EmailMe Form - PARSONAGE ALLOWANCE FORM

Name *

First Last

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Type of home *

Apartment

House

I rent/own the above-listed dwelling unit: *

My estimated ANNUAL housing expenses for the 12 month period

Beginning *

MM / DD / YYYY

Ending *

MM / DD / YYYY

Rent Or Mortgage Payments *

$ Dollars . Cents

Real Estate Taxes (for homeowners only)

$ Dollars . Cents

Utilities (gas, electric, water, telephone, etc.)

$ Dollars . Cents

Repairs & Maintenance

$ Dollars . Cents

Homeowner's or Tenant's Insurance

$ Dollars . Cents

Furniture & Furnishings

$ Dollars . Cents

Total Annual Housing Expenses (total of all expenses listed above) *

$ Dollars . Cents

Less annual parsonage allowance to be received from other institutions by you or your spouse

$ Dollars . Cents

Total Annual Parsonage Allowance Requested *

$ Dollars . Cents

Monthly Parsonage Allowance (Total Annual Divided By 12) *

$ Dollars . Cents

The above is an accurate estimate of my anticipated housing expenses. Should my housing expenses change significantly during the course of the year, I will promptly notify my employer and submit a new Parsonage Allowance Request Form.
I hereby agree to indemnify and hold Ma'ayanot harmless from any responsibility for any taxes, penalties, fines or other assessments resulting from parsonage payments. I realize that it is my responsibility to report as income to the IRS any part of the designated allowance, which in fact is not used for housing purposes. I am aware that I am personally liable for any Social Security/Medicare taxes that are due on the above stipend. I also realize that there is no pension match by Ma'ayanot on parsonage.

Signature *

Clear

Date Submitted *

MM / DD / YYYY