SENIOR CITIZEN PROPERTY TAX WORK PROGRAM Application Form
Town of Ipswich
July 1, 2014 – June 30, 2015
SENIOR CITIZEN PROPERTY TAX WORK PROGRAM
Name of Applicant________________________________Phone____________________
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
Name of Employer Date of Employment Description of Duties
Please discuss any hardships or unusual expense that affects your ability to meet your living costs.
Emergency Contact: Include Name/Phone Number/Relationship
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.