Page 2 of 3 RP-467 (2022)
6 List the income of each owner and spouse of each owner for the applicable income tax year. Attach additional sheets if necessary.
(See instructions to determine the applicable income tax year and the income to be included.)
7 Of the income specied in line 6c how much, if any, was used to pay for an owner’s care in a
residential health care facility? Attach proof of amount paid: enter 0 if not applicable.
(see instructions) ............................................................................................................................ 7
7a Total income of owner(s) and spouse(s) (subtract line 7 from line 6c) ................................ 7a
8 If a deduction for unreimbursed medical and prescription drug expenses is authorized by any
of the municipalities in which the property is located (see instructions), complete the following:
8a Unreimbursed medical and prescription drug costs
(deduct any amounts reimbursed by
insurance). ............................................................................................................................. 8a
8b Total income of owner(s) and spouse(s) (subtract line 8a from line 7a) .............................. 8b
9 If a deduction for veteran’s disability compensation is authorized by any of the municipalities
in which the property is located, complete the following
(see instructions):
9a Veteran’s disability compensation received (attach proof, enter 0 if not applicable) ........... 9a
9b Total income of owner(s) and spouse(s) (subtract line 9a from line 8b) .............................. 9b
Name of owner(s) Source of income Amount of income
Name of spouse(s) if not owner of property Source of income of spouse(s) Amount of income of
spouse(s)
6b Total income of spouse(s) .................................................................................................... 6b
6c Total income of owner(s) and spouse(s) (add line 6a and line 6b) ...................................... 6c
6a Total income of owner(s) ..................................................................................................... 6a
10 Did the owner or spouse le a federal or New York State income tax return for the applicable income tax year?
(see instructions to determine the applicable income tax year) ....................................................................................... Yes No
If answer is Yes, attach copy of such return or returns
(if you do not have a copy, see instructions).
11 Does a child (or children), including those of tenants or lessees, reside on the property and attend a
public school, grades pre-K through 12? ................................................................................................................. Yes No
11a If the answer to 11 is Yes, list name and location of school(s):
11b If the answer to 11 is Yes, was the child (or were the children) brought into the residence in whole or in
substantial part for the purpose of attending a particular school within the school district? ............................ Yes No
