Download or print the 2021 Pennsylvania Form PA-1000 (Property Tax or Rent Rebate Claim) for FREE from the Pennsylvania Department of Revenue.
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IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
2105010058
PA-1000
Property Tax or Rent
Rebate Claim 05-21 (FI)
PA Department of Revenue
P.O. Box 280503
Harrisburg PA 17128-0503
I
START
2021
OFFICIAL USE ONLY
Check your label for accuracy. If incorrect, do not use the label. Complete Section I.
Your Social Security Number
Spouse’s Social Security Number
➜
II Fill in only one oval in each
If Spouse is
Deceased, fill
in the oval.
PLEASE WRITE IN YOUR SOCIAL SECURITY NUMBER(S) ABOVE
Last Name
First Name
MI
First Line of Address
Second Line of Address
City or Post Office
State
Spouse’s First Name
MI
ZIP Code
County Code School District Code
*
*
CODES
*REQUIRED
section.
1. I am filing for a rebate as a:
P. Property Owner – See
instructions
R. Renter – See instructions
B. Owner/Renter – See
instructions
2. I Certify that as of Dec. 31, 2021,
I am (a):
A. Claimant age 65 or older
B. 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
Country Code
3.
Filing on behalf of a
decedent
Claimant’s Birthdate MM/DD/YY Spouse’s Birthdate MM/DD/YY Daytime Telephone Number
III
Dollars
TOTAL INCOME received by you and your spouse during 2021
divided by 2) . . . . . . . . . .
4.
divided by 2) . . . . . . . . . . .
5.
6. Total Benefits from Pension, Annuity, IRA Distributions and Railroad Retirement Tier 2 (Do not
include federal veterans’ disability payments or state veterans’ payments.) . . . . . . . . . . . . . . . . . . .
6.
7. Interest and Dividend Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.
4. Social Security, SSI and SSP Income (Total benefits $
5. Railroad Retirement Tier 1 Benefits (Total benefits $
Cents
LOSS
8.
8. Gain or Loss on the Sale or Exchange of Property. . . . . . . . . If a loss, fill in this oval. . . . .
LOSS
9.
9. Net Rental Income or Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . If a loss, fill in this oval. . . . .
LOSS
10.
10. Net Business Income or Loss . . . . . . . . . . . . . . . . . . . . . . . . . If a loss, fill in this oval. . . . .
Other Income.
11a. Salaries, wages, bonuses, commissions, and estate and trust income. . . . . . . . . . . . . . . . . . . . .
11a.
11b. Gambling and Lottery winnings, including PA Lottery winnings, prize winnings and the value
of other prizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11b.
11c. Value of inheritances, alimony and spousal support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11c.
11d. Cash public a-sistance/relief. Unemployment compensation and workers’ compensation,
except Section 306(c) benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . .
11d.
11e.
11f. Gifts of cash or property totaling more than $300, except gifts between
members of a household. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11f.
11g. Miscellaneous income and annualized income amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11g.
12. Claimants with Federal Civil Service Retirement System Benefits enter $9,514 or $19,028.
See the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12.
13. TOTAL INCOME. Add only the positive income amounts from Lines 4 through 11g and subtract
the amount on Line 12. See Page 3 for income limitations. Enter this amount on Line 23. . . . . . . .
13.
IMPORTANT: You must submit proof of the income you reported – See the instructions on Pages 7 to 9.
2105010058
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IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
2105110056
PA-1000 2021 05-21 (FI)
START
Your Social Security Number
➜
Your Name:
PROPERTY OWNERS ONLY
14. Total 2021 property tax. Submit copies of receipted tax bills.
15. Property Tax Rebate. Enter the maximum standard rebate
amount from Table A for your income level here: (_______)
. . . . . . . . . . . . . . . . . . . . . . . . . . . 14.
Compare this amount to line 14 and
enter the lesser amount to the right. 15.
RENTERS ONLY
16. Total 2021 rent paid. Submit PA Rent Certificate and/or rent receipts . . . . . . . . . . . . . . . . . . . . . . 16.
17. Multiply Line 16 by 20 percent (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.
18. Rent Rebate. Enter the maximum rebate amount
Compare this amount to line 17 and
from Table B for your income level here: (_______)
enter the lesser amount to the right.
18.
OWNER – RENTER ONLY
19. Property Tax/Rent Rebate. Enter the maximum
rebate amount from Table A for your income
level here: (_______)
Compare this amount to the sum of
Lines 15 and 18 and enter the lesser
amount to the right.
19.
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 20, 21 and 22. The department will mail you a paper check. If your rebate will be going to a bank
account within the U.S., you have the option to have your rebate directly deposited. If you want the department to directly deposit your rebate
into your checking or savings account, complete Lines 20, 21 and 22.
Checking
20. Place an X in one box to authorize the Department of Revenue to directly deposit your rebate
into your: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.
21. Routing number. Enter in boxes to the right. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Savings
21.
22. Account number. Enter in boxes to the right. . . . . . . . . . 22.
23.
Enter the amount from Line 13 of
the claim form on this line and circle
the corresponding Maximum Rebate
amount for your income level.
Owners use Table A and Renters
use Table B.
TABLE B - RENTERS ONLY
TABLE A - OWNERS ONLY
INCOME LEVEL
Maximum
INCOME LEVEL
Maximum Standard
Rebate
Rebate
$
0 to $ 8,000
$650
$
0 to $ 8,000
$650
$ 8,001 to $15,000
$500
$ 8,001 to $15,000
$500
$15,001 to $18,000
$300
$18,001 to $35,000
$250
IV 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 year
upon conviction. The claimant is also subject to a penalty of 25 percent of the entire amount claimed.
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 by
members of my household. I authorize the PA Department of Revenue access to my federal and state Personal Income Tax records, my PACE records, my
Social Security Administration records and/or my Department of Human Services records. This access is for verifying the truth, correctness and
completeness of the information reported in this claim.
Claimant’s Signature
Date
MM/DD/YY
Spouse’s Signature
Date
Please sign the PA-1000 after printing.
1.
Please sign the PA-1000 after printing.
2.
PREPARER: I declare that I prepared this return, and that it is to the best of my
knowledge and belief, true, correct and complete.
MM/DD/YY
Preparer’s Signature, if other than the claimant
Please sign the PA-1000 after printing.
Witnesses’ Signatures: If the claimant cannot sign, but only makes a mark.
Date
Please sign the PA-1000 after printing.
Please sign the PA-1000 after printing.
Name of claimant’s power of attorney or nearest relative. Please print.
Telephone number of claimant’s power of attorney or nearest relative.
Preparer’s Name. Please print.
Home address of claimant’s power of attorney or nearest relative. Please print.
Preparer’s telephone number
City or Post Office
State
ZIP Code
Claim filing deadline – June 30, 2022
You can call 1-888-728-2937 after June 1 to verify the status of your claim.
2105110056
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The PA Property Tax / Rent Rebate Program benefits income-eligible Pennsylvanians age 65 and older; widows and widowers age 50 and older; and people with disabilities age 18 and older.
Form PA-1000 requires you to list multiple forms of income, such as wages, interest, or alimony .
We last updated the Property Tax or Rent Rebate Claim in January 2022,
so this is the latest version of Form PA-1000, fully updated for tax year 2021. You can download or print current or past-year PDFs of Form PA-1000 directly from TaxFormFinder.
You can print other Pennsylvania tax forms here.
TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms.
These related forms may also be needed with the Pennsylvania Form PA-1000.
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