Fill - Free fillable 104PTC Book Property Tax/Rent/Heat Rebate (Colorado DORA) PDF form

(10/18/19)

Booklet Includes:

Instructions

DR 0104PTC Application and Afdavit

Property Tax/Rent/Heat Rebate

Book

104PTC

Read all instructions before completing

the application, forms and afdavit.

Colorado Property Tax/Rent/Heat

Rebate Filing Guide

You might qualify for the PTC if you are:

Colorado

resident

A single person

with total income of

less than $15,192

A married couple

with total combined

income of less

than $20,518

At least 65 years old

A surviving spouse at

least 58 years old;

Disabled for all of 2019,

regardless of age, and

received benets for

the full year.

Proving lawful U.S. presence is mandatory

Applicants 18 years old or older must sign the afdavit of the PTC application and list

their valid Colorado driver license or ID number on the application. You must have a

Colorado State-issued driver license or ID card before applying for the PTC. See the last

page of this booklet for more information about lawful presence.

2019

Page 3

Do you qualify for the PTC Rebate?

Step 1

Did you live in Colorado from January 1–December 31, 2019? If you visit family out of state, but return to your Colorado

home, you are still a Colorado resident. Yes. Continue to STEP 2. No. You do not qualify for the PTC.

Step 2

Is your TOTAL income from all sources less than the amounts in the table below?

Single $15,192

Married (combined income) $20,518

Yes. Continue to STEP 3. No.

You do not qualify for the PTC.

Step 3

As of December 31, 2019, did you meet one of the age criteria in the list below? If married, at least one person has to

meet the criteria.

• Age 65 or older, or

• A surviving spouse, age 58 or older. If you were divorced before your spouse died, you are not considered a

surviving spouse and must therefore meet one of the other age criteria, or

• A disabled person of any age who was unable to engage in any substantial gainful activity for medical reasons.

You also must have qualied for full benets from January 1–December 31, 2019 from a bona de public or

private plan or source, based solely on your disability.

Yes. Continue to STEP 4. No.

You do not qualify for the PTC.

Step 4

Were you lawfully present in the United States during 2019? Applicants 18 years old or older must have a valid

Colorado driver license or ID card or other acceptable form of identication, and must supply the number on their

PTC application. See the last page of this booklet for more information.

Yes. Continue to STEP 5. No. You do

not qualify for the PTC.

Step 5

Did you pay property tax, rent or heating bills during this PTC period?

Yes. Continue to STEP 6. No.

You do not

qualify for the PTC.

Step 6

Were you claimed as a dependant on someone else’s federal income tax return?

Yes. You do not qualify for the PTC.

No. You qualify. Continue to the application.

When will my rebate be issued?

The Colorado PTC Rebate is paid on a set schedule based on when your application is processed. This payment schedule

is set and cannot be changed, except that any processing or payment dates that fall on the weekend will instead happen

on the next business day. We recommend that you le in January or early February. For faster delivery of your rebate,

we recommend that you sign up for Direct Deposit (see page 5). Please review the application/payment chart below.

Application received,

approved, and processed

before

Anticipated

Direct Deposit

Payment Dates

Anticipated

Paper Check

Payment Dates

Amount of Each

Installment Payment

Number

of Equal

Installments

March 10, 2020 April 5, 2020 April 15, 2020 1/4 of total rebate 4

June 10, 2020 July 5, 2020 July 15, 2020 1/3 of total rebate 3

September 10, 2020 October 5, 2020 October 15, 2020 1/2 of total rebate 2

December 10, 2020 January 5, 2021 January 15, 2021 Full rebate 1

December 31, 2021 10 weeks after receipt 12 weeks after receipt Full rebate 1

Do not call prior to these dates.

Example: Mary Jones mails her application on January 20, 2020, she selects Direct Deposit and her application is received

and approved before March 10, 2020. She will receive 4 equal payments, one of each being deposited in her account by

4/5/20, 7/5/20, 10/5/20 and 1/5/21.

Deadline for ling your application

Applications for the Colorado PTC Rebate for calendar year 2019 must be led by December 31, 2021. Applications

received after that date will be denied.

