Application For Real Estate Tax Exemption For Elderly Or Permanently/totally Disabled Homeowners Form Page 3
ADVERTISEMENT
1
2
3
4City of Winchester, Tax Relief Application: _________________________________________________________________
Gross Income for the Past Calendar Year:
Enter the gross income before deduction from all sources, for calendar year 2015, of the applicant, spouse,
and all other relatives/ contributing members living in the dwelling. (Other than necessary caretaker or bona fide
tenant) List each person’s income separately. Use additional sheets if necessary. You must attach supporting
documentation for each amount listed.
Yearly Gross Income
Applicant
Spouse
Other
Salaries, Wages, etc.
Social Security
Pensions
Rental Income
Interest and Dividends
Social Services (Welfare)
Capital Gains
Alimony and Child Support
Other Income
Total Yearly Gross Income:
Total Combined Gross Income of Applicant, Spouse and Other Contributing Members: $ _________________
IF THE ABOVE TOTAL EXCEEDS $40,000 YOU DO NOT QUALIFY THIS YEAR. Please return this form or
notify the Commissioner of the Revenue office if you wish to receive an application next year.
Net Financial Worth at End of Past Calendar Year:
Applicant’s Value
Spouse’s Value
Assets
Cash – on hand and in banks
(Checking and Savings)
Stocks, bonds, IRAs, CDs, Trusts
(Attach listing)
Real estate other than primary dwelling
(Attach listing)
Other personal property
(excluding household)
Cash value of life insurance/ annuities
Amounts owed to you
Other assets (Attach listing)
Automobiles (OFFICE USE ONLY)
Non-qualifying portion of primary
dwelling (OFFICE USE ONLY)
Total Assets:
(a) Total Combined Assets of Applicant and Spouse: $ ____________________________________________
If Total Combined Assets exceed $75,000, please complete the following Liabilities section.
(Please complete other side of this form)
Page 3 of 4
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 150-490-014 - Property Tax Deferral Application For 61 Or Younger And Disabled Or 62 Or Older - 2013
Financial
Form 150-490-014 - Property Tax Deferral Application For 61 Or Younger And Disabled Or 62 Or Older - 2014
Financial
Form 150-490-014 - Property Tax Deferral Application For 61 Or Younger And Disabled Or 62 Or Older - 2012
Financial
Form 150-490-014 - Property Tax Deferral Application For 61 Or Younger And Disabled Or 62 Or Older - 2016
Financial
Application For A Central Visual Acuity Disability Permit Form - Wyoming Game And Fish Department
Legal
Related Categories
Parent category: Financial