Fillable As provided by Rhode Island General Law 44-3-3 (City of Providence)

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As provided by Rhode Island General Law 44-3-3 (City of Providence)

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City of Providence
Indigent Application
As provided by Rhode Island General Law 44-3-3 (16), any person deemed impoverished may
request relief from property taxes. To qualify for consideration you must:
Reside in the home for the entire calendar year
Provide the Assessor’s Office with any and all documents to substantiate your request
REQUIRED: federal tax return (if applicable), (3) months of bank checking/savings
statements, proof of income, receipts of expenses (listed on the second page) such as
rent/mortgage, utilities etc.
Allow an appraiser from our office to inspect the property for assessment purposes
Furnish a complete application with all photocopies of supporting documents already made
Must be completed by the applicant him/herself PRIOR to submission
Applicant Information
Claimant 1
Name:
Date:
Last
First
M.I.
Claimant 2
Name:
Date:
Last
First
M.I.
Property
Address:
Street Address
Phone:
Email
Age of Claimant
1:
Age of Claimant 2:
Number of
dependents:
Disclaimer and Signature
I, the undersigned claimant, attest that all information contained herein is true to the best of my knowledge and that the City of
Providence is authorized to investigate and verify any such information.
Signature 1:
Date:
Signature 2:
Date:
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City of Providence
Indigent Application
Household Expenses Gross Monthly Income
Reserve
Expense
Monthly
Mortgage
Property Taxes
Homeowners Insurance
Association Fees
Other Mortgages
Automobile
Other automobile
Auto Insurance
Gasoline
Water
Sewer
Gas
Oil
Electricity
Medical (Not covered by
insurance)
Insurance (life/disability)
Child/Dependent Care
Groceries
Total:
Income
Applicant
Co-
Applicant
Social Security
Unemployment
Pension/Annuity
Dividend and Interest
Rental/Board
SNAP
Wages
Cash Public
Assistance
Child Support
Total Income:
Combined Income:
Checking Account
Total:
Savings Account Total:
Cash On Hand:
Stocks/Bonds Total:
Total:
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As provided by Rhode Island General Law 44-3-3 (City of Providence)

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Completed 24 January 2021

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