VISITABLE HOUSING TAX CREDIT APPLICATION  
  A CREDIT OF TWENTY PERCENT (20%) OF REAL PROPERTY TAXES FOR PROPERTY OWNERS THAT CONSTRUCT 
VISITABLE DWELLING AS PROVIDED UNDER ACT NO.7320, APPROVED NOVEMBER 10th, 2011  
 
This form must be completed and returned to the Office of the Tax Assessor 
before January 1st of the year in which the application is being processed. 
 
Name:………………………………………..…………………………………………………………….. 
 
Mailing Address…………………………………………………………………………………………… 
 
Contact Number……………………….………Email…….………………………………………………. 
 
Parcel No: ___ - ___ ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ 
                                                     (Located on right side of bill) 
 
Did you receive a Certificate of Visitability from the Commissioner of the Department of Planning and 
Natural Resources? YES............... NO……………  
 
 
I,…………………………………………………,being duly sworn, say that the foregoing statement is 
correct and that as Owner, Partner, Trustee, Administrator, Guardian or Agent, 
 
 I certify this property is a residential dwelling in the District of ………………………………. 
 
 I certify this property is one to four family dwelling units 
 
  
Signature ………………………………………..………… Date…………………………………... 
 
 
 
 
 
 
 
 
 
 
Subscribed and sworn to before me this……..day of………………………..………, 20……. 
 
 
…………………………………..………… 
                    Notary Public 
 
 
FOR USE BY THE OFFICE OF THE TAX ASSESSOR 
 
Tax year credit approved for ………………….. Expiration date of tax credit…………………… 
 
Certificate No. Attached ……………..Verified By………………………………………..    
 
Recorded By………………………………………… Date……………………………………….. 
Designate below the residential property on which you claim Tax Credit  pursuant to Act No. 7320 
A 
FOR OFFICE USE ONLY  -    DO NOT WRITE IN THIS SPACE 
B 
C  
Lot No./Street or Estate 
Current Year Tax Amount             
Amount of Credit 20% of B