§ 403.3. Contents of claim form.
Each claimant applying for a rebate under the Senior Citizens Property Tax or Rent Rebate Act shall file a claim, penalty of fraud provided, with the Department of Revenue, Property Tax or Rent Rebate Bureau, on forms supplied by the Department. The claim shall contain name of claimant, address, and Social Security number as well as the following:
(1) Reasonable proof of household income.
(2) Reasonable proof of the size and nature of the property claimed as a homestead.
(3) If for a property tax rebate, the tax receipts or other proof that the real property taxes have been paid.
(i) If the tax receipts fail to indicate that the claimant is the sole owner of the property exclusive of any interest owned by claimant’s spouse, reasonable proof of claimant’s ownership may be required by the Department.
(ii) Reasonable proof of ownership must be in the form of a legal document such as a deed, deed of trust, will, contract of sale or decree of distribution.
(4) If for a rent rebate in lieu of property taxes, reasonable proof that the rent in connection with the occupancy of a homestead has been paid.
(i) A completed ‘‘Rent Certificate,’’ which accompanies the claim form and instruction booklet, signed by the landlord of the claimant or an agent of the landlord shall be accepted as reasonable proof.
(ii) Rent receipts signed by the landlord or his agent indicating the claimant’s name, the address of the rental unit, the period of tenancy, the amount of rent paid, and the real property tax status of the rental unit may be accepted as reasonable proof.
(iii) A completed affidavit or certification executed by the claimant which indicates the name of the claimant, the address of the rental unit, the name and address of the landlord, the period of tenancy, the amount of rent paid, the real property tax status of the rental unit and that the claimant has been unable to obtain the signature of his landlord may be accepted as reasonable proof.
(5) If the claimant is a widow, or widower, an affidavit or certification of such status.
(6) Reasonable proof of disability.
(i) If the claimant is a permanently disabled person, the claim shall contain proof that he is eligible to receive disability benefits under either the Federal Social Security Act or the Federal Railroad Retirement Act. No person who has been found not to be disabled by the Social Security Administration or the Railroad Retirement Board shall be granted a rebate under the act. Proof that an individual was eligible for disability benefits under the Supplemental Security Income program (SSI) shall be acceptable proof of disability under this section.
(ii) A claimant who is not covered under the Federal Social Security Act or the Federal Railroad Retirement Act shall submit proof of permanent and total disability in the form of medical reports or records indicating diagnosis and prognosis of the claimant’s condition and signs, symptoms and laboratory findings if applicable or appropriate. These documents will be evaluated by the Bureau using the same standards used by the Social Security Administration in determining permanent and total disability.
(iii) A claimant who is not covered under the Federal Social Security Act or the Federal Railroad Retirement Act and who is unable to submit proof of permanent and total disability may be examined by a physician designated by the Department and his status determined using the same standards used by the Social Security Administration. The fee for such an examination, including necessary laboratory tests and X-rays, shall be determined prior to the examination and shall be paid to the physician by the Department. The claimant will not be reimbursed by the Department for any expenses incidental to the examination such as costs of meals or transportation.
(7) If a claimant is a senior citizen, the first claim shall include proof that the claimant or claimant’s spouse was 65 years of age or over, or 50 years of age or over in the case of a widow or widower, as of December 31 of the calendar year in which real property taxes or rent were due and payable.
(8) The claim form must be signed by the claimant. If, in lieu of his signature, the claimant ‘‘makes his mark’’ (X), two persons must sign the claim form as witnesses to his mark. If the claimant is unable to sign his name or make his mark on the claim form, an authorized attorney-in-fact or guardian shall sign the claim form and attach thereto a copy of the power-of-attorney, guardianship papers or other documents entitling him to sign the claim form.
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