . . . . . . . . . . . . . . . . .63800Washington . . . . . . . . . . . . . . . . . . .63880

WAYNEForest City Regional . . . . . . . . . . . .58300North Pocono . . . . . . . . . . . . . . . . . .35650Susquehanna Community . . . . . . . .58650Wallenpaupack Area . . . . . . . . . . . .64830Wayne Highlands . . . . . . . . . . . . . . .64870Western Wayne . . . . . . . . . . . . . . . .64890

WESTMORELANDBelle Vernon Area . . . . . . . . . . . . . .65060Blairsville-Saltsburg . . . . . . . . . . . . .32110Burrell . . . . . . . . . . . . . . . . . . . . . . .65070Derry Area . . . . . . . . . . . . . . . . . . . .65160Franklin Regional . . . . . . . . . . . . . . .65260Greater Latrobe . . . . . . . . . . . . . . . .65310Greensburg Salem . . . . . . . . . . . . . .65320Hempfield Area . . . . . . . . . . . . . . . .65380Jeannette City . . . . . . . . . . . . . . . . .65410Kiski Area . . . . . . . . . . . . . . . . . . . . .65440Leechburg Area . . . . . . . . . . . . . . . .03450Ligonier Valley . . . . . . . . . . . . . . . . .65490Monessen City . . . . . . . . . . . . . . . . .65580Mount Pleasant Area . . . . . . . . . . . .65590New Kensington-Arnold . . . . . . . . . .65630Norwin . . . . . . . . . . . . . . . . . . . . . . .65650Penn-Trafford . . . . . . . . . . . . . . . . . .65710Southmoreland . . . . . . . . . . . . . . . .65750Yough . . . . . . . . . . . . . . . . . . . . . . . .65890

WYOMINGElk Lake . . . . . . . . . . . . . . . . . . . . . .58250Lackawanna Trail . . . . . . . . . . . . . . .66500Lake-Lehman . . . . . . . . . . . . . . . . . .40390Tunkhannock Area . . . . . . . . . . . . . .66750Wyalusing Area . . . . . . . . . . . . . . . .08900Wyoming Area . . . . . . . . . . . . . . . . .40920

YORKCentral York . . . . . . . . . . . . . . . . . . .67130Dallastown Area . . . . . . . . . . . . . . . .67160Dover Area . . . . . . . . . . . . . . . . . . . .67180Eastern York . . . . . . . . . . . . . . . . . .67220Hanover Public . . . . . . . . . . . . . . . .67280Northeastern . . . . . . . . . . . . . . . . . .67440Northern York County . . . . . . . . . . .67460Red Lion Area . . . . . . . . . . . . . . . . .67550South Eastern . . . . . . . . . . . . . . . . .67620South Western . . . . . . . . . . . . . . . . .67640Southern York County . . . . . . . . . . .67650Spring Grove Area . . . . . . . . . . . . . .67670West Shore . . . . . . . . . . . . . . . . . . .21900West York Area . . . . . . . . . . . . . . . .67850York City . . . . . . . . . . . . . . . . . . . . . .67900York Suburban . . . . . . . . . . . . . . . . .67940

SCHOOL DISTRICT CODE SCHOOL DISTRICT CODE SCHOOL DISTRICT CODE SCHOOL DISTRICT CODE

INDIANA

Apollo-Ridge . . . . . . . . . . . . . . . . . .03060Armstrong . . . . . . . . . . . . . . . . . . . .03085Blairsville-Saltsburg . . . . . . . . . . . . .32110Harmony Area . . . . . . . . . . . . . . . . .17350Homer Center . . . . . . . . . . . . . . . . .32330Indiana Area . . . . . . . . . . . . . . . . . . .32370Marion Center Area . . . . . . . . . . . . .32520Penns Manor Area . . . . . . . . . . . . . .32630Punxsutawney Area . . . . . . . . . . . . .33800Purchase Line . . . . . . . . . . . . . . . . .32730United . . . . . . . . . . . . . . . . . . . . . . .32800

JEFFERSON

Brockway Area . . . . . . . . . . . . . . . . .33070Brookville Area . . . . . . . . . . . . . . . . .33080Clarion-Limestone Area . . . . . . . . . .16170Dubois Area . . . . . . . . . . . . . . . . . . .17200Punxsutawney Area . . . . . . . . . . . . .33800

JUNIATA

Greenwood . . . . . . . . . . . . . . . . . . .50300Juniata County . . . . . . . . . . . . . . . . .34360

