tax-relief-for-service-charges-paid

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					                                                  Tax Relief for Service Charges Paid


                             Claimant’s Name

                             Address




                             PPS Number
                             The above can be obtained from your Tax Credit Certificate
                             Tax year to which the claim relates                                                         Y Y Y Y
                             Amount paid in full and on time in the previous calendar year, in respect of:
                             Fixed Annual Charge/Lift Charge/Pay by Weight                                 €        ,          . 0 0

                             Bin Tags Purchased                                                                €    ,          . 0 0

                             Name of Local
                             Authority/Private
                             Contractor

                              Declaration which must be signed
                             I declare that all particulars in this form are correct to the best of my knowledge and belief.
                             Signature                                                                        D D MM Y Y
                                                                                                         Date D D / M M / Y Y

                             Phone No.

                             E-mail
                             4-year time limit - A claim for tax relief must be made within 4 years after the end of the tax year to
                             which the claim relates.

                             The following section should be completed where the Service Charges were paid by someone
                             resident in the home other than the person liable for the charges, and where the liable person
                             wishes to disclaim the relief in favour of the claimant.
                             Name of Individual
                             Disclaiming Relief
                             Address




                             I hereby disclaim any entitlement to tax relief under Section 477 Taxes Consolidation Act 1997 for
RPC001174_EN_WB_L_1_INSERT




                             service charges paid in the calendar year                                       Y Y Y Y
                             on my
                             behalf by

                             Signed                                                                      Date D D / M M / Y Y

				
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posted:7/25/2012
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