RPW_V03.001_RPT_FILE300 944HP LaserJet 5LœCï€ê odXXÿÿÿÿDINU"Ø£Z“°ØSMTJÈHP LaserJet 5LInputBinUPPERRESDLLUniresDLLOrientationPORTRAITResolutionOption1PaperSizeLETTEREconomodeOption1RETOption1HalftoneHT_PATSIZE_AUTO 39 winspoolHP LaserJet 5LNe09: 64.000 64.000 2.000 2.000 116APPLICATION FOR HOMESTEAD TAX EXEMPTIONY 105 105YYYNc:\progra~1\WinGAP\data\reval2\DD_RDD.INI 1 9rpSection02 211 360 360 14 14 1 12240 15840YStandard Report (No Columns) 0 0 0 0 0N 1 768 0 1Y 12rpDataSource02 3N 1 20Saleinfo.SaledateN 1 10rpRDDTable02 142DBFCDXC:\PROGRAM FILES\WINGAP\DATA\REVAL2\REALPROP.DBFRealpropREALPROPC:\PROGRAM FILES\WINGAP\DATA\REVAL2\REALPROP.CDX 00 3 10rpRDDTable02 117DBFCDXC:\PROGRAM FILES\WINGAP\DATA\REVAL2\OWNER.DBFOwnerOWNEROWNERownkey 0ownkeyRealprop.Ownkey1 0 10rpRDDTable02 124DBFCDXC:\PROGRAM FILES\WINGAP\DATA\REVAL2\REPROP.DBFRepropREPROPREPROPrealkey 0realkeyRealprop.Realkey1 0 10rpRDDTable02 132DBFCDXC:\PROGRAM FILES\WINGAP\DATA\REVAL2\SALEINFO.DBFSaleinfoSALEINFOSALEINFOrealkey 0realkeyRealprop.Realkey0 005 54 -100 11866NBackground BandNNN 0 0 605 50 -1 0NPage HeaderNNN 0 005 66 0 0NGroup Hdr: Realprop.RealkeyNNN 0 005 48 500 0NPage BodyNNN 0 005 66 1000 10890NGroup Ftr: Realprop.RealkeyNNN 0 1 702 223 0 0 15105 5070 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33001 17rpEmbeddedSection02 211 0 0 0 0 1 5070 15105YStandard Report (No Columns) 0 0 0 0 0N 1 0 0 1Y 12rpDataSource02 3N 0 1 10rpRDDTable02 94DBFCDXC:\PROGRAM FILES\WINGAP\DATA\REVAL2\DEFAULTS.DBFDefaultsDEFAULTS 00 005 54 -100 5070NBackground BandNNN 0 0 205 48 500 12945NPage BodyNNN 0 97 502 223 0 945 15015 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 9030 7770 5985 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 0 7560 3675 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 0 6930 15015 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 0 1155 15015 630 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 0 0 15015 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 202 223 0 7140 9030 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 316'Location of Property (Street Address): ' + iif(realprop.house_no>0,numtrim(Realprop.house_no)+' ',' ')+iif(realprop.extension>' ',realprop.extension+' ',' ')+trim(realprop.stdirect)+' ' +trim(realprop.street_nam)+' '+realprop.sttype 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 11970 7560 3045 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 169'Land District Number: ' + iif(Realprop.Landdist>' ',realprop.landdist,realprop.landgmd) 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 9030 7560 2940 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 118'Land Lot Number: ' + Realprop.Landlot 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 9030 7350 5985 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33003 122'Map/Parcel Number: ' + realprop.parcel_no 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 2835 2730 4620 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33003 223iif( alltrim(Owner.firstname) >' ', alltrim(owner.lastname)+', ' + alltrim(owner.firstname)+' ' + owner.middle , alltrim( owner.lastname ) ) 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 2835 2940 4620 210 0 -1 0 0 -1 0 0 -1 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 203iif( len(alltrim(owner.address1))=0, iif(len(alltrim(owner.address2)) > 0, owner.address2, owner.address3), owner.address1) 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 0 7350 3690 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33003 177'Date Property Purchased: ' + iif(dtos(saleinfo.saledate) > ' ' , dtoc(Saleinfo.Saledate) , ' ') 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 10500 7770 4515 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33003 113saleinfo.deedpage@R 99999 / 99999 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 1575 7560 2100 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33003 111Saleinfo.Saleprice9,999,999,999 0YNN00ARIAL -160 0NNNN 0 0" 0 602 223 0 7770 3675 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 92Kind of Title Held: 000ARIAL -160 0NNNN 0 0" 0 202 223 3675 7350 5355 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33003 122'From Whom Purchased: ' + Saleinfo.grantor 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 15015 0 -2520 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33003 190"Homestead Year: " + iif(substr(dtos(today()),5,4) > '0401', str(year(today()) + 1 , 4,0) , str(year(today())) 0YNN00ARIAL -180 0NNNN 0 0" 0 602 223 0 0 2940 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 95LGS-Homestead Rev 1-07 000ARIAL -180 0NNNN 0 0" 0 602 223 4515 0 6090 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 108APPLICATION FOR HOMESTEAD EXEMPTION 100ARIAL -180 0YNNN 0 0" 0 602 223 0 210 15015 735 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 565The homestead exemptions provided for in this Application form are those authorized by Georgia law. Counties are authorized to provide for local homestead exemptions that may vary from the ones shown on this application. Applicants seeking a homestead exemption in lieu of or in addition to these should contact the local Tax Commissioner or Tax Receiver for additional information. If this application is denied, an appeal may be filed in accordance with O.C.G.A. Section 48-5-311.  