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Liberty County Solid Waste Authority APPLICATION FOR EXEMPTION FROM ANNUAL SOLID WASTE ASSESSMENT MUST BE 65 YEARS OLD OR OLDER WITH AN ANNUAL INCOME OF NO MORE THAN $25,000.00. Please use information as it appears from your past year’s annual ad valorem (tax or mobile home) bill when completing this application so the proper exemption credit can be applied to your bill. Applicants Name: Last First Middle Initial:________ Street Phone Map & Parcel Tax Account Do you own this property? Yes or Total Number of persons residing at this List each person(s) name, age, and relationship who resides at this address: Annual Income from Social Security, Retirement and Disability: Annual Net Income (from all sources):$ Total Gross Annual Income (from all sources): Applicants Signature: Return the completed form with supporting documentation of all income and proof of age to: Liberty County Assessors Office 100 Main St. Suite 1550 Hinesville, GA 31313