Form Ar1000ptr - Homestead Property Tax Refund Claim - 1998
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11998
State of Arkansas
AR1000PTR
FOR 1997
DO NOT STAPLE OR WRITE IN THIS AREA
REAL ESTATE
FIRST NAME and INITIAL (List both if applicable)
LAST NAME
YOUR SOCIAL SECURITY NUMBER
PRESENT ADDRESS (Number and Street, Apartment Number or Rural Route)
SPOUSE’S SOCIAL SECURITY NUMBER
CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE
DATE OF BIRTH
MARITAL STATUS
TELEPHONE NUMBER
SINGLE (Or Widowed)
MARRIED
01.
2.
Were you a resident of Arkansas during ALL OF 1997 AND 1998?
YES
NO
03.
Did you own and occupy a homestead during the ENTIRE YEAR OF 1997?
YES
NO
04.
Are you a World War One veteran, or the widow of such veteran?
YES
NO
05.
Income
Income of
1998 HOUSEHOLD INCOME
of
Spouse, if
IMPORTANT NOTICE
Claimant
applicable
Claimants who have spouses confined to a nursing home do not have to report income assigned to the nursing home.
Please itemize all of your 1998 household income below. Enter the amounts received for the year.
.00
.00
6. * Social Security payments of all types, including amount deducted for Medicare.
(See SSA-1099 Form. block 3). .................. 6
0
.00
.00
7. * Veteran’s Pensions and disability payments. ............................................................................................................................. 7
0
.00
.00
8. * Railroad Retirement benefits. .................................................................................................................................................... 8
0
.00
.00
9.
Salaries, or income from Farm or self-employment: Remit schedule or statement. .................................................................. 9
0
.00
.00
10.
Interest income from banks, savings and loan companies, etc. ................................................................................................ 10
.00
.00
11.
Dividends, income from banks, savings and loan companies, etc. ........................................................................................... 11
.00
.00
(Submit Federal schedule or statement). ........................................................................................ 12
12.
Rent and royalties income.
.00
.00
13.
Sales of real estate, stocks, bonds. (Submit Federal schedule or statement). ........................................................................... 13
.00
.00
14. * Public employees retirement or Federal retirement and pensions. ............................................................................................. 14
.00
.00
15.
Cash, Public Assistance and Relief ( SSI, etc.) .......................................................................................................................... 15
16.
Miscellaneous income (Alimony payments, workers’ compensation, Loss of Time insurance,
.00
.00
or any other pension or annuity not listed above. Please list source.) ....................................................................................... 16
* These sources of income are not reportable for WWI veterans or widows of WWI veterans.
17. Total 1998 Income of claimant and spouse.
Total of Both Incomes
(If your total 1998 household income exceeds $16,000.00, you are not eligible to file this claim.)........................................................................................ 17
.00
18. From the table below, enter the maximum refund for the income on Line 17. $ ____________________________________________________
19. Enter your 1997 real estate taxes paid. (Please do not include personal property, improvement , drainage sewage, or any
special taxes which are not refundable. Attach 1997 receipt to claim.)
19
.00
20. Enter the SMALLER of Lines 18 or 19. This is the amount of your PTR Refund. .......................................................................................................... 20
.00
IF YOUR INCOME IS:
THE MAXIMUM REFUND IS:
IF YOUR INCOME IS:
THE MAXIMUM REFUND IS:
$0
to
$08,000.00................................for this income level
$300.00
$10,001.00
to
$11,000.00................................for this income level
$150.00
$8,001.00
to
$09,000.00................................for this income level
$250.00
$11,001.00
to
$12,000.00................................for this income level
$125.00
$9,001.00
to
$10,000.00................................for this income level
$200.00
$12,001.00
to
$16,000.00................................for this income level
$100.00
I declare under the penalties of perjury that to the best of my knowledge this is a true, correct and complete claim.
If prepared by another person, this declaration is based on all the information of which he has knowledge.
CLAIMANT SIGNATURE
DATE
NAME, ADDRESS AND TELEPHONE NUMBER OF AGENT OR PREPARER OTHER THAN THE CLAIMANT
SIGN
HERE
ID/SSN#
_____________________________________
SPOUSE’S SIGNATURE (If married, spouse must also sign).
DATE
Name: _________________________________________
SIGN
Address: ________________________________________
City: _________________State: ______Zip _____________
If signed by other than claimant, sign claimant’s name, and give reasons for claimant’s inability to sign, such as
blind, disabled, etc. Also furnish information requested for agent or preparer.
Phone Number: (
) ___________________________
PTR 1 (R 9/98)
Page 1
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