000ARIAL -160 0NNNN 0 0" 0 602 223 4515 945 6090 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 94APPLICANT INFORMATION 100ARIAL -180 0YNNN 0 0" 0 602 223 0 945 1530 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 83SECTION A: 000ARIAL -180 0YNNN 0 0" 0 602 223 0 1155 15015 315 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 227List below the address of any other property where you or your spouse have applied for and been granted a homestead exemption of the current year:  000ARIAL -160 0NNNN 0 0" 0 602 223 0 1785 13020 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 221Are you and your spouse a Georgia resident, US citizen or alien with legal authorization from the US Immigration and Naturalization Service?  000ARIAL -160 0NNNN 0 0" 0 602 223 13020 1785 1995 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 97[ ] YES [ ] NO 000ARIAL -160 0NNNN 0 0" 0 602 223 0 2730 1050 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 91Applicant:  000ARIAL -160 0NNNN 0 0" 0 602 223 7455 2730 1050 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 88Spouse:  000ARIAL -160 0NNNN 0 0" 0 602 223 1050 2730 1785 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 86Name:  000ARIAL -160 0NNNN 0 0" 0 602 223 1050 2940 1785 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 96Street Address:  000ARIAL -160 0NNNN 0 0" 0 602 223 1050 3150 1785 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 98City, State, Zip:  000ARIAL -160 0NNNN 0 0" 0 602 223 1050 3360 1785 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 100Social Security No:  000ARIAL -160 0NNNN 0 0" 0 602 223 1050 3570 3150 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 95Year of Birth:  000ARIAL -160 0NNNN 0 0" 0 602 223 1050 3780 6405 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 113County where registered to vote:  000ARIAL -160 0NNNN 0 0" 0 602 223 1050 3990 4515 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 112County where car is registered:  000ARIAL -160 0NNNN 0 0" 0 602 223 4200 3570 3255 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 94Phone Number:  000ARIAL -160 0NNNN 0 0" 0 502 223 7455 2940 1050 1050 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -1 11311760N 330 330 502 223 0 2940 1050 1260 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -1 11311760N 330 330 202 223 2835 3150 4620 210 0 -1 0 0 -1 0 0 -1 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 230alltrim(Owner.City) + ' ' + Owner.State + ' ' + iif(len(alltrim(Owner.Zip)) = 5, alltrim(owner.zip) , left(owner.zip,5) + '-' + substr(owner.zip,6,4)) 0YNN00ARIAL -160 0NNNN 0 0" 0 502 223 2835 3360 4620 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 602 223 8505 2730 6510 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 86Name:  000ARIAL -160 0NNNN 0 0" 0 602 223 8505 2940 6510 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 96Street Address:  000ARIAL -160 0NNNN 0 0" 0 602 223 8505 3150 6510 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 98City, State, Zip:  000ARIAL -160 0NNNN 0 0" 0 602 223 8505 3360 6510 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 100Social Security No:  000ARIAL -160 0NNNN 0 0" 0 602 223 8505 3570 3150 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 95Year of Birth:  000ARIAL -160 0NNNN 0 0" 0 602 223 11655 3570 3360 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 94Phone Number:  000ARIAL -160 0NNNN 0 0" 0 602 223 8505 3780 6510 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 113County where registered to vote:  000ARIAL -160 0NNNN 0 0" 0 602 223 5565 3990 9450 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 172If you or your spouse are in the military service, list state shown as your home of record:  000ARIAL -160 0NNNN 0 0" 0 602 223 0 4200 15015 525 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 324If you answer Yes to any of the questions below, please follow the instructions to determine if you qualify for an increased homestead amount. Please see Tax Commissioner or Receiver for additional information and qualifications requirements.  