Page 4

Instructions

Apply Online

If you have received rebates for the last two years, you can le this application online instead of mailing it. Visit

Colorado.gov/RevenueOnline and simply answer the questions to help guide you through the application process. Using

the online application will help prevent errors or incomplete information, which might otherwise delay your rebate. You must

supply an email address to le online.

For more information about the PTC Rebate, read publication FYI General 2 for Privacy Act Notice on Colorado.gov/Tax,

the Taxation Division's informational website. Enter information for the 2019 calendar year only. Combining information from

other years will cause your application to be delayed or denied.

• Names—Enter your legal name as it appears on your driver license or ID card.

• Civil Unions — Parties to a Civil Union must le as married.

• Physical address — If you did not live at this address for the full year, attach a list of all the places you lived throughout

this year. Be sure to include the dates you lived at each location.

• Mailing address — Be certain this is your current mailing address, otherwise you may not receive your rebate.

• Driver license or ID number and expiration date —The Department might request additional proof of Colorado residency

if your license or ID was not valid for the full year.

• Email address, if you have one.

• Conrm your eligibility by checking the appropriate box. Check only one box. If you check box D, attach a copy of your

disability statement that is less than 90 days old. The statement must be provided by the agency that pays the benets.

Veterans Administration Award letters must show the disability percentage at 50% or more.

• First-time lers must provide proof of full-year Colorado residency. If you did not hold your Colorado driver license or ID

card from January 1–December 31, 2019, you must attach a copy of your lease or rental agreement.

Income

Line 1 Enter the number of months (1–12) you were covered by Medicare. If your premiums were paid by Medicaid or

if you were not on Medicare, enter 0.

Lines 2-6 Enter the gross income you received for each item listed. Do not list only the taxable portion. The gross amount

should be clearly identified on the statement(s) you received from the payor. Do not include Medicare benefits

on line 2 if they were paid on your behalf by a third party.

Line 7 Review the tables below and report any income you received from these sources that is not already included on

lines 2-6.

You must report this income:

AFDC or TANF Received (exclude payments received for dependents) Life Insurance Distributions (exclude funeral expenses)

Alimony Lottery and Gambling Winnings

All Taxable Income Old Age Pension (OAP)

Capital Gains Rental Income or Loss (exclude expenses, but not depreciation)

Commissions Royalties

Disability Insurance Settlements Stock Dividends or Rights (only if reported on federal income tax return)

Disability Payments Tier 1 & 2 Railroad Retirement

Farm Income or Loss (exclude expenses, but not depreciation) Veterans Benets

Inheritance Worker’s Compensation

Do not report this income:

Capital Losses or Return of Capital Home Care Allowances or Adult Foster Care Assistance

Child Support Received Income Tax Refunds

Colorado PTC Rebates Received Veterans Service-connected Disability (permanent)

Gifts Welfare Payments Received for Dependent Children (AFDC, etc.)

Heat/Fuel Assistance such as LEAP

Expenses

Line 8

Enter the total amount of property tax paid, if any. DO NOT include any supplement/assistance that was paid by

the Senior Homestead Exemption. Include only taxes that you paid in the calendar year 2019.

Line 9

Enter the total rent you paid for January 1–December 31, 2019, if any.

Line 10

Enter the total heat/fuel expenses you paid to heat your home during 2019, if any. DO NOT include any heat/

fuel expenses that were included in your rent payment.

Line 11

Check the appropriate box to indicate whether your meals were included in your rent. If meals were included for

only part of the time you paid rent, enter how much rent was paid when your meals were included.

Page 5

Line 12

Check the appropriate box to indicate whether your heat/fuel was included in your rent. If heat/fuel was included

for only part of the time you paid rent, enter how much rent was paid when your heat/fuel was included.

Direct Deposit

You are not required to enroll in Direct Deposit, but it is highly recommended. For faster processing of your rebate, enter

the routing and account numbers and account type. Include hyphens, but do NOT enter spaces or special symbols. We

recommend that you contact your nancial institution to ensure you are using the correct information and that they will honor

a direct deposit. See the sample check below to assist you in nding the account and routing numbers.