LACKAWANNA

Abington Heights . . . . . . . . . . . . . . .35030Carbondale Area . . . . . . . . . . . . . . .35130Dunmore . . . . . . . . . . . . . . . . . . . . .35220Forest City Regional . . . . . . . . . . . .58300Lackawanna Trail . . . . . . . . . . . . . . .66500Lakeland . . . . . . . . . . . . . . . . . . . . .35460Mid Valley . . . . . . . . . . . . . . . . . . . .35550North Pocono . . . . . . . . . . . . . . . . . .35650Old Forge . . . . . . . . . . . . . . . . . . . . .35660Riverside . . . . . . . . . . . . . . . . . . . . .35700Scranton City . . . . . . . . . . . . . . . . . .35740Valley View . . . . . . . . . . . . . . . . . . . .35840

LANCASTER

Cocalico . . . . . . . . . . . . . . . . . . . . . .36130Columbia Borough . . . . . . . . . . . . . .36150Conestoga Valley . . . . . . . . . . . . . . .36170Donegal . . . . . . . . . . . . . . . . . . . . . .36220Eastern Lancaster County . . . . . . . .36230Elizabethtown Area . . . . . . . . . . . . .36240Ephrata Area . . . . . . . . . . . . . . . . . .36260Hempfield . . . . . . . . . . . . . . . . . . . . .36310Lampeter-Strasburg . . . . . . . . . . . . .36360Lancaster . . . . . . . . . . . . . . . . . . . . .36400Manheim Central . . . . . . . . . . . . . . .36440Manheim Township . . . . . . . . . . . . .36450Octorara Area . . . . . . . . . . . . . . . . .15650Penn Manor . . . . . . . . . . . . . . . . . . .36520Pequea Valley . . . . . . . . . . . . . . . . .36530Solanco . . . . . . . . . . . . . . . . . . . . . .36700Warwick . . . . . . . . . . . . . . . . . . . . . .36900

LAWRENCE

Blackhawk . . . . . . . . . . . . . . . . . . . .04160Ellwood City Area . . . . . . . . . . . . . .37200Laurel . . . . . . . . . . . . . . . . . . . . . . . .37400Mohawk Area . . . . . . . . . . . . . . . . . .37500Neshannock Township . . . . . . . . . . .37520New Castle Area . . . . . . . . . . . . . . .37530Shenango Area . . . . . . . . . . . . . . . .37620Union Area . . . . . . . . . . . . . . . . . . . .37700Wilmington Area . . . . . . . . . . . . . . . .37800

LEBANON

Annville-Cleona . . . . . . . . . . . . . . . .38030Cornwall-Lebanon . . . . . . . . . . . . . .38130Eastern Lebanon County . . . . . . . . .38230Lebanon . . . . . . . . . . . . . . . . . . . . . .38460Northern Lebanon . . . . . . . . . . . . . .38500Palmyra Area . . . . . . . . . . . . . . . . . .38530

LEHIGH

Allentown City . . . . . . . . . . . . . . . . .39030Bethlehem Area . . . . . . . . . . . . . . . .48100Catasauqua Area . . . . . . . . . . . . . . .39130East Penn . . . . . . . . . . . . . . . . . . . .39230Northern Lehigh . . . . . . . . . . . . . . . .39450Northwestern Lehigh . . . . . . . . . . . .39460Parkland . . . . . . . . . . . . . . . . . . . . . .39510Salisbury Township . . . . . . . . . . . . .39560Southern Lehigh . . . . . . . . . . . . . . .39570Whitehall-Coplay . . . . . . . . . . . . . . .39780

LUZERNE

Berwick Area . . . . . . . . . . . . . . . . . .19110Crestwood . . . . . . . . . . . . . . . . . . . .40140

Dallas . . . . . . . . . . . . . . . . . . . . . . . .40160Greater Nanticoke Area . . . . . . . . . .40260Hanover Area . . . . . . . . . . . . . . . . . .40300Hazleton Area . . . . . . . . . . . . . . . . .40330Lake-Lehman . . . . . . . . . . . . . . . . . .40390Northwest Area . . . . . . . . . . . . . . . .40600Pittston Area . . . . . . . . . . . . . . . . . .40660Wilkes-Barre Area . . . . . . . . . . . . . .40885Wyoming Area . . . . . . . . . . . . . . . . .40920Wyoming Valley West . . . . . . . . . . .40930