000ARIAL -160 0NNNN 0 0" 0 602 223 0 4725 1155 525 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 92[ ] YES  000ARIAL -160 0YNNN 0 0" 0 602 223 1155 4725 420 525 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 751. 000ARIAL -160 0YNNN 0 0" 0 602 223 1575 4725 13440 525 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 298Were you or your spouse age 62 or older as of Jan 1 of the year of this application? Go to Sections C1 and/or C2 on the back of this application to determine whether you meet the gross and/or net income requirements.  000ARIAL -160 0NNNN 0 0" 0 602 223 15015 5250 -13440 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 165Were you or your spouse age 65 or older as of Jan 1 of the year of this application?  000ARIAL -160 0NNNN 0 0" 0 602 223 15015 5565 -13440 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 129Are you or your spouse a 100% disabled verteran?  000ARIAL -160 0NNNN 0 0" 0 602 223 15015 5880 -13440 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 139Are you the unmarried surviving spouse of a 100% disabled veteran? 000ARIAL -160 0NNNN 0 0" 0 602 223 15015 6195 -13440 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 152Are you the unmarried surviving spouse of a US service member killed in action? 000ARIAL -160 0NNNN 0 0" 0 602 223 15015 6510 -13440 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 173Are you the unmarried surviving spouse of a firefighter or peace officer killed in the line of duty? 000ARIAL -160 0NNNN 0 0" 0 602 223 1155 5250 420 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 752. 000ARIAL -160 0YNNN 0 0" 0 602 223 1155 5565 420 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 753. 000ARIAL -160 0YNNN 0 0" 0 602 223 1155 5880 420 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 754. 000ARIAL -160 0YNNN 0 0" 0 602 223 1155 6195 420 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 755. 000ARIAL -160 0YNNN 0 0" 0 602 223 1155 6510 420 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 756. 000ARIAL -160 0YNNN 0 0" 0 602 223 0 5250 1155 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 92[ ] YES  000ARIAL -160 0YNNN 0 0" 0 602 223 0 5565 1155 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 92[ ] YES  000ARIAL -160 0YNNN 0 0" 0 602 223 0 5880 1155 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 92[ ] YES  000ARIAL -160 0YNNN 0 0" 0 602 223 0 6195 1155 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 92[ ] YES  000ARIAL -160 0YNNN 0 0" 0 602 223 0 6510 1155 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 92[ ] YES  000ARIAL -160 0YNNN 0 0" 0 602 223 4500 6930 6090 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 93PROPERTY INFORMATION 100ARIAL -180 0YNNN 0 0" 0 602 223 0 6930 1530 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 83SECTION B: 000ARIAL -180 0YNNN 0 0" 0 202 223 9030 7140 5985 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 186'Lot Size or Number of Acres: ' + iif(Realprop.Totalacres > 0 , ltrim(str(realprop.totalacres,8,2)) , ' ') 0YNN00ARIAL -160 0NNNN 0 0" 0 602 223 0 7560 1575 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 89Purchased Price: 000ARIAL -160 0NNNN 0 0" 0 602 223 3675 7560 5355 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 88Amount of Lien: 000ARIAL -160 0NNNN 0 0" 0 602 223 3675 7770 5355 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 93To Whom is Lien Due: 000ARIAL -160 0NNNN 0 0" 0 602 223 9030 7770 1470 210 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 87Deed Recorded: 000ARIAL -160 0NNNN 0 0" 0 602 223 0 7980 9030 525 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 229Is any part of the property used for business purposes? [ ] YES [ ] NO If yes, what kind of business & how much of the property is used?  000ARIAL -160 0NNNN 0 0" 0 602 223 9030 7980 5985 525 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 172Is any part of the property rented? [ ] YES [ ] NO If yes, what kind is rented?  000ARIAL -160 0NNNN 0 0" 0 602 223 0 8820 15015 1680 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 1325I, the undersigned, do solemnly swear that the above sttements made in support of this application are true and correct, that I am the bona fide owner of the property described in this application, that I actually occupied same on January 1 of the year for which application is made, that I am an eligible applicant for the homestead exemption applied for, qualifying or meeting the definition of the word "applicant" as defined in O.C.G.A. Section 48-5-40 and that no transaction has been made in collusion with another for the purpose of obtaining a homestead exemption contrarty to law. Sworn to and subscribed to before me, this ________ day of _________________________,20_______. Applicant Signature: _________________________________________________________ _____________________________________________ __________________________________________ _______________ Tax Commissioner or Receiver [ ] APPROVED [ ] DENIED Board of Tax Assessors Date  000ARIAL -160 0NNNN 0 0" 0 602 223 10605 8505 -6090 315 0 -1 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 95AFFIDAVIT OF APPLICANT 100ARIAL -200 0YNNN 0 0" 0 602 223 0 10500 6195 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 112THIS SECTION FOR TAX ASSESSOR USE ONLY: 000ARIAL -180 0YNNN 0 0" 0 602 223 6195 10500 1470 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 77CODE 100ARIAL -180 0YNNN 0 0" 0 602 223 7665 10500 1470 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79AMOUNT 100ARIAL -180 0YNNN 0 0" 0 502 223 9135 10500 5880 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 602 223 4725 10710 1470 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 87STATE TAX >> 000ARIAL -180 0NNNN 0 0" 0 602 223 4725 10920 1470 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 85COUNTY TAX>> 000ARIAL -180 0NNNN 0 0" 0 602 223 4725 11130 1470 210 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 85SCHOOL TAX>> 000ARIAL -180 0NNNN 0 0" 0 502 223 6195 10710 1470 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 6195 10920 1470 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 6195 11130 1470 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 7665 10710 1470 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 7665 10920 1470 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 502 223 7665 11130 1470 210 0 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 202 223 2835 3360 4620 210 0 -1 0 0 -1 0 0 -1 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 198iif(len(alltrim(owner.ssn)) > 0 , left(Owner.Ssn,3) + '-' + substr(owner.ssn,4,2) + '-' + substr(owner.ssn,6,4) , ' ') 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 2520 3570 1680 210 0 -1 0 0 -1 0 0 -1 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 142iif(year(Owner.Birthdate1) > 0 , year(Owner.Birthdate1) , ' ') 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 5460 3570 1995 210 0 -1 0 0 -1 0 0 -1 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 376iif(len(alltrim(Owner.Homephone)) > 0 , '(' + left(Owner.Homephone,3) + ') ' + substr(Owner.Homephone,4,3) + '-' + substr(Owner.Homephone, 7,4) , iif(len(alltrim(Owner.Workphone)) > 0 , '(' + left(Owner.Workphone,3) + ') ' + substr(Owner.Workphone,4,3) + '-' + substr(Owner.Workphone,7,4) , ' ')) 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 10395 3360 4620 210 0 -1 0 0 -1 0 0 -1 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 202iif(len(alltrim(owner.ssn1)) > 0 , left(Owner.Ssn1,3) + '-' + substr(owner.ssn1,4,2) + '-' + substr(owner.ssn1,6,4) , ' ') 0YNN00ARIAL -160 0NNNN 0 0" 0 202 223 9975 3570 1680 210 0 -1 0 0 -1 0 0 -1 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 33003 141iif(year(Owner.Birthdate2) > 0, year(Owner.Birthdate2) , ' ') 0YNN00ARIAL -160 0NNNN 0 0" 0 602 223 0 2100 15015 525 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 263 If you are a non-citizen with legal authorization from the US Immigration and Naturalization Service, please provide your Legal Alien Registration # _______________________________________ 000ARIAL -160 0NNNN 0 0" 005 46 1002 0NSummaryNNN 0 0 0 0 005 50 1001 0NPage FooterNYN 0 005 46 1002 12000NSummaryNNN 0 97 602 223 105 315 1365 315 20 0 0 20 0 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 84SECTION C1: 000ARIAL -200 0YNNN 0 0" 0 602 223 1470 315 13860 315 0 -1 0 20 0 0 20 0 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 148COMPLETE THIS SECTION TO DETERMINE ELIGIBILITY FOR NET INCOME REQUIREMENT  100ARIAL -200 0YNNN 0 0" 0 602 223 105 630 15225 315 20 0 0 0 -1 0 20 0 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 211If filing Joint Income Tax Return, Applicant must complete Column 1A only. If filing separately, both Columns 1A and 1B must be completed 100ARIAL -200 0YNNN 0 0" 0 602 223 105 945 15225 315 20 0 0 0 -1 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 120INCOME FOR TAX YEAR ENDING DECEMBER 31, 20_____ 100ARIAL -200 0YNNN 0 0" 0 602 223 13545 1260 -1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 82COLUMN 1A 100ARIAL -200 0YNNN 0 0" 0 602 223 13545 1260 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 82COLUMN 1B 100ARIAL -200 0YNNN 0 0" 0 602 223 13545 1575 -1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 82APPLICANT 100ARIAL -200 0YNNN 0 0" 0 602 223 13545 1575 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79SPOUSE 100ARIAL -200 0YNNN 0 0" 0 602 223 13545 1890 -1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 11760 3150 1785 315 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 11760 2835 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 