Fillable Form Ppb-8 - Property Tax Assistance Application

Form Ppb-8 - Property Tax Assistance Application - 2011 Page 4

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Afﬁ rmation and Applicant Signature

All applicants must complete this section.

I own or am under contract for deed to purchase a

mobile/manufactured home

or home

(please place an X in the box beside the one that applies to you) that may include land up to ﬁ ve acres.

I occupied this residence for at least seven months during the previous calendar year as my/our primary

residence.

Under penalty of law, I afﬁ rm that the information provided in this application form is true and correct.

Signature _______________________________________

Date

M M / D D / Y Y Y Y

SSN

Signature _______________________________________

Date

M M / D D / Y Y Y Y

SSN

Phone

(

)

*Head of Household Information (To be completed by the applicant, if ﬁ ling as Head of Household.)