f
Senioif Citizens Annual Refund Application
|
|
Note: *AII Fields Must Be Filled in |
1 |
Claimant Name |
First |
Middle Initial |
Last Name |
2 |
Claimant Address |
1 3Loo H LsP |
3 |
Claimant City, State ft Zip Code |
City |
State |
Zip Code |
|
|
|
1f Senioif Citizens Annual Refund Application Note: *AII Fields Must Be Filled in1Claimant NameFirstMiddle InitialLast Name2Claimant Address1 3Loo H LsP3Claimant City, State ft Zip CodeCityStateZip Code K J4 |
Claimant Telephone |
Office |
Home |
Cellular |
|
|
|
1f Senioif Citizens Annual Refund Application Note: *AII Fields Must Be Filled in1Claimant NameFirstMiddle InitialLast Name2Claimant Address1 3Loo H LsP3Claimant City, State ft Zip CodeCityStateZip Code K J4Claimant TelephoneOfficeHomeCellular 5 |
Claimant Birthdate: |
Must be 65 years of age, or older as of 3/11/2009 dd/mm/yyyy format |
6 |
Property Tax Number: |
Example PIN Number (XX-XX-XXX-XXX-XXXX) piNlH\ -fST"-fuo"-(ooo-(1131 |
7 |
Water Account Number: |
1 xx-xx-xxx-xxxx-xxx format |
8 |
Building Type: |
'^^Condo r Townhouse r Co-op Apartment |
9 |
Signature information on Next Page |
|
|
|
|
|
|
|
|
Please print this and return application to your aldermanic office before July 1