11760 2520 1785 315 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 2205 -1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 11760 3465 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 11760 4095 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 11760 3780 1785 315 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 11760 4410 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 11760 4725 1785 315 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 15597567N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 15330 1890 -1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 3150 1785 315 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 2835 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 2520 1785 315 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 15330 2205 -1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 3465 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 4095 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 4725 1785 315 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 11311760N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 4410 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 13545 3780 1785 315 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 1155 1890 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 1 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 2205 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 2 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 2520 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 3 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 2835 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 4 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 3150 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 5 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 3465 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 6 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 3780 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 7 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 4095 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 8 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 4410 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 9 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 4725 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 80Line 10 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 1890 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 149Total Income from Public or Private retirement, disability or pension system 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 2205 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 106Total Income from Social Security 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 2520 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 146Total Income from both retirement and Social Security (Line 1 plus Line2) 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 2835 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 123Maximum Social Security amount (from Tax Receiver) 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 3150 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 164Retirement Income over maximum Social Security (Line 3 less Line 4) - If less than 0, use 0 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 3465 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 102Other income from all sources 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 3780 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 107Adjust Income (Line 5 plus Line 6) 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 4095 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 135Standard or Itemized Deductions from Georgia Income Tax Return 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 4410 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 129Personal Exemption amount from Georgia Income Tax Return 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 4725 10605 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 111Net Income (Line 7 less Lines 8 and 9) 000ARIAL -200 0NNNN 0 0" 0 502 223 105 1260 11655 630 20 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 602 223 105 5040 15225 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 238If filing Joint Income Tax Return, Line 10, Column 1A must be less than $10,000. If filing Separately, total of Line 10, Column 1A plus 1B must be less than $10,000 000ARIAL -200 0NNNN 0 0" 0 602 223 105 5565 1365 315 20 0 0 20 0 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 83SECTION C2 000ARIAL -200 0YNNN 0 0" 0 602 223 1470 5565 13860 315 0 -1 0 20 0 0 20 0 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 122COMPLETE THIS SECTION TO DETERMINE ELIGIBILITY  100ARIAL -200 0YNNN 