CITY OF PITTSBURGH
ACT 77 -- PROPERTY TAX RELIEF APPLICATION FOR 2009
412 255-2525
This is a two-sided form. Complete both sides of this application.
Print the following information:
Property Owner Name:
Street Address:
City
State
Zip Code
Property Tax Account Number as it appears on your tax bill:
1) Property Address ________________________
Date purchased ____________
Is the property used as your principal residence?
Yes ( ) No ( )
How many years have you occupied the property? ________________
2) Does anyone beside you and your spouse own this house? Yes ( ) No ( )
Does this other owner live with you? Yes ( )
No ( )
Does Not Apply ( )
If No, what is their address?_____________________________________________
3) If not owned and occupied for at least 10 consecutive years, what property did
you OWN and OCCUPY in Allegheny County as your principal residence prior to
purchasing your current residence?
Address______________________________________
Date Purchased _________________
Ward or Municipality____________________________
Block & Lot_____________________
4) I certify that I am: (check one)
a.
A Claimant, age 50 or older. (attach proof)
( )
b.
A Claimant under 50 with spouse age 50 or older
who resides in the same household. (attach proof)
( )
c.
Permanently disabled and age 18 or older (you must
provide proof of disability).
( )
Date of Birth
Spouse’s Date of Birth
Check here if Spouse is Deceased ( )
Date of Death____________________
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rev 8/1/02