LYCOMING

Canton Area . . . . . . . . . . . . . . . . . . .08100East Lycoming . . . . . . . . . . . . . . . . .41200Jersey Shore Area . . . . . . . . . . . . . .41400Loyalsock Township . . . . . . . . . . . . .41420Montgomery Area . . . . . . . . . . . . . .41500Montoursville Area . . . . . . . . . . . . . .41510Muncy . . . . . . . . . . . . . . . . . . . . . . .41530South Williamsport Area . . . . . . . . .41610Southern Tioga . . . . . . . . . . . . . . . .59700Wellsboro Area . . . . . . . . . . . . . . . .59850Williamsport Area . . . . . . . . . . . . . . .41720

MCKEAN

Bradford Area . . . . . . . . . . . . . . . . . .42080Kane Area . . . . . . . . . . . . . . . . . . . .42230Oswayo Valley . . . . . . . . . . . . . . . . .53750Otto-Eldred . . . . . . . . . . . . . . . . . . .42600Port Allegany . . . . . . . . . . . . . . . . . .42630Smethport Area . . . . . . . . . . . . . . . .42750

MERCER

Commodore Perry . . . . . . . . . . . . . .43130Crawford Central . . . . . . . . . . . . . . .20135Farrell Area . . . . . . . . . . . . . . . . . . .43250Greenville Area . . . . . . . . . . . . . . . .43280Grove City Area . . . . . . . . . . . . . . . .43290Hermitage . . . . . . . . . . . . . . . . . . . .43330Jamestown Area . . . . . . . . . . . . . . .43360Lakeview . . . . . . . . . . . . . . . . . . . . .43390Mercer Area . . . . . . . . . . . . . . . . . . .43500Reynolds . . . . . . . . . . . . . . . . . . . . .43530Sharon City . . . . . . . . . . . . . . . . . . .43560Sharpsville Area . . . . . . . . . . . . . . . .43570West Middlesex Area . . . . . . . . . . . .43750Wilmington Area . . . . . . . . . . . . . . . .37800

MIFFLIN

Mifflin County . . . . . . . . . . . . . . . . . .44460Mount Union Area . . . . . . . . . . . . . .31600

MONROE

East Stroudsburg Area . . . . . . . . . .45200Pleasant Valley . . . . . . . . . . . . . . . .45520Pocono Mountain . . . . . . . . . . . . . . .45540Stroudsburg Area . . . . . . . . . . . . . . .45600

MONTGOMERY

Abington . . . . . . . . . . . . . . . . . . . . . .46030Boyertown Area . . . . . . . . . . . . . . . .06075Bryn Athyn Borough . . . . . . . . . . . .46050Cheltenham Township . . . . . . . . . . .46130Colonial . . . . . . . . . . . . . . . . . . . . . .46160Hatboro-Horsham . . . . . . . . . . . . . .46360Jenkintown . . . . . . . . . . . . . . . . . . . .46380Lower Merion . . . . . . . . . . . . . . . . . .46450Lower Moreland Township . . . . . . . .46460Methacton . . . . . . . . . . . . . . . . . . . .46530Norristown Area . . . . . . . . . . . . . . . .46560North Penn . . . . . . . . . . . . . . . . . . . .46570Perkiomen Valley . . . . . . . . . . . . . . .46610Pottsgrove . . . . . . . . . . . . . . . . . . . .46630Pottstown . . . . . . . . . . . . . . . . . . . . .46640Souderton Area . . . . . . . . . . . . . . . .46710Springfield Township . . . . . . . . . . . .46720Spring-Ford Area . . . . . . . . . . . . . . .46730Upper Dublin . . . . . . . . . . . . . . . . . .46830Upper Merion Area . . . . . . . . . . . . .46840Upper Moreland Township . . . . . . . .46850Upper Perkiomen . . . . . . . . . . . . . . .46860Wissahickon . . . . . . . . . . . . . . . . . . .46930

MONTOUR

Danville Area . . . . . . . . . . . . . . . . . .47180Warrior Run . . . . . . . . . . . . . . . . . . .49800

NORTHAMPTON

Bangor Area . . . . . . . . . . . . . . . . . . .48080Bethlehem Area . . . . . . . . . . . . . . . .48100Catasauqua Area . . . . . . . . . . . . . . .39130

