Real Estate Tax Relief For Elderly And/or Totally Disabled Persons Application - City Of Alexandria - 2005

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City of Alexandria, Virginia
OFFICIAL USE ONLY
OFFICIAL USE ONLY
INFO REQUEST
APPROVED:
RE PP
2005 TAX RELIEF PROGRAMS FOR
PARTIAL:
RE PP
THE ELDERLY OR TOTALLY DISABLED
ST
1
REQUEST DATE
(REAL ESTATE TAX EXEMPTION OR DEFERRAL &
DENIED:
RE PP
PERSONAL PROPERTY TAX RELIEF)
ND
2
REQUEST DATE
DEFERRAL:
RE
INITIAL/DATE:
APPLICATION FILING DUE DATE IS APRIL 15, 2005
DATABANK NO:
PERSONAL PROPERTY ACCT. #
APPLICANT INFORMATION
NAME (Applicant)
SOCIAL SECURITY #
BIRTH DATE
NAME (Spouse)
SOCIAL SECURITY #
BIRTH DATE
ADDRESS
CITY /STATE
ZIP CODE
HOME PHONE #
DAYTIME CONTACT PHONE #
NAME AND PHONE # TO CONTACT IF FURTHER INFORMATION IS REQUESTED:
COMPLETE FOR ALL OTHER OWNERS AND RELATIVES RESIDING IN THE PROPERTY
NAME
RELATIONSHIP
SOCIAL SECURITY #
BIRTH DATE
1. TYPE OF RELIEF: CHECK TYPE
REAL ESTATE TAX RELIEF (Home)
DEFERRAL
RELIEF & DEFERRAL
PERSONAL PROPERTY TAX (Car Tax)
2. IS THE PROPERTY IN THE APPLICANT’S NAME?
REAL ESTATE:
YES
NO
PERSONAL PROPERTY:
YES
NO
[ ]
[ ]
[ ]
[ ]
3. WERE YOU RESIDING AT THE ABOVE ADDRESS ON OR BEFORE JANUARY 1, 2005?
YES
NO
[ ]
[ ]
4. ELIGIBILITY FOR EXEMPTION:
I WAS 65 YEARS OF AGE ON OR BEFORE JANUARY 1, 2005 (REAL ESTATE TAX RELIEF).
I WAS 65 YEARS OF AGE ON OR BEFORE APRIL 15, 2005 (PERSONAL PROPERTY TAX RELIEF).
I WAS PERMANENTLY AND TOTALLY DISABLED ON OR BEFORE JANUARY 1, 2005 (REAL
ESTATE TAX RELIEF)/ ON OR BEFORE APRIL 15, 2005 (PERSONAL PROPERTY TAX RELIEF).
Application Page 1 of 4

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