0 0" 0 602 223 15330 5880 -13860 315 0 -1 0 0 -1 0 20 0 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 118FOR FEDERAL ADJUSTED GROSS INCOME REQUIREMENT 100ARIAL -200 0YNNN 0 0" 0 602 223 105 6510 15225 315 20 0 0 0 -1 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 120INCOME FOR TAX YEAR ENDING DECEMBER 31, 20_____ 100ARIAL -200 0YNNN 0 0" 0 602 223 105 6195 15225 315 20 0 0 0 -1 0 20 0 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 203For each member residing in the household, complete the social security number & federal adjusted gross income in the spaces below 100ARIAL -200 0YNNN 0 0" 0 602 223 105 5880 1365 315 20 0 0 0 -1 0 0 -1 0 0 -1 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0YNNN 0 0" 0 602 223 1155 7665 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 1 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 7980 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 2 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 8295 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 3 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 8610 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 4 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 8925 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 5 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 9240 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 6 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 9555 -1050 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 79Line 7 000ARIAL -200 0NNNN 0 0" 0 502 223 105 6825 11655 840 20 0 0 0 0 0 0 0 0 0 0 0 13 0 -2 30 30 -2 16777215N 330 330 602 223 11760 6825 1785 840 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 98SOCIAL SECURITY NUMBER 100ARIAL -200 0YNNN 0 0" 0 602 223 13545 6825 1785 840 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 104FEDERAL ADJUSTED GROSS INCOME 100ARIAL -200 0YNNN 0 0" 0 602 223 1155 7665 3360 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 97Name of Household Member 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 7980 3360 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 97Name of Household Member 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 8295 3360 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 97Name of Household Member 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 8610 3360 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 97Name of Household Member 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 8925 3360 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 97Name of Household Member 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 9240 3360 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 97Name of Household Member 000ARIAL -200 0NNNN 0 0" 0 602 223 1155 9555 3360 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 97Name of Household Member 000ARIAL -200 0NNNN 0 0" 0 602 223 4515 7665 7245 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 4515 7980 7245 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 4515 8295 7245 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 4515 8610 7245 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 4515 8925 7245 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 4515 9240 7245 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 4515 9555 7245 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 11760 7665 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 11760 7980 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 11760 9240 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 11760 9555 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 13545 7665 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 11760 8925 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 11760 8610 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 11760 8295 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 13545 8925 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 13545 8610 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 13545 8295 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 13545 7980 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 13545 9555 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 13545 9240 1785 315 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 105 9870 11655 735 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 175ADJUSTED GROSS INCOME - TOTAL OF LINES 1 THRU 7 MUST BE LESS THAN $30,000>>>>>>>>>>>>>>>>>>>>>>>>>>>  100ARIAL -200 0YNNN 0 0" 0 602 223 11760 9870 1785 735 20 0 0 20 0 0 20 0 0 20 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 602 223 13545 9870 1785 735 40 0 0 40 0 0 40 0 0 40 0 0 13 0 -2 30 30 -2 16777215N 330 33002 73 000ARIAL -200 0NNNN 0 0" 0 100 34Realprop.RealkeyRealprop.Realkey 0 0