BENSALEM TOWNSHIP SCHOOL DISTRICT Dorothy D. Call Administrative Center 3000 Donallen Drive Bensalem, PA 19020 General Instructions Attached is an application for Senior Citizen Property Tax assistance. Persons who complete this application should note the following: 1. Property tax assistance applies only to living senior citizens sixty-five (65) years of age or over whose legal and permanent residence is the residence for which tax assistance is sought. 2. If you apply for and receive a Homestead Exclusion or similar rebate related to another property, YOU ARE NOT ELIGIBLE FOR THIS REBATE. 3. Only one claimant per household (person filing the claim (sixty-five years of age or over) shall be entitled to property tax assistance. If two or more persons in one homestead are able to meet the qualification as a claimant; they may determine who the claimant shall be. If they are unable to agree, the school district shall determine to whom assistance is to be paid. 4. It is not necessary that the school real estate tax be paid by the claimant, provided the tax is paid prior to filing the claim. 5. Each application should include reasonable proof of household income, a copy of the receipted school real estate tax bill, and proof that the claimant was age sixty-five years or over during the 2017 calendar year. 6. An application filed with fraudulent intent, will be disallowed in full and a penalty of twenty-five percent (25%) of the amount claimed shall be imposed. The penalty and the amount of the disallowed claim will bear interest at the rate of one-half of one percent per month from the date of the claim until repaid. The claimant and any person assisting in the preparation or filing of a fraudulent claim shall be guilty of a misdemeanor and upon conviction thereof shall be sentenced to pay a fine not exceeding one thousand dollars ($1,000.00) or undergo imprisonment not exceeding one year, or both. 7. A claim shall be disallowed if the claimant received title to the property primarily for the purpose of receiving property tax assistance. 8. For additional information call 215-750-2800, Extension 4200. 9. This claim must be filed by June 30, 2018 for taxes due and paid in 2017. Mail to: Bensalem Township School District 3000 Donallen Drive Bensalem, PA 19020 Attention: Business Department
Part A -- Claimant's Identification Please complete the application in full (lines 1 through 10). Part B -- Amount of 2017 Property Tax Paid and State Rebate Received In 2017. Enter the total amount of paid 2017 school property tax on line 11. No credit for interest or penalty payments may be used. Municipal assessments, per capita and occupation taxes must not be included in your computation of real estate property tax paid. Include only property tax on land which is reasonably necessary for the use of your dwelling as a home. Enter the amount of State of PA rebate received in 2017 on line 12. Part C 2017 Household Income When completing lines 13 through 21, combine the total income received by you and your spouse as well as any other residents of your home during 2017. Note: This includes both taxable and non-taxable income and is NOT subject to the deductions on federal or state personal income tax forms. Income means all income from whatever sources including salaries, wages, bonuses, commissions, income from self-employment, alimony, support money, cash public assistance and relief, the gross amount of any pensions or annuities including railroad retirement benefits, all income from state unemployment insurance and veterans disability payments, all interest received from federal, state, or local government, income from capital gains, rentals, worker s compensation insurance benefits and proceeds and gifts of cash or property if they exceed a total value of three hundred dollars ($300). Income shall not include surplus food or other non-cash relief supplies by a governmental agency. Review of tax return may be required. Line 13: Wages, salaries and other compensation: List the total amount received in 2017 by all residents of the household. Attach statements to verify amounts. Line 14: Social Security, SSI, and Railroad Retirement: List 50% of the total combined annual amount received by all residents of the household. Attach a statement of 2017 earnings from the Social Security Office. Line 15: Pensions and Annuities: The full amount of all types of pensions and annuities received in 2017 must be included. List the source of this income. Attach statements to verify amounts. Line 16: Interest and Dividends: Include interest and dividends credited or received during 2017 from any source, regardless of whether you actually received the cash. Be sure to include both taxable and non-taxable income. Attach statements to verify amounts.
Line 17: Capital Gains: Include the entire amount of capital gains (Long Term and Short Term) realized during 2017. Capital losses may only be used to offset capital gains. Attach statement to verify amounts. Line 18: Cash Gifts, Life Insurance, and Death Benefits: Include cash gifts unless they do not total $300; life insurance and death benefits unless they are less than $5,000. Line 19: State and Local Grants/Rebates: Include rebates or grants of assistance received from the Commonwealth of Pennsylvania. Line 20: Other Income: Report the total amount of all other types of income (including rental), received by all residents of the household during 2017 on line 20. Line 21: Total Household Income: Add lines 13 through 20 and enter the total at line 21.
Part D -- Tax Assistance Household Income Maximum Assistance $ 0-6,999 $ 750 7,000-7,999 700 8,000-8,999 650 9,000-9,999 605 10,000-10,999 565 11,000-11,999 530 12,000-12,499 495 12,500-12,999 460 13,000-13,499 425 13,500-13,999 395 14,000-14,499 365 14,500-14,999 335 15,000-15,499 305 15,500-15,999 280 16,000-16,499 255 16,500-16,999 230 17,000-17,499 205 17,500-17,999 180 18,000-18,499 160 18,500-18,999 140 19,000-19,499 120 19,500-19,999 100
(Print in ink or type) BENSALEM TOWNSHIP SCHOOL DISTRICT BENSALEM, PA 19020-1898 PROPERTY TAX ASSISTANCE FORM Part A - Claimant s Identification Part C 2017 Household Income 1. Name: 13. Wages, Salaries & Other Compensation: 2. Address: 14. Social Security & Railroad Retirement Benefits ** 3. Phone #: 15. Pensions & Annuities: 4. Birth Date: 16. Interest & Dividends: Month Day Year 5. Social Security #: 17. Capital Gains: 6. Spouse s First Name: 18. Cash Gifts over $300, 7. Spouse s Birth Date: Life Insurance over $ 5,000 8. Spouse s Social Security #: 19. State/Local Rebates: 9. Address Listed on the Property Tax Bill: 20. Other Income: 21. Total Household Income: 10. Is the Homestead Exclusion applied to the tax bill of this property? Yes No ** Note Claim only 50% Part B - Real Estate Tax Paid Part D - Tax Assistance 11. Amount of 2017 School Real Estate Tax paid on 22. Total Household Income: the property listing on line 9. (Please attach your (Line 21): $ receipt of tax paid): $ 12. Amount of Commonwealth of PA rebate received 23. Total School Real Estate Tax paid in 2017: $ (Line 11): $ 24. Amount of Assistance (See table on Instruction Sheet) $ (Assistance May Not exceed Net Tax Paid) ------------------------------------------------------------------------------------------------------------------------------------------------------------------ All fraudulent claims will be disallowed in full and a 25% penalty will be imposed. Interest will also be charged on fraudulent claims. I declare that I prepared this return and that to the best of my knowledge and belief it is true, correct and complete. I certify that the amount of refund requested from the Bensalem Township School District and the Commonwealth of PA rebate program does not exceed the amount I actually paid in 2017 for School Real Estate taxes. Claimant s Signature Date Signature of Preparer Date (If other than the claimant)
Office Use Only 1. Date Received: Age: Taxes Paid: Total Rebates from state or local government: 2. Verification Received for: 3. Approved for: Income: Amount: Assistance 4. Signed Date: