Sd Eform-1291 - Application For Paraplegic Property Tax Reduction - 2012

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SD EForm - 1291
V13
PT 46B - APPLICATION FOR PARAPLEGIC PROPERTY TAX REDUCTION
(SDCL 10-4-24.11, 10-4-24.12, 10-4-24.13)
(ATTACH – INFORMATION FOR TAX RELIEF PROGRAMS IN SOUTH DAKOTA)
Applicant’s Name
Applicant’s Mailing Address
_______________________________________________
_______________________________________________
=============================================================================
Personal Information
=============================================================================
________________________________________________________________________________
Last Name
First Name
Social Security Number
Mailing Address
County
Telephone Number
month)_____(day)___(year)____
City
State
Zip Code
Birth Date
Parcel Number _______________________________
Legal description of property for which exemption is requested:
REMINDER: Application must be made on an annual basis
=============================================================================
Eligibility
=============================================================================
A. Are you a paraplegic or an individual with
the loss or loss of use of both lower extremities?
YES
NO
B. Is your home specifically designed as a wheel chair home?
YES
NO
C. Did you own and occupy your home during the entire year of 2012?
YES
NO
D. Do you live alone and have a yearly income under $8,000?
YES
NO
OR Do you live in a household whose members'
combined income is under $12,000?
YES
NO
I have examined this claim and it is correct to the best of my knowledge.
Date
Claimant's signature
Preparer's signature
Address
City
Telephone Number
PT 46B (12/12)
REMINDER: Application must be made on an annual basis

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