Intercepted Rebates

The Department will intercept your rebate if you owe back taxes or if you owe a balance to another Colorado government

agency. If you are ling a joint return and only one party is responsible for the unpaid debt, you may le a written claim

to Injured Spouse Desk, 1375 Sherman St, Room 240, Denver, CO 80261. Claims must include copies of all W-2, W-2G,

any 1099 and/or TPQY/BPQY statements received by both parties. DO NOT attach your claim to this application. It will

not be processed.

Signature(s)

Sign and date your application. Failure to sign and date your application will cause delays and/or denial of your rebate.

Afdavit

Complete the afdavit for lawful U.S. presence.

Special Circumstances

Disabled Children: Complete the following to calculate the PTC rebate for disabled children:

a) Enter the total income for the disabled child. $

b) Enter the total income for the household, including the disabled child. $

c) Divide line A by line B. Enter the result.

Multiply the amount of property tax, rent, and/or heat/fuel expenses by the amount on line c. This is the child’s portion of the expense.

Example: Jose is a disabled child under age 18, who received $6,000 in SSI this year. His parents do not meet the

age criteria for the PTC Rebate, but earned $8,000 from wages this year. The family pays $3,600 in rent and $300

heat/fuel to heat the home.

a) $6,000

b) $14,000

c) 42.9%

Line 9 of Jose’s application is $1,544 ($3,600 x 0.429) and line 10 is $129 ($300 x 0.429).

Married Persons: If you were legally married but never divorced, then you are still considered married. This is true even if

you have a legal separation. If you are married, you MUST include all information about your spouse including all income and

expenses s/he had in 2019. (Unless one spouse within a married couple resides in a nursing home/assisted living center,

see the next page for more details.)

Non-married Persons Sharing a Home: If you share a home with another adult and you share the expenses of the home,

please note the following:

Page 6

Property Tax

One Owner: Only the owner of the home should enter the property tax amount on their application. If the other person

living in the home pays the owner rent, the owner must report the rent as income on line 7 and the renter can report

the rent expense on their application on line 9.

Joint Ownership: Each owner may enter the property tax amount they paid on their own application. The amount

should be calculated according to their ownership percentage in the property. Enter the appropriate amount on line 8

of each person’s application.

Rent and/or Heat/Fuel

Each qualied person may enter the amount of rent and/or heat/fuel expenses on lines 9 and 10 of their own application.

Example: Bob and Joe share an apartment and they split expenses. Bob pays 55% and Joe pays 45%. Their rent is $4,800 and

their heat/fuel is $400. Bob should list $2,640 on line 9 and $220 on line 10. Joe will list $2,160 on line 9 and $180 on line 10.

Nursing Home Residents: Persons living in nursing homes or assisted living centers are NOT eligible for the PTC Rebate

unless one of the following applies:

• The applicant was in assisted living for only part of the year, and

• Before they moved into assisted living, they paid rent and/or heat/fuel. In this case, the rent rebate is based

on 20% of the rental expenses and 100% of the total income received;

• They paid 2018 property taxes while residing in assisted living during 2019. In this case, they may report the

full amount of property tax paid.

• Only one spouse within a married couple resides in a nursing home/assisted living center. The spouse who

maintains the home may le as a single person to report his/her income and expenses only.

Deceased Persons: Surviving spouses or legal representatives may le a PTC application on behalf of a deceased person

whose date of death was during the application year. Complete the application as usual. You must mark the box next to the

name of the deceased person. Write “

DeceaseD” in large letters in the white space above the tax year of the return. Write

“Filing as surviving spouse” or “Filing as legal representative” after your signature. Be sure to also attach form DR 0102 and

a copy of the death certicate to the application.

Rebate Status

You must allow a minimum of 12 weeks to process your application. To check the status of your PTC Rebate, follow

these steps:

1. Visit Colorado.gov/RevenueOnline.

2. Click on "Request a Letter ID" in the Additional Services section. Fill in the requested information.

You will receive the Letter ID by mail in about 2 weeks.

3. After you receive the Letter ID, return to Colorado.gov/RevenueOnline.

4. Click on "Where's My Refund / Rebate?" in the Quick Links section.

5. Click the down-arrow next to Account Type and select Property Tax/Rent/Heat Rebate.

6. SSN is the default setting or you can click the down arrow to select ITIN.

7. Enter your SSN or ITIN.

8. Enter your Letter ID, then click OK.

DO NOT call to check your status before April 20, 2020. Please note that the phone wait times can be very long,

so we recommend that you use the internet instead. The rebate status on the internet provides the most current

information available.

