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Online Request for exemption of per capita tax Form
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Email
*
Your email
NAME (Last, First, Middle Initial)
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STREET ADDRESS
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DATE OF BIRTH
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CURRENT ACCOUNT NUMBER (if known)
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CHECK REASON(S) BELOW FOR REQUESTING EXEMPTION
1. Minor - under 18 years of age before July 1 of the tax year (Proof of age must be enclosed)
2. Full time Student, less than 26 years of age, - Attach proof of full time status in
college (school invoice) Required each year
3. Over 65, Single and make under $5000 per year (Copy of Income Tax return required)
4. Over 65, Married and together make $8000 or less (excluding Social Security)
(Copy of Income Tax return required)
5. Permanent Disability or on Public Assistance
(Copy of Public Assistance Benefits or Social Secutiy Benefit Statement Required)
I affirm that the above statements are true and correct.
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Yes
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Today's Date
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Send completed form with all required documentation to: Arnold City Treasurer 1829 Fifth Ave. Arnold, PA 15068
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