(Exemption Period: One year based on fiscal year July 1 through June 30)
(if different than address of property)
3.Are you currently receiving benefits from at least one of the following programs:
o Energy assistance subsidy o Public assistance –supplemental security income (SSI) or food stamps o Veterans or social security disability benefits
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE PREPARED AND EXAMINED THIS APPLICATION, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS TRUE, CORRECT, AND COMPLETE.