Home

SENIOR CITIZEN PROPERTY TAX WORK PROGRAM Application Form

Town of Ipswich

July 1, 2014 – June 30, 2015

SENIOR CITIZEN PROPERTY TAX WORK PROGRAM

APPLICATION

 

Name of Applicant________________________________Phone____________________

 

Address____________________________________________Date_________________

 

 

Eligibility Requirements: Please answer the following questions. (Yes or No)

____________Are you 60 years of age or older?

____________Are you the assessed owner of the taxed property in Ipswich?

____________Is the property for which financial assistance is being requested your primary residence? ____________Can you produce a copy of your current local real estate tax bill for which financial assistance is being requested? (Please attach a copy to this application.)

____________Can you commit to 93 hours of service?

 

 

Volunteer Experience: Include previous placements through this program if applicable.

 

Name of Organization Date Description of Duties

 

1.

 

 

2.

 

 

3.

 

 

Work Experience

 

Name of Employer Date of Employment Description of Duties

 

1.

 

 

2.

 

(Optional)

Please discuss any hardships or unusual expense that affects your ability to meet your living costs.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

Emergency Contact: Include Name/Phone Number/Relationship

 

 

 

 

 

 

Please Note:

All employees/volunteers that are involved with the Ipswich Senior Center must be subject to a CORI (Criminal Offender Record Indicator) check.

 

 

 

If accepted into the Senior Citizen Property Tax Program for the Town of Ipswich, I agree to comply with the rules of the program. To the best of my knowledge, all information provided in this application is accurate.

 

 

________________________________________________

Applicant’s Signature

 

__________________________

Date