Easton Area . . . . . . . . . . . . . . . . . . .48330Nazareth Area . . . . . . . . . . . . . . . . .48480Northampton Area . . . . . . . . . . . . . .48490Northern Lehigh . . . . . . . . . . . . . . . .39450Pen Argyl Area . . . . . . . . . . . . . . . . .48560Saucon Valley . . . . . . . . . . . . . . . . .48600Wilson Area . . . . . . . . . . . . . . . . . . .48860

NORTHUMBERLAND

Danville Area . . . . . . . . . . . . . . . . . .47180Line Mountain . . . . . . . . . . . . . . . . .49350Milton Area . . . . . . . . . . . . . . . . . . . .49500Mount Carmel Area . . . . . . . . . . . . .49510Shamokin Area . . . . . . . . . . . . . . . .49650Shikellamy . . . . . . . . . . . . . . . . . . . .49660Southern Columbia Area . . . . . . . . .19750Warrior Run . . . . . . . . . . . . . . . . . . .49800

PERRY

Fannett-Metal . . . . . . . . . . . . . . . . . .28200Greenwood . . . . . . . . . . . . . . . . . . .50300Newport . . . . . . . . . . . . . . . . . . . . . .50400Susquenita . . . . . . . . . . . . . . . . . . . .50600West Perry . . . . . . . . . . . . . . . . . . . .50800

PHILADELPHIA

Philadelphia City . . . . . . . . . . . . . . .51500

PIKE

Delaware Valley . . . . . . . . . . . . . . . .52200East Stroudsburg Area . . . . . . . . . .45200Wallenpaupack Area . . . . . . . . . . . .64830

POTTER

Austin Area . . . . . . . . . . . . . . . . . . .53030Coudersport Area . . . . . . . . . . . . . . .53130Galeton Area . . . . . . . . . . . . . . . . . .53280Keystone Central . . . . . . . . . . . . . . .18360Northern Potter . . . . . . . . . . . . . . . .53550Oswayo Valley . . . . . . . . . . . . . . . . .53750Port Allegany . . . . . . . . . . . . . . . . . .42630

SCHUYLKILL

Blue Mountain . . . . . . . . . . . . . . . . .54080Hazleton Area . . . . . . . . . . . . . . . . .40330Mahanoy Area . . . . . . . . . . . . . . . . .54450Minersville Area . . . . . . . . . . . . . . . .54470North Schuylkill . . . . . . . . . . . . . . . .54500Panther Valley . . . . . . . . . . . . . . . . .13660Pine Grove Area . . . . . . . . . . . . . . .54600Pottsville Area . . . . . . . . . . . . . . . . .54610Saint Clair Area . . . . . . . . . . . . . . . .54680Shenandoah Valley . . . . . . . . . . . . .54720Schuylkill Haven Area . . . . . . . . . . .54730Tamaqua Area . . . . . . . . . . . . . . . . .54760Tri-Valley . . . . . . . . . . . . . . . . . . . . .54780Williams Valley . . . . . . . . . . . . . . . .54880

SNYDER

Midd-West . . . . . . . . . . . . . . . . . . . .55500Selinsgrove Area . . . . . . . . . . . . . . .55710

SOMERSET

Berlin Brothersvalley . . . . . . . . . . . .56100Conemaugh Township Area . . . . . . .56180Meyersdale Area . . . . . . . . . . . . . . .56520North Star . . . . . . . . . . . . . . . . . . . .56550Rockwood Area . . . . . . . . . . . . . . . .56630Salisbury-Elk Lick . . . . . . . . . . . . . .56700Shade-Central City . . . . . . . . . . . . .56720Shanksville-Stonycreek . . . . . . . . . .56740Somerset Area . . . . . . . . . . . . . . . . .56770Turkeyfoot Valley Area . . . . . . . . . . .56840Windber Area . . . . . . . . . . . . . . . . . .56910

SULLIVAN

Sullivan County . . . . . . . . . . . . . . . .57630

SUSQUEHANNA

Blue Ridge . . . . . . . . . . . . . . . . . . . .58100Elk Lake . . . . . . . . . . . . . . . . . . . . . .58250Forest City Regional . . . . . . . . . . . .58300Montrose Area . . . . . . . . . . . . . . . . .58450Mountain View . . . . . . . . . . . . . . . . .58460Susquehanna Community . . . . . . . .58650

TIOGA

Canton Area . . . . . . . . . . . . . . . . . . .08100Galeton Area . . . . . . . . . . . . . . . . . .53280Northern Tioga . . . . . . . . . . . . . . . . .59600Southern Tioga . . . . . . . . . . . . . . . .59700Wellsboro Area . . . . . . . . . . . . . . . .59850

PA SCHOOL DISTRICTS & CODES BY COUNTY


Since its inception in 1971, the Pennsylvania Lottery has contributed more than $25.8 billion to programs that include property tax and rent rebates; free transit and reduced-fare shared rides; the low-cost prescription drug programs PACE andPACENET; care services; and the 52 Area Agencies on Aging, including hundreds of senior centers throughout the state.

