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original document ·
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unofficial consolidation, the official version is held by the municipal clerk.
1
274 Main Street
Antigonish, Nova Scotia
Canada B2G 2C4
P: (902) 863 - 2351
Low Income Property Tax ExempƟon Affidavit
I, ____________________________________ of _____________________________________
First and Last Name Civic Address
in the Province of Nova Scotia, do solemnly declare that:
1. I permanently reside and own the property at the above civic address for which a tax
exemption is being claimed.
2. I am a resident of the Town of Antigonish in the Province of Nova Scotia.
3. The information in Exhibit "A" to this Affidavit, entitled "Statement of Income", is true and
correct.
4. That I have provided a copy of my Revenue Canada Notice of Assessment for the calendar
year preceding the fiscal year of the Town, attached to this affidavit.
5. I consent to the Town of Antigonish carrying out such inquiries as it deems necessary in
order to assess my claim and I agree that the Town of Antigonish has my authorization and
consent to obtain information from any third-party source whatsoever and I will execute any
necessary documentation required in order to disclose information to the Town of
Antigonish.
AND I make this solemn declaration conscientiously believing the same to be true and
knowing that it is of the same force and effect as if made under oath and by virtue of the
Canada Evidence Act.
SOLEMNLY DECLARED before me at
Antigonish, in the County of Antigonish and
correct to the best of my knowledge in the
Province of Nova Scotia, this ________ day of
20______.
________________________________________
A Commissioner of the Supreme Court of
Signature of Applicant Nova Scotia, a Notary
Public, or
A member of the Council of the Town of
Antigonish.
This is to certify that the foregoing is true
and correct to the best of my knowledge
and ability.
_______________________________________
Signature of Applicant
______________________________________
Phone
2
274 Main Street
Antigonish, Nova Scotia
Canada B2G 2C4
P: (902) 863 - 2351
Exhibit 'A' Statement of Income
The total income of the members of my family residing in the same household as me at
the above civic address for the preceding calendar year, excluding War Veterans
Allowance Act (Canada) or pension paid pursuant to the Pension Act (Canada), was less
than $28,510 and was as follows:
Employment Income
Old Age Security
Canada or Quebec Pension
Other Pensions
Unemployment Insurance
Interests
Dividends
Rental Income
Taxable Capital Gains
Alimony or Maintenance Income
Workers Compensation
RRSP Income
Special Assistance Payments
Old Age Security Supplements
Other Income
Total Annual Income from all Sources
$