Federal Credit and Colorado Insurance Programs

Individuals whose income does not exceed certain thresholds and/or have qualifying children may be eligible for a refund

resulting from the federal Earned Income Tax Credit (EITC) and/or low-cost health insurance through Child Health Plan Plus

(CHP+). You may obtain additional information regarding the EITC online at IRS.gov or by calling Colorado United Way at

211. Additional information regarding CHP+ can be found online at CCHP.org or by calling 1-800-359-1991.

*190104PT19999*

DR 0104PTC (10/07/19)

COLORADO DEPARTMENT OF REVENUE

Denver CO 80261-0005

Colorado.gov/Tax

(1063)

2019 Colorado Property Tax/Rent/Heat Rebate Application

Mark here if this application is being led to correct a previously led 2019 PTC application.

Last Name (yourself) First Name Middle Initial

Deceased Date of Birth

(MM/DD/YYYY) SSN

Yes

Colorado Driver License/ID Number Expiration Date

(MM/DD/YYYY)

Last Name (spouse, if married) First Name Middle Initial

Deceased Date of Birth

(MM/DD/YYYY) SSN

Yes

Spouse's Driver License/ID Number Expiration Date

(MM/DD/YYYY)

Physical Address Phone Number

City State ZIP

Mailing Address (if different from physical address) Email Address

City State ZIP

If you did not live at the address listed above for all of 2019, you must attach a list of addresses at which you lived during 2019 and the dates

you lived at each location.

Check the rst box that applies to you or your spouse/partner. If none apply, do not ll out this form because you do not qualify for this rebate.

A Age 65 or older on December 31, 2019.

B A widow or widower at least 58 years of age on December 31, 2019.

Totally disabled for all of 2019 and received payment of full benets from Social Security, SSI or the

Department of Human Services based solely on such disability.

Totally disabled for all of 2019 and received payment of full benets from a bona de public or private plan or

source based solely on such disability. You MUST attach proof of disability (see page 4 of the instruction book

for examples of proof).

*190104PT29999*

DR 0104PTC (10/07/19)

COLORADO DEPARTMENT OF REVENUE

Denver CO 80261-0005

Colorado.gov/Tax

Name Account Number

List in the boxes below the TOTAL amount(s) received January through December 2019. If joint, add together the income

for both parties before listing the total. DO NOT enter your monthly amounts.

Enter the number of months (1-12) you received Medicare during 2019. If your

Medicare premiums were paid by Medicaid, enter 0.

Social Security, SSI and/or A.N.D. benets

Colorado Old Age Pension

Private or VA pension payments received 4

Wages, salaries and tips 5

Interest and dividends 6

Other income, Explain 7

Enter your property tax, rent and heat expenses.

If you paid 2018 property tax in 2019, enter amount here. 8

If you paid rent, enter the total for the year here. 9

10.

If you paid heat or fuel expenses, enter the total for the year here. 10

11.

Are your meals included in your rent payments?

No Yes OR Only part of the year, enter amount

12.

Was your heat included in your rent payments?

No Yes OR Only part of the year, enter amount

Direct

Deposit

Routing Number

Type: Checking Savings

Account Number

I declare under penalty of perjury in the second degree that to the best of my knowledge and belief the information herein is true, correct and complete.

Furthermore, I authorize the Department of Revenue to contact the appropriate agencies to verify any information provided on this form and the

agencies are hereby authorized to release such information to the Department of Revenue.

Your Signature Date

(MM/DD/YY)

Mail to: Colorado Department of Revenue,

Denver, CO 80261-0005

Spouse/Partner Signature Date (MM/DD/YY) Prepared by

IMPORTANT — You must also complete and sign the afdavit on the next page.

Afdavit — Restrictions on Public Benets

IMPORTANT — Do not forget to sign and attach this form with your application.

Yourself

swear or afrm under penalty of perjury under the laws of

the State of Colorado that (check one):

1. I am a United States citizen.

2. I am not a United States citizen, but I am a Permanent Resident of the United States.

3. I am not a United States citizen, but I am lawfully present in the United States pursuant to Federal law.

If you are not a United States citizen, enter your Alien Registration Number.

