Tax Relief Programs For The Elderly Or Totally Disabled - 2006 Form
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OFFICIAL USE ONLY
OFFICIAL USE ONLY
APPROVED: RE PP
1
ST
REQUEST DATE
2006 TAX RELIEF PROGRAMS FOR
PARTIAL:
50% 25%
THE ELDERLY OR TOTALLY DISABLED
2
ND
REQUEST DATE
DENIED:
RE PP
(REAL ESTATE TAX EXEMPTION OR DEFERRAL &
PRORATION DEFERRAL
PERSONAL PROPERTY TAX RELIEF)
RELIEF AMOUNT
INITIAL/DATE:
OFFICIAL USE ONLY
Received Date __________ Completed Date __________
APPLICATION DUE DATE IS APRIL 17, 2006
PERSONAL PROPERTY ACCT. NO:
DATABANK NO:
APPLICANT INFORMATION
NAME (Applicant)
SOCIAL SECURITY #
BIRTH DATE
NAME (Spouse)
SOCIAL SECURITY #
BIRTH DATE
:12345-
STATE
ZIP CODE
ADDRESS:
CITY:
VA
Alexandria
WORK :
EXT
TELEPHONE NUMBER: HOME:
PERSON TO CONTACT IF FURTHER INFORMATION IS REQUESTED:
EXT
TELEPHONE #:
NAME:
COMPLETE FOR ALL OTHER OWNERS AND RELATIVES RESIDING IN THE PROPERTY
NAME
RELATIONSHIP
SOCIAL SECURITY #
AGE
1.
TYPE OF RELIEF :
(CHECK BOX)
REAL ESTATE TAX RELIEF (Home)
DEFERRAL
RELIEF & DEFERRAL
PERSONAL PROPERTY TAX (Car Tax)
2.
IS THE PROPERTY IN THE APPLICANT’S NAME?
NO
PERSONAL PROPERTY:
YES
NO
YES
REAL ESTATE:
NO
YES
3.
WERE YOU RESIDING AT THE ABOVE ADDRESS ON OR BEFORE JANUARY 1, 2006?
[ ]
[ ]
4.
ELIGIBILITY FOR EXEMPTION:
I AM NOW OR WILL BE 65 YEARS OF AGE ON OR BEFORE NOVEMBER 15, 2006 (REAL ESTATE TAX RELIEF).
I WAS 65 YEARS OF AGE ON OR BEFORE APRIL 17, 2006 (PERSONAL PROPERTY TAX RELIEF).
I WAS PERMANENTLY AND TOTALLY DISABLED AS OF ___________________ (Please provide date).
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