Revised May 2008 
 TAX CREDIT 
FOR PROTECTION OF HOMESTEAD OR UNIMPROVED PROPERTY WHOSE TAX INCREASED 
MORE THAN 125% OVER THE PRIOR YEAR, AS PROVIDED UNDER ACT NO. 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) 
 
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 $135,000 per year for household’s gross 
Income?................................What is your total income?................... 
 
Document verified........................................................................ 
666666666666666666666666666666666666666666666666666666666666666666666 
 
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 ………………………………. 
 

 This property is unimproved property in the District of …..………………………………..………… 
 
 
 
 
 
 
 
 
………………………………………………… 
 
 
 
 
 
 
 
                              Signature 
 
Subscribed and sworn to before me this………….day of………………………………, 20……………… 
 
 
…………………………………………… 
                    Notary Public 
555555555555555555555555555555555555555555555555555555555555555555 
FOR USE BY THE OFFICE OF THE TAX ASSESSOR 
 
Verified By………………………………………..   Approved By………………………………………… 
Designate below the owner- occupied property on which you claim Tax Credit  pursuant to Act No.6991 
A 
FOR OFFICE USE ONLY  -    DO NOT WRITE IN THIS SPACE 
B 
C  
D 
E 
F 
Lot No./Street or Estate 
Prior Year Tax 
Amount           
Current Year Tax 
Amount           
Amount of 
Increase          
(C-B) 
Percent 
Increase      
(D/B) 
Amount of Credit 
40% of D no 
more than 
$5,000.00