If joint, spouse or partner

swear or afrm under penalty of perjury under the laws of

the State of Colorado that (check one):

1. I am a United States citizen.

2. I am not a United States citizen, but I am a Permanent Resident of the United States.

3. I am not a United States citizen, but I am lawfully present in the United States pursuant to Federal law.

If you are not a United States citizen, enter your Alien Registration Number.

I understand that this sworn statement is required by law because I have applied for a public benet. I understand

that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public

benet. I further acknowledge that making a false, ctitious, or fraudulent statement or representation in this sworn

afdavit is punishable under the criminal laws of Colorado as perjury in the second degree under §18-8-503, C.R.S.

and it shall constitute a separate criminal offense each time a public benet is fraudulently received.

Your Signature Date (MM/DD/YY)

Spouse/Partner Signature Date (MM/DD/YY)

*190104PT39999*

PRSRT STD

U.S. POSTAGE

PAID

COLORADO DEPT

OF REVENUE

Please read all instructions before completing the forms.

STATE OF COLORADO

DEPARTMENT OF REVENUE

Ofcial State of

Colorado Publication

Do not mail application until after January 1.

Evidence of Lawful Presence

The Colorado Property Tax/Rent/Heat (PTC) Rebate is a public benet. Under Colorado law, individuals who are 18 years

old or older and are applying for a public benet must establish lawful presence in the United States. PTC applicants must

complete and sign the form “Afdavit — Restrictions on Public Benets,” which is part of the form DR 0104PTC in this

booklet. Applicants must include on the form DR 0104PTC a valid Colorado driver license number or Colorado identication

number, if available. On the form DR 0104PTC application, the following may be written in the boxes for driver license/ID

number if the applicant does not have those forms of ID:

•

“Military” — U.S. military card or military dependent’s ID card

• “Coast” — U.S. Coast Guard Merchant Mariner Card

• “Tribal” — Native American Tribal Document

• “Other” — Other forms of ID are accepted. See the information below.

• “Waiver” — In some circumstances an identication waiver may be obtained.

Applicants may obtain additional information regarding Accepted Forms of Identication and the Waiver Process either

online at Colorado.gov/Tax or by phone by calling 303-238-7378. PTC applicants who do not have a Colorado driver license

or ID card number must include with their form DR 0104PTC a photo-quality color copy of any one of the other accepted

forms of identication. Documents that are business card size must be enlarged to 200% or twice their original size. Valid

driver licenses from other states will not be accepted because PTC applicants must be full-year Colorado residents. Note:

If you have already obtained a waiver from the identication requirements, you do not need to obtain another waiver. The

waiver is already on le with the Colorado Department of Revenue.

PTC applications will be denied until the required identication information is submitted and/or the afdavit is

completed and submitted.

Forms and information are available at these Taxpayer Service Centers:

Colorado Springs

2447 N. Union Blvd.

Pueblo

827 W. 4th Street, Suite A

Denver

1375 Sherman Street

Grand Junction

222 S. 6th Street, Room 208

Fort Collins

3030 S. College Avenue

Department of Revenue Phone Numbers

Taxpayer Assistance .................................................................................................................303-238-SERV (7378)

Driver License/ID Card Info ..................................................................................................................303-205-5600

TTY/TTD Service ..................................................................................................................................800-659-2656

Have you applied for LEAP?

You may be eligible to receive assistance with your heating bills through LEAP. You may also be

eligible to receive free home energy saving services like window caulking and attic insulation.

Please call toll free 1-866-HEAT-HELP for more information.

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

104PTC Book Property TaxRentHeat Rebate (Colorado DORA)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank 104PTC Book Property Tax/Rent/Heat Rebate (Colorado DORA) Form

Use our library of forms to quickly fill and sign your DORA forms online.

Related forms

Fillable 104PTC Book Property Tax/Rent/Heat Rebate (Colorado DORA)

Fill Online, Printable, Fillable, Blank 104PTC Book Property Tax/Rent/Heat Rebate (Colorado DORA) Form

Use our library of forms to quickly fill and sign your DORA forms online.

Related forms

First 20 documents completely FREE!