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THE COMMISSIONERS OF LEONARDTOWN
SENIOR CITIZENS EXEMPTION
(Chapter 137, Article I, Sections 1-5)
FY 2021 APPLICATION
HOMEOWNER NAME(S) BIRTHDATE
BIRTHDATE
MAILING ADDRESS
STREET ADDRESS OF DWELLING
Is this your principal residence? Yes No
Total number of residents in household (including applicant)
Please name and provide gross income for each
Name Gross annual income(exclude Social Security)
PLEASE PROVIDE CALENDAR YEAR 2019 TAX RETURNS FOR EACH OF THE ABOVE NAMED PERSONS.
Signed: Date:
Signed: Date:
I HEREBY CERTIFY that on this day of 2020 before me, the subscriber, a Notary Public of the
State of Maryland, in and for County aforesaid, personally appeared
and made oath in due form of law that the aforegoing facts stated in this application
are true and correct.
Notary Public
FOR TOWN USE ONLY
Combined gross income
Reduction of assessment Tax credit
Approved: Date