Tax Assessors Office
25 Dorrance Street, RM 208
Providence, RI 02903
Tel: 401-421-5900
Plat: ________ Lot: ________ Unit: ______
APPLICATION FOR
100% SOCIAL SECURITY DISABILITY EXEMPTION
Applicants must file by March 15
th
. Forms are available at the Providence City Assessors Office. Applicant must
own and reside at the property prior to December 31
st
. A “Residence” is to be considered four (4) living units or
less. Dwellings containing commercial, retail and/or office space are NOT eligible for the social security disability
exemption.
All exemptions will terminate upon conveyance of the property, death of the person exempted or moving of said
person from the property. Exemption will terminate upon the termination of disability benefits.
Section One
:
Applicant: ________________________________ Date of Birth: _____________________________
Spouse: ___________________________________ Date of Birth: _____________________________
Phone Number: ___________________________________ E-Mail Address: ___________________________
Address: _______________________________________________________
Providence, Rhode Island ______________
Zip Code
Section Two:
Number of Living Units in Your Residence: _______
Section Three
:
Required Documents: [ ] SS Award Letter [ ] Driver’s License OR [ ] RI ID
THE UNDERSIGNED DOES HEREBY SWEAR THAT THE ABOVE INFORMATION IS TRUE
AND CORRECT TO THE BEST OF HIS OR HER KNOWLEDGE.
___________________________________ ______________________________
APPLICANT SIGNATURE DATE
click to sign
signature
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