Tax Relief Programs For The Elderly Or Totally Disabled - 2006 Form Page 2

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INCOME INFORMATION (FOR 1/1/2005 - 12/31/2005)
Round Amounts to Nearest $
PROOF OF ALL INCOME MUST BE PROVIDED
APPLICANT AND SPOUSE
Applicant
Spouse
1
Social Security
2
Pension
3
Annuity
4
Interest and Dividends (Include State and Municipal Bonds)
5
Salary, Bonus and Commissions
6
VA State Tax Refund
7
Rental Income (Net)
8
Other Income (Sick or Disability Pay, Gifts, Alimony, Child Support, etc.)
$0
$0
9
Total Gross Income For Each Person
$
$
$0
$
10
Total Combined Gross Income for Applicant & Spouse
Other Owner or
Other Owner or
ALL OTHER OWNERS AND RELATIVES RESIDING IN THE PROPERTY
Relative 1
Relative 2
11
Social Security
12
Pension
13
Annuity
14
Interest and Dividends (Include State and Municipal Bonds)
15
Salary, Bonus and Commissions
16
VA State Tax Refund
17
Rental Income (Net)
18
Other Income (Sick or Disability Pay, Gifts, Alimony, Child Support, etc.)
$0
$0
$
$
19
Total Gross Income For Each Person
$0
$
20
Total Combined Gross Income for Relative(s)
OFFICIAL USE ONLY
$0
Total Income for Personal Property Tax Relief (Line 10)
$
$0
Total Gross Income for Real Estate Tax Relief (Line 10 + Line 20)
$
Less Disability Exclusion
Less Other Owner/Relative Exclusion
$
Total Net Income for Real Estate Tax Relief
2

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