Senior Citizen And Disabled Persons Reduction In Property Taxes (Page 2 of 2) in pdf

APPLICATION INSTRUCTIONS

Your claim is filed with the King County Assessor’s office for taxes payable in 2017 under the requirements of RCW 84.36. Due to high

volume, the review process can take several weeks. You will receive written notice once your application is processed.

NUMBERS BELOW CORRESPOND TO THE SECTIONS OF THE APPLICATION

Mark all boxes that apply to you. If you are disabled and under 61 years of age, you must:

Supply a current, physician-signed disability form indicating the year the disability occurred, the type of disability and if

the disability is temporary or permanent. Or provide your SSI or VA award letter.

Provide the addresses and locations for all properties you own world-wide.

Complete:

Birth date

Spouse/domestic partner birth date. For domestic partner eligibility, attach a partnership agreement.

Date of purchase and date of occupancy of this home

Copy of a driver’s license or identification for each applicant

Write in your parcel/tax account number, which is in the upper left-hand corner of your Property Tax Statement/Bill. If you cannot

locate this number, leave blank, and staff will enter the number.

Combined Disposable Income and Allowable Expenses Deductions:

Some income and financial support sources are listed below—Include ALL resources, even though not all income types will

be used to calculate combined disposable income. (Attach copies of documentation):

Social Security (less Medicare)

VA or Disability Income - (exclusions may exist)

Retirement and Pension Income

Taxable IRA or Annuity Disbursements

Trust and/or Royalty Disbursements

Taxable and non-taxable Interest or Dividends

*Capital Gain–do NOT include any loss amount

Partnership Disbursements

Business Income

Rental Income (before depreciation)

Public Assistance (exclusions may exist)

Money received from another country

Wages or Alimony

Money received from family - (Gift letter must be provided)

Unemployment compensation

Income from co-tenants that reside in the home

Non-reimbursed expenses (deductions) include, but are not limited to (documentation required):

Nursing Home

assisted living facility

Adult Family Home