The Pennsylvania Lottery remains the only state lottery that designates all its proceeds to programs that benefit older residents. In fiscal year 2014-15, the Lottery achieved sales of $3.8 billion; contributions to the Lottery Fund totaled morethan $1 billion.

As an agency of state government, the Pennsylvania Lottery is a successful enterprise of which all Pennsylvanians can be proud.

THE PENNSYLVANIA LOTTERY

The Pennsylvania Lottery was established by the Legislature in 1971. The primary purpose of creating theLottery was, and remains, to generate funds for programs that benefit older Pennsylvanians.

Where does the money go*?

RETAILERAND

BENEFIT VENDOR OPERATINGPRIZES PROGRAMS COMMISSIONS EXPENSES

63.1 27.8 7.2 1.9 cents cents cents cents

*Profits based on sales and interest income

CUSTOMER SERVICES AND ASSISTANCE


www.revenue.pa.gov• Property Tax/Rent Rebate applicants may now check

the status of rebates online through the Revenue e-Services center, as well as by phone. To use theonline application, each applicant must enter his/herSocial Security number, date of birth and the amount ofthe rebate requested.

• If you have Internet access, you can find answers tocommonly asked questions by using the department’sOnline Customer Service Center. Use the Find anAnswer feature to search the database of commonlyasked questions. If you do not find your answer in thisarea, you can submit your question to a customer service representative.

Property Tax/Rent Rebate Taxpayer Service andInformation Center• Call 1-888-222-9190 for personal assistance during

normal business hours, 7:30 a.m. to 5 p.m.

1-888-PATAXESTouch-tone service is required for this automated 24-hourtoll-free line. Call to order forms or check the status of apersonal income tax account, corporation tax account orproperty tax/rent rebate. Harrisburg-area residents maycall 717-425-2533.

Services for Taxpayers with Special Hearing and/orSpeaking Needs: 1-800-447-3020 (TTY)

To obtain forms, visit a Revenue district office or use oneof the following services:

Internet: www.revenue.pa.govForms, brochures, and other information are available onthe department’s website. If you do not have Internetaccess, visit your local public library.

E-mail Requests for Forms: [email protected] 24-hour Forms Ordering Message Service:1-800-362-2050.

• This line serves taxpayers without touch-tone telephone service.

Written Requests: PA DEPARTMENT OF REVENUE TAX FORMS SERVICE UNIT1854 BROOKWOOD STREETHARRISBURG PA 17104-2244

Free Preparation AssistanceYou can receive free assistance in preparing yourProperty Tax/Rent Rebate form through the VolunteerIncome Tax Assistance (VITA) and Tax Counseling for theElderly (TCE) programs. Visit the department’s website orcontact the nearest Revenue district office for information.

Revenue District OfficesIf you need assistance preparing your claim form or havequestions, please contact your local Department ofRevenue district office. See Page 19 for a list of offices.

PA Department of Aging (www.aging.pa.gov) The Department of Aging has served as an advocate forthe interests of older Pennsylvanians at all levels of government since 1978. Information on the following programs and services can be found on its website.

Area Agencies on AgingEach Area Agency on Aging has trained staff available toanswer questions and make referrals to other agencies inthe community that provide the specific services neededby the individual. Refer to the government pages of yourlocal phone directory to find the Area Agency on Agingoffice nearest you.

PACE, PACENET and PACE Plus Medicare (1-800-225-7223)PACE, PACENET and PACE Plus Medicare arePennsylvania’s prescription assistance programs forolder adults, offering low-cost prescription medication toqualified residents age 65 and older.

Long-Term Care Services (1-866-286-3636)This program, administered by the Department of HumanServices and funded by the Pennsylvania Lottery and fed-eral Medical Assistance money, provides nursing facilityand home- and community-based services to qualifyinglow-income seniors and individuals with disabilities.

Free and Reduced-Fare TransportationThe Department of Transportation distributes Lotteryfunding to local transit authorities to provide free andreduced-fare mass transit for older residents. Contactyour local transit authority for more information.

