Application For Real Estate Tax Exemption Or Deferral And/or Personal Property Tax Relief Page 2
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INCOME INFORMATION (FOR 1/1/2006 - 12/31/2006)
PROOF OF ALL INCOME MUST BE PROVIDED
APPLICANT AND SPOUSE (Enter annual, not monthly, amounts)
Applicant
Spouse
1 Wages, salaries, and commissions
2 Interest income (include State and Municipal Bonds)
3 Dividend income (taxable and non-taxable)
4 State of Virginia tax refund as shown on line 10, Form 1040
5 Other (alimony, gifts, child support, etc.)
6 Business income or loss
7 Capital gains or losses
8 Distributions from IRA or other retirement accounts
9 Pensions and annuities
10 Rental real estate, royalties, partnerships, etc. (net)
11 Unemployment compensation, disability, sick pay, etc.
12 Social Security or Railroad Retirement payments
$0
$0
13 Total gross income for each
$0
14 Total combined gross income for applicant & spouse
ALL OTHER OWNERS AND RELATIVES RESIDING IN THE PROPERTY
(Enter annual amounts only)
Other Owner/
Other Owner/
Relative 1
Relative 2
15 Wages, salaries, and commissions
16 Interest income (include State and Municipal Bonds)
17 Dividend income (taxable and non-taxable)
18 State of Virginia tax refund as shown on line 10, Form 1040
19 Other (alimony, gifts, child support, etc.)
20 Business income or loss
21 Capital gains or losses
22 Distributions from IRA or other retirement accounts
23 Pensions and annuities
24 Rental real estate, royalties, partnerships, etc. (net)
25 Unemployment compensation, disability, sick pay, etc.
26 Social Security or Railroad Retirement payments
$0
$0
27 Total gross income for each person
$0
28 Total combined gross income for other owners/relative(s)
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