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Pennsylvania Free Printable 2023 PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA-1000 RC) for 2024 Pennsylvania PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA Property Tax/Rent Rebate)

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PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA Property Tax/Rent Rebate)
2023 PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA-1000 RC)

IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING 2305210052 PA Rent Certificate PA Rent Certificate and Rental Occupancy Affidavit PA-1000 RC (EX) MOD 03-23 (FI) PA Department of Revenue START 2023 OFFICIAL USE ONLY Name as shown on PA-1000 Social Security Number ➜ You may make photocopies of this form as needed. If filing as a renter, you must provide proof of the rent you paid. If you rented at more than one address, you must submit proof for each address. PA RENT CERTIFICATE Your landlord must provide all the information on Lines 1 through 8. Your landlord, or your landlord’s authorized agent, must sign this PA Rent Certificate. If your landlord, or your landlord’s authorized agent, does not sign this PA Rent Certificate, you must complete Lines 1 through 8 and the Rental Occupancy Affidavit below. Your Rental Occupancy Affidavit must be notarized. 1. Street address of the residence for which the claimant paid rent 3. Rental unit is (fill in the appropriate oval): City, State, ZIP Code 2. Owner’s business name or landlord’s name (last, first, middle initial) if an individual Apartment in a House Mobile Home Lot Apartment Building Nursing Home Boarding Home Private Home Mobile Home Assisted Living Personal Care Home Building Name: Landlord’s Address City, State, ZIP Code Domiciliary Care Landlord’s EIN (if applicable) and daytime telephone number Foster Care If Domiciliary or Foster Care or if a Boarding or Personal Care Home, you must submit a copy of your contract agreement. Dollars YOU MUST COMPLETE ALL LINES. IF NONE, ENTER “0”. Cents Explanation of Item 4. 4. What was the amount of rent per month? (Include only the amount charged for rental. Do not include security deposits or amounts paid for food, medicine, medical care or personal care.) If your rental amounts changed during the year, please explain in the space provided. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. How much of the monthly rental amount was paid or subsidized by a governmental agency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 6. Total monthly amount of rent paid. (Subtract Line 5 from Line 4.) . . . . . . . . . . . . . . 6. Explanation of Item 7. 7. Number of months unit was occupied by the claimant in 2023. (If less than 12 months, please explain in the space provided.) . . . . . . . . . . . . . . . . . . 7. 8. What was the total rent paid in 2023 by the claimant? (Multiply Line 6 by Line 7.) Enter the amount here and on Line 16 of the claim form or the appropriate line(s) of Schedules D, E or F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. LANDLORD’S OATH: (Read carefully before signing) I certify that the information provided on this PA Rent Certificate is true, correct and complete to the best of my knowledge, information and belief. I further certify that – fill in the applicable oval(s). I was required to pay 2023 property taxes on the property in which the claimant resided in 2023. I made, or was required to make, a payment in lieu of taxes for 2023 on the property in which the claimant resided in 2023. The property in which the claimant resided in 2023 was tax exempt. Other names, excluding the spouse or minor children, appear on the lease. Please sign and date after printing. X Landlord’s Signature Date MM/DD/YY OCCUPANCY AFFIDAVIT I am, or am filing on behalf of, the claimant named above. I certify that I was unable to obtain the landlord’s signature on the PA Rent Certificate for the following reason(s): Affidavit: I certify that I am, or am filing on behalf of, the claimant named above. I also affirm all the information on the above PA Rent Certificate and Occupancy Affidavit is true, correct and complete to the best of my knowledge, information and belief. x Claimant's Signature. Please sign after printing. Claimant's Signature Notarize: Subscribed and sworn before me this day of x Date 20 Signature of Notary Public. Please sign after printing. Signature of Notary Public MM/DD/YY 2305210052 Reset Entire Form 2305210052 TOP OF PAGE PRINT
Extracted from PDF file 2023-pennsylvania-form-pa-1000-rc.pdf, last modified January 2019

More about the Pennsylvania Form PA-1000 RC Other TY 2023

If filing as a renter, you must provide proof of the rent you paid. If you rented at more than one address, you must submit proof for each address.

Your landlord must provide all the information on Lines 1 through 8. Your landlord, or your landlord’s authorized agent, must sign this PA Rent Certificate. If your landlord, or your landlord’s authorized agent, does not sign this PA Rent Certificate, you must complete Lines 1 through 8 and the Rental Occupancy Affidavit below. Your Rental Occupancy Affidavit must be notarized.

We last updated the PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA Property Tax/Rent Rebate) in January 2024, so this is the latest version of Form PA-1000 RC, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form PA-1000 RC directly from TaxFormFinder. You can print other Pennsylvania tax forms here.


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Related Pennsylvania Other Forms:

TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Pennsylvania Form PA-1000 RC.

Form Code Form Name
Form PA-1000 Property Tax or Rent Rebate Claim
Form PA-1000 Booklet Property Tax or Rent Rebate Program Instruction Booklet
Form PA-1000 B/D/E Widow or Widower/Public Assistance/Business Use Prorations (PA Property Tax/Rent Rebate)
Form PA-1000 PS Physician's Statement of Permanent and Total Disability (PA Property Tax/Rent Rebate)
Form PA-1000 F/G Multiple Owner or Lessor Prorations/Income Annualization (PA Property Tax/Rent Rebate)
Form PA-1000 A Deceased Claimant and/or Multiple Home Prorations (PA Property Tax/Rent Rebate)

Download all PA tax forms View all 175 Pennsylvania Income Tax Forms


Form Sources:

Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania Form PA-1000 RC from the Department of Revenue in January 2024.

Show Sources >

Historical Past-Year Versions of Pennsylvania Form PA-1000 RC

We have a total of three past-year versions of Form PA-1000 RC in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form PA-1000 RC

2023 PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA-1000 RC)

2022 Form PA-1000 RC

2022 PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA-1000 RC)

2021 Form PA-1000 RC

2021 PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA-1000 RC)


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