APPRISE (1-800-783-7067)APPRISE is a free health insurance counseling programdesigned to help older Pennsylvanians with Medicare.Counselors are specially trained volunteers who cananswer your questions about Medicare and provide youwith objective, easy-to-understand information aboutMedicare, Medicare Supplemental Insurance, Medicaidand Long-Term Care Insurance.

Report Elder Abuse (1-800-490-8505)Any person who believes an older adult is being abused,neglected, exploited or abandoned may call the statewideelder abuse hotline toll-free, 24 hours a day.

OTHER PROGRAMS AND SERVICES

FORMS ORDERING SERVICES

TELEPHONE SERVICES

ONLINE SERVICES

NOTE: Please call ahead to verify a district office’s address and its services or visit the department’swebsite at www.revenue.pa.gov for information. Taxpayer assistance hours are

8:30 a.m. to 5:00 p.m.

ERIE

JOHNSTOWN

GREENSBURG

PITTSBURGHHARRISBURG

SUNBURY

SCRANTON

BETHLEHEM

READING

PHILADELPHIA

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PA DEPARTMENT OF REVENUE DISTRICT OFFICES


BETHLEHEM44 E BROAD STBETHLEHEM PA 18018-5998610-861-2000

CHESTER6TH FL STE 602419 AVENUE OF THE STATESCHESTER PA 19013-4451610-619-8018

ERIE448 W 11TH STERIE PA 16501-1501814-871-4491

GREENSBURGSECOND FL15 W THIRD STGREENSBURG PA 15601-3003724-832-5283

HARRISBURG LOBBY STRAWBERRY SQ HARRISBURG PA 17128-0101717-783-1405

JOHNSTOWN425 MAIN STJOHNSTOWN PA 15901-1808814-533-2495

NORRISTOWNSECOND FL STONY CREEK OFFICE CENTER151 W MARSHALL STNORRISTOWN PA 19401-4739610-270-1780

PHILADELPHIASTE 204A110 N 8TH STPHILADELPHIA PA 19107-2412215-560-2056

PHILADELPHIAACDMY PLZ SHPG CTR3240 RED LION RDPHILADELPHIA PA 19114-1109215-821-1860

PITTSBURGH – DOWNTOWN411 7TH AVE - ROOM 420PITTSBURGH PA 15219-1905412-565-7540

PITTSBURGH – GREENTREE11 PARKWAY CTR STE 175875 GREENTREE RDPITTSBURGH PA 15220-3623412-929-0614

READINGSTE 239625 CHERRY STREADING PA 19602-1186610-378-4401

SCRANTONRM 207BANK TOWERS207 WYOMING AVESCRANTON PA 18503-1427570-963-4585

SUNBURY535 CHESTNUT STSUNBURY PA 17801-2834570-988-5520


My Fellow Pennsylvanians:

The Property Tax/Rent Rebate program is one of many valuable programs benefiting older residents funded through the Pennsylvania Lottery. Hundreds of thousands of olderPennsylvanians and residents with disabilities benefit from rebates of up to $975 each year.

The Pennsylvania Lottery, which has funded property tax relief for seniors since the early 1970s,remains the only lottery in the nation that devotes all proceeds to programs that benefit olderresidents. Since its inception, the Lottery has contributed more than $25.8 billion to programsthat have grown to include the Property Tax/Rent Rebate program, a free and reduced-fare publictransit program, the low-cost prescription drug programs PACE and PACENET, long-term careservices and the 52 Area Agencies on Aging that serve all 67 counties, as well as hundreds offull- and part-time senior community centers across the state.

All of these programs and services are part of Pennsylvania’s commitment to ensuring healthier,happier lives for its 2.9 million older residents.

In fiscal year 2013-14, on an average day, the Lottery helped provide seniors with nearly 24,700prescriptions, over 105,000 transit rides, nearly $904,000 in care services and more than 22,800hot meals.

The Property Tax/Rent Rebate program is available to qualified older Pennsylvanians and permanently disabled residents. If you think a friend, neighbor or family member may qualifyfor a rebate, tell them about the program. It’s a benefit they deserve, and I do not want a singlesenior to miss out on the help they need.

Sincerely,

TOM WOLF

Governor

COMMONWEALTH OF PENNSYLVANIAOFFICE OF THE GOVERNOR

HARRISBURG

2015 PA Property Tax or Rent Rebate Program … PA-1000 Pennsylvania Property Tax or Rent Rebate...

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