Application for Exemption from 2011 Per Capita Tax

Application for Exemption from 2011 Per Capita Tax

<p> MONAGHAN TOWNSHIP APPLICATION FOR EXEMPTION FROM 2011 PER CAPITA TAX</p><p>INSTRUCTIONS: (This form must be completed and submitted for tax year 2011). </p><p>If you are requesting an exemption for the reason that your total annual income for the year 2010 is less than $5,000.00, you must complete Section A, Section B and Section D. The application must be completed after December 31, 2010, and the application, with any necessary documentation, must be submitted to the Monaghan Township Tax Collector not later than March 31, 2011. </p><p>Military personnel on active duty and stationed outside of the boundaries of Monaghan Township must complete Section A, Section C and Section D. The completed application may be submitted to the Monaghan Township Tax Collector at any time after June 30, 2011, but not later than October 15, 2011 for the exemption to be approved for the current year and for the payment of the 2011 Monaghan Township Per Capita Tax to be waived. Exemption applications submitted after October 15, 2011 will be considered for a refund only and must be submitted not later than March 31, 2011 . Active duty service and station outside the boundaries of Monaghan Township must be concurrent and exclusive to the calendar year, 2011.</p><p>SECTION A:</p><p>Name ______SS# ______</p><p>Address ______Zip ______</p><p>Present employer ______</p><p>Your phone no. ______Employer phone no. ______</p><p>SECTION B: </p><p>Please list all sources of income for the past year (January 1 through December 31).</p><p>Salary or Wages $______Alimony/Child Support $______</p><p>Public Assistance $______Rental Income $______</p><p>Unemployment $______Pensions $______</p><p>Workman's Comp $______Interest and Dividends $______</p><p>Self-Employment$______Disability $______</p><p>Social Security $______Other income (explain) $______</p><p>TOTAL INCOME $______SECTION C:</p><p>In addition to the following information, please provide a photocopy of your military identification card. </p><p>Armed Services - Branch or Service: ______</p><p>Station: ______</p><p>Dates of Active Duty Service for year 2000______Dates stationed as above: from ______until ______</p><p>SECTION D:</p><p>I HEREWITH AFFIRM THAT THE STATEMENTS GIVEN IN THIS APPLICATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.</p><p>______Signature of Applicant Date</p><p>**Please remember to submit proof of income.</p><p>TOWNSHIP USE ONLY</p><p>To be completed by Tax Collector</p><p>The applicant for this exemption has _____ has not _____ remitted the Per Capita tax to me.</p><p>______Tax Collector Signature Date</p><p>To be completed by Township Secretary</p><p>Application received ______Date</p><p>Income verification ______</p><p>E I T cross reference______</p>

View Full Text

Details

  • File Type
    pdf
  • Upload Time
    -
  • Content Languages
    English
  • Upload User
    Anonymous/Not logged-in
  • File Pages
    2 Page
  • File Size
    -

Download

Channel Download Status
Express Download Enable

Copyright

We respect the copyrights and intellectual property rights of all users. All uploaded documents are either original works of the uploader or authorized works of the rightful owners.

  • Not to be reproduced or distributed without explicit permission.
  • Not used for commercial purposes outside of approved use cases.
  • Not used to infringe on the rights of the original creators.
  • If you believe any content infringes your copyright, please contact us immediately.

Support

For help with questions, suggestions, or problems, please contact us