Revised April 2008 
 DISABLED PERSONS HOMESTEAD TAX CREDIT 
 
FOR HOMESTEAD PROTECTION OF DISABLED PERSONS, THROUGH TAX CREDIT FROM THE 
PAYMENT OF REAL PROPERTY TAXES AS PROVIDED UNDER ACT 6991 TWENTY-SEVENTH 
LEGISLATURE OF THE VIRGIN ISLANDS OF THE U.S., APPROVED MARCH 10 , 2008. 
 
This form must be completed and returned to the Office of the Tax Assessor 
on or before January 1st of each taxable year. 
 
 
Name:………………………………………..…………………………………………………………….. 
 
Mailing Address…………………………………………………………………………………………… 
 
Parcel No:…………………………………………………………………………………………………. 
                                                        (Located on upper right hand of bill) 
 
Designate below the owner- occupied property on which you claim Disabled Persons Tax Credit pursuant to Act No. 6991  
STREET NO. OF 
  
  
                    FOR OFFICE USE ONLY 
  
HOUSE AND/OR LOT 
NAME OF STREET OR ESTATE 
NAME OF 
QTR 
                 DO NOT WRITE IN THIS SPACE 
  
  
  
Assessment 
Taxes 
If not 
exempted 
  
  
  
Exempted 
Exempted 
State reason 
  
  
  
  
  
  
  
  
  
  
  
  
 
Did you receive income from the above property by rental, lease, or otherwise, between January 1st,   
20___ to January 1st, 20___.......................................................................................................................... 
 
Is your total income from all sources more than $30,000 per year for individual’s gross income or more 
than $50,000 per household’s gross income?................................What is your total income?................... 
 
Have you been found to suffer a disability as determined by Social Security Administration? 
......................Document verified………………………………. 
555555555555555555555555555555555555555555555555555555555555555555555 
 
I,…………………………………………………, being duly sworn, say that the foregoing statement is 
correct and that as Owner, Partner, Trustee, Administrator, Guardian or Agent, I have been residing in the 
above described property in the District of …………………………………………………………………. 
 
 
 
 
 
 
 
 
 
………………………………………………… 
 
 
 
 
 
 
 
                              Signature 
 
Subscribed and sworn to before me this………….day of………………………………, 20……………… 
 
 
…………………………………………… 
                    Notary Public 
666666666666666666666666666666666666666666666666666666666666666666 
FOR USE BY THE OFFICE OF THE TAX ASSESSOR 
 
Verified By………………………………………..   Approved By…………………………………………