Real Estate Exemption Or Deferral And Personal Property Tax Relief Form - 2004
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4OFFICIAL USE ONLY
OFFICIAL USE ONLY
City of Alexandria, Virginia
INFO REQUEST
APPROVED:
RE
PP
1ST REQUEST
PARTIAL:
RE
PP
2004 TAX RELIEF PROGRAMS FOR
DATE
DENIED:
RE
PP
THE ELDERLY OR TOTALLY DISABLED
2ND REQUEST
DATE
DEFERRAL:
RE
(REAL ESTATE TAX EXEMPTION OR DEFERRAL &
PERSONAL PROPERTY TAX RELIEF)
INITIAL/DATE:
APPLICATION FILING DU E DATE IS APRIL 15, 2004
DATABANK NO:
PERSONAL PROPERTY ACCT. #
APPLICANT INFORMATION
NAME
SOC IAL SECU RITY #
BIRTH DATE
ADDRESS:
CITY/STATE
ZIP CODE
PHONE NUMBER:
NAME AND PHONE # OF PERSON TO CONTACT IF FURTHER INFORMATION IS REQUESTED:
COMPLETE FOR ALL OTHER OWNERS AND RELATIVES RESIDING IN THE PROPERTY
NAME
RE LATIO NS HIP
SOC IAL SECU RITY #
BIRTH DATE
1.
TYPE OF REL IEF: CHECK TYPE
REAL ESTA TE TAX RELIEF (Home)
DEFERRAL
RELIEF & DEFERR AL
PER SO NAL PRO PER TY T AX (C ar Tax )
2.
IS THE PROPER TY IN THE APPLICANT’S NAME?
RE AL ESTA TE :
YES
NO
PERS ON AL PR OP ER TY :
YES
NO
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3.
WER E YOU RESIDING AT TH E ABOVE ADDR ESS ON OR BE FOR E JANUARY 1, 2004?
YES
NO
[
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[
]
4.
ELIGIBILITY FOR EXEMPTION:
I W AS 65 YEAR S O F AG E O N O R BE FO RE J ANU ARY 1, 2004 (RE AL ES TAT E TA X R ELIEF).
I W AS 65 YEAR S O F AG E O N O R BE FO RE A PRIL 15 , 2004 (PER SO NAL PRO PER TY T AX R ELIEF).
I WAS PER MANENT LY AND TOTALLY DISABLED ON OR BEFO RE JANUARY 1, 2004 (REAL ESTATE TAX
RELIEF)/ON OR BEFORE APRIL 15, 2004 FOR PERSONAL PROPERTY TAX RELIEF.
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