Form DEX-41 "Application for Property Tax/Rent Rebate Due the Decedent" - Pennsylvania

What Is Form DEX-41?

This is a legal form that was released by the Pennsylvania Department of Revenue - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2022;
  • The latest edition provided by the Pennsylvania Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DEX-41 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Revenue.

ADVERTISEMENT
ADVERTISEMENT

Download Form DEX-41 "Application for Property Tax/Rent Rebate Due the Decedent" - Pennsylvania

Download PDF

Fill PDF online

Rate (4.3 / 5) 65 votes
(EX) 04-22 (FI)
APPLICATION FOR
PROPERTY TAX/RENT
REBATE DUE THE DECEDENT
DECEDENT INFORMATION
SECTION I
START
Name of Decedent
Date of Death
Decedent’s Social Security Number
APPLICATION SUBMITTER INFORMATION
SECTION II
Name
Street Address
City
State
ZIP Code
I am filing this application as (select only one oval):
1.
The surviving spouse. (Attach a copy of the decedent’s death certificate.)
2.
The personal representative of the decedent’s estate. (Attach a copy of a short certificate or court order showing your appointment.)
3.
The personal representative of the decedent where a will has NOT been probated or where there is no will. (Attach a copy of the
decedent’s death certificate and a receipted copy of the claimant’s funeral bill and proof that you directly paid for funeral expenses that
are equal to or greater than the amount of the rebate being claimed. Acceptable proof of this payment include the front and back of the
canceled check, a credit card/bank statement, or other document showing you personally paid for the funeral expenses.
State your relationship to the decedent:
. Sign the affidavit below and have your signature notarized.)
AFFIDAVIT
SECTION III
Complete Section III only if Oval 3 is selected in Section II.
I am making a request for monies due the decedent and certify that the information provided on this claim has been examined by me and is,
to the best of my knowledge, true and correct. Any monies that I receive as a result of this claim will be disbursed according to the laws of
the Commonwealth of Pennsylvania.
PLEASE SIGN AFTER PRINTING
(SIGNATURE OF PERSON FILING THIS CLAIM)
NOTARIZATION
SECTION IV
Subscribed and sworn before me this
day of
20
.
PLEASE SIGN AFTER PRINTING
(SIGNATURE OF NOTARY PUBLIC)
TOP OF PAGE
Reset Entire Form
PRINT
(EX) 04-22 (FI)
APPLICATION FOR
PROPERTY TAX/RENT
REBATE DUE THE DECEDENT
DECEDENT INFORMATION
SECTION I
START
Name of Decedent
Date of Death
Decedent’s Social Security Number
APPLICATION SUBMITTER INFORMATION
SECTION II
Name
Street Address
City
State
ZIP Code
I am filing this application as (select only one oval):
1.
The surviving spouse. (Attach a copy of the decedent’s death certificate.)
2.
The personal representative of the decedent’s estate. (Attach a copy of a short certificate or court order showing your appointment.)
3.
The personal representative of the decedent where a will has NOT been probated or where there is no will. (Attach a copy of the
decedent’s death certificate and a receipted copy of the claimant’s funeral bill and proof that you directly paid for funeral expenses that
are equal to or greater than the amount of the rebate being claimed. Acceptable proof of this payment include the front and back of the
canceled check, a credit card/bank statement, or other document showing you personally paid for the funeral expenses.
State your relationship to the decedent:
. Sign the affidavit below and have your signature notarized.)
AFFIDAVIT
SECTION III
Complete Section III only if Oval 3 is selected in Section II.
I am making a request for monies due the decedent and certify that the information provided on this claim has been examined by me and is,
to the best of my knowledge, true and correct. Any monies that I receive as a result of this claim will be disbursed according to the laws of
the Commonwealth of Pennsylvania.
PLEASE SIGN AFTER PRINTING
(SIGNATURE OF PERSON FILING THIS CLAIM)
NOTARIZATION
SECTION IV
Subscribed and sworn before me this
day of
20
.
PLEASE SIGN AFTER PRINTING
(SIGNATURE OF NOTARY PUBLIC)
TOP OF PAGE
Reset Entire Form
PRINT