Form Rp-467 - Application For Partial Tax Exemption For Real Property Of Senior Citizens (And For Enhanced School Tax Relief (Star) Exemption) Page 2

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RP-467 (11/09)
2
9.
Income of each owner and spouse of each owner for the calendar year immediately preceding date
of application MUST be set forth. (Attach additional sheets if necessary; see instruction #9 for
income to be included.)
Name of owner(s)
Source of income
Amount of income
Name of spouse (s) if
Source of income
Amount of income
not owner of property
of spouse(s)
of spouse(s)
Subtotal income of owner(s) and spouse (s)
$ ___________________
10. Of the income specified in #9 how much, if any, was used to pay for an
owner’s care in a residential health care facility? (See instruction #10)
(Attach proof of amount paid: enter zero if not applicable.)
$ __________________
Subtotal income of owner(s) and spouse(s) [#9 minus #10]
$ __________________
“Local Option Only”
11. If a deduction for unreimbursed medical and prescription drug
expenses is authorized by any of the municipalities in which the
property is located (see instructions #11), complete the following:
(a) Medical and prescription drug costs;
$ __________________
(b) Subtract amount of (a) paid or reimbursed by insurance:
$ __________________
(c) Unreimbursed amount of (a) (attach proof of expenses and
reimbursement, if any; enter zero if option not available):
$ __________________
Subtotal income of owner (s) and spouse (s) [#10 minus #11 (c)]
$ __________________
“Local Option Only”
12. If a deduction for veteran’s disability compensation is authorized
by any of the municipalities in which the property is located
(see instruction #12), complete the following:
Veteran’s disability compensation received (attach proof,
enter zero if not applicable)
$ __________________
Total income of owner(s) and spouse(s) [11(c) minus 12]
$ __________________

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