PDF document

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Form PTR-2A
Homeowners
Verification of 2020 Property Taxes
(Use blue or black ink. See instructions for completion on back.)

Part I — To Be Completed by Applicant (Part II to be completed by tax collector)

Social Security # – – Spouse’s/CU Partner’s Social Security # – –

Name
Last Name, First Name, and Middle Initial (Follow with first name and initial of spouse/CU partner if filing jointly. Only enter spouse/CU partner’s last name if different.)

Address
Street City State ZIP Code

Block Lot Qualifier
A. Did you own this property with someone who was not your spouse/CU partner? Yes No
B. If yes, indicate the share (percentage) of the property that you (and your spouse/CU partner) owned. %
C. Did this property consist of multiple units? Yes No
D. If yes, indicate the share (percentage) of the property used as your main home. %

Part II — To Be Completed by Tax Collector

2020 Property Taxes

Check box if property had a tax appeal for 2020 ............................................................................................
Check box if property had an added assessment for 2020 .............................................................................

1. Assessed Value ..........................................................................................................................$

2. Tax Rate (including fire and other special tax rates) .................................................................... %

3. Total Property Taxes (Multiply line 1 by line 2) ...........................................................................$

4. REAP Credit (if any) ...................................................................................$

5. Enter amount from line 3. If applicant answered “Yes” to Questions A and/or C
above, you must apportion the amount on line 3 when completing this line.
(See instructions on back.) ...................................................................................................... $

Homeowners, enter this amount on line 10 of your Form PTR-2

Under the penalties of perjury, I certify that I am the local tax collector of ,
where the above property is located. I further certify that the above-stated amounts of property taxes due were paid
for Calendar Year 2020 and are true and accurate to the best of my knowledge. I have placed my stamp below for
verification.

(Name) (Date)

(Title)

(If you complete this form, be sure to enclose it with your Form PTR-2 application.)

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Form PTR-2A – Instructions

Part I – To Be Completed by Applicant four-unit property. The units are equal in size, and one of
Social Security Number. If your marital/civil union status the units was your main home. You occupied one-fourth
as of De cember 31, 2020, was single, enter only your Social (25%) of the property as your main home. Enter 25% as
Security number in the space provided on Form PTR-2A. If your share of occupancy.
your status as of December 31, 2020, was married/CU cou-
ple, you must report both applicants’ numbers in the order Part II – To Be Completed by Tax Collector
in which the names are listed on the application. If you were Enter the appropriate amounts for Calendar Year 2020 as
married or in a civil union but living apart from your spouse/ follows:
CU partner, and you did not have access to or receive sup-
port from their income, you are considered “Single” for pur- Line 1. Enter the assessed value of the property. If the
poses of the Property Tax Reimbursement. You should enter assessed value changed for the tax year, use the final
only your Social Security number on Form PTR-2A. assessed value.

Name and Address. Print or type your name (last name Line 2. Enter the tax rate. Include fire and other special tax
first) and complete address of the property for which you are rates.
claiming the reimbursement in the spaces provided. Also
include your spouse’s/CU partner’s name if filing jointly. Line 3. Multiply the assessed value on line 1 by the tax
rate on line 2 and enter the result on line 3. This is the total
Block/Lot/Qualifier. Enter the block and lot numbers of the amount of taxes due before any deductions and/or credits
principal residence (main home) for which you are claiming are subtracted (e.g., senior citizen’s deduction, Homestead
the reimbursement in the spaces provided. Include quali- Benefit credit).
fier if applicable. (Only condominiums may have qualifiers
assigned to them.) Line 4. Enter the amount of any Regional Efficiency Aid
Program (REAP) credit the homeowner(s) received.
A. Multiple Owners. Check “Yes” if you owned the
property that was your main home with someone who Line 5. If the applicant answered “No” to the questions at
was not your spouse/CU partner — even if the other both line A and line C, enter the amount of property taxes
owner(s) did not live there. For example, you and your from line 3.
sister owned the home you lived in. If you (and your
spouse/CU partner) were the sole owner(s), check If the applicant answered “Yes” at either line A or line C, you
“No.” must apportion the amount of property taxes to be entered
on line 5. If title to the property is held by the eligible
B. Percentage of Ownership. If you answered “Yes” at applicant with others as tenants in common or joint tenants
line A, enter the share (percentage) of the property that (except in the case of husband and wife or CU partners),
you (and your spouse/CU partner) owned. For exam- or if the property consists of more than one unit, the
ple, you and your spouse owned a home with your applicant is only eligible for the proportionate share of the
sister. Your sister did not live with you, and you and reimbursement that reflects the percentage of ownership or
your spouse paid all the property taxes. You must enter the percentage of occupancy.
50% as your share of ownership because you and your
spouse owned only one-half (50%) of the property. The Multiple Owners. If the applicant answered “Yes” at
shares of ownership of the property are considered to be Part I, line A, multiply the amount of property taxes on
held equally by all owners. If the shares of ownership are line 3 by the percentage of ownership shown at Part I,
not equal, you must provide documentation as to the per- line B, and enter the result on line 5.
centage of ownership.
Multi-Unit Properties. If the applicant answered
C. Multi-Unit Properties. Check “Yes” if your main home “Yes” at Part I, line C, multiply the amount of property
was a unit in a multi-unit property that you owned. For taxes on line 3 by the percentage of occupancy
example, you owned a property consisting of four resi- shown at Part I, line D, and enter the result on line 5.
dential units and you occupied one of the units as your
main home. If the property is not a multi-unit property, If the applicant answered “Yes” to the questions at both
check “No.” lines A and C, multiply the amount of property taxes on
line 3 by the percentage of occupancy shown at Part I,
Note: Residents of condominium complexes, co- line D, and enter the result on line 5.
ops, and continuing care retirement facilities are not
considered to be living in multi-unit properties and Certification. Complete the certification portion of Form
should check “No.” PTR-2A. Sign and date the certification and place the
authorization stamp in the space provided. (Use blue or
D. Percentage of Occupancy. If you answered “Yes” at black ink.)
line C, enter the share (percentage) of the property
used as your main home. For example, you owned a

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