WPC !)xtˌP&; U|ܜ{IE(g}c,'[eGw{u_P;J"x&P ɖt[d}]q?8ua^N-wpc .ɑ A{PK-DkB[ $Ye'P}l_~c;C[Hrʽl4'6tڂs! P4j|Ku]șx6ਸa"(QכDRzS)C}¥.cNuVlSZLf`?}|`w~$A AǢr{r6e^XWwgM`xwߎO( wj{ۅ%:!uܔ\@Fga| 0 X 1 7iU.x#UNo %N 1u 72:^ lwx4| m( ;$ US "pZ4TimesNewRomanPS-BoldMT@\0Custom1Custom123  8x?OU[agmsyCustom2Custom2A.1.1.1.1.1.1.1.1.LB ZCalibrihp color LaserJet 2550 PS0(9 Z6Times New Roman RegularX3#37=CIQYag1.a.i.(1)(a)(i)1)a) i)X{8 Ys8:i+003|xU ;!USUS.,  _  b  X;XXX DOVERTOWNSHIPb`    Eb  REQUESTFOREXONERATIONOFPERCAPITATAXb     EFORTHEYEAR20____ Z  ۩XX;NOTE:DeadlineforapplicationisNovember30thoftheyearofexoneration!!  ^   6۩INSTRUCTIONS: X   :THISFORMMUSTBECOMPLETEDINEVERYDETAIL.THEFORMISINTENDEDFORONE(1) W  APPLICANTONLYANDISTOBERETURNEDTOTHETAXCOLLECTOR,KRISTINEB.KEENER    :NAMEX;X6: |  _____________________________________________________________________________ h  6XX;LAST   `  FIRST h      p MIDDLE T   #ӀADDRESSX;X6: S  __________________________________________________________________________ ?   6XX;ԀAGE:X;X6Ԁ_______________6XX;DATEOFBIRTHX;X6:_____________________   6XX;SEXX;X6:_________________    #  b  REASONS:b   ۩XX;TheBoardofSupervisorshavesetthepolicythatapersonwhoisdependentofanotherpersonforfederalincometax q purposesintheyearinwhichtheexonerationissought,cannotbeexoneratedfrompercapitatax.Personsnotdependent !q uponanotherfortaxpurposesrequestingexoneration,willbeacteduponfavorablyifallotherrequirementsofincome ! andstatuscanbemet.6۩   (x83 "\"  \ 2x  A  .3      SINGLEPERSONSwhosetotalgrossincomefromallsourcesamountsto$5,000.00orlessduring j thetaxyear.NOTE:Listsourcesandamountsatthebottomofthisform.THISMUSTBE 0 COMPLETED!!\ ݌   Ќ  "\"  \ 2x  B  .3      MARRIEDPERSONSwhosejointgrossincomefromallsourcestotals$9,000.00orlessduringthe U" taxyear.Marriedpersonsmustfileseparateexonerationrequests.Incomeistobeaddedtogetherto #k determineeligibility.NOTE:Listsourcesandamountsatthebottomofthisform.THISMUSTBE #1 COMPLETED!!\ ݌ $ Ќ  "\"  \ 2x  C  .3      PersonswhoaremembersoftheArmedForcesoftheUnitedStatesonactivedutymaybe V&! exonerated.Itisalsopermissibleforaspouse,parent,orguardiantodosoforthem.Station 'l" _____________________________________________________.\ ݌ '2# Ќ   Branchofservice____________________.Relationshiptoapplicantexecutingthisformfor )$ theaboveperson______________________________. W*%     Iherewithaffirmthatthestatementsgiveninthisapplicationaretrueandcorrecttothebestof ,V' myknowledgeandbelief. ,(    sDATE:______________SIGNATUREOF  APPLICANT: v ____________________________________________ <     sSIGNATUREOFWITNESS: ; ____________________________________________   M   5 SIGNATUREOFTAXCOLLECTOR: `  _____________________________________ & v .  . M    5ANNUALINCOMEFROM:  <   PublicAssis./Unemployment   ______________Compensation a  ______________Self-Employment 'w  ______________SocialSecurity =  ______________Interest   ______________Commissions y  ______________Rents$ ?  ______________Other U  %, %6% % %%,  v  z   X  %%6 X $  < _____________$ x  _____________$ T  _____________$   _____________$ l  _____________  $_____________ 4  z   $_____________ ?   TOTAL$______________ >   WSalary/Wage @ $  < Benefits @ $Annuities @     $Profiles @ $Bonuses @ $ x ! Pensions @ $ > "   W$_____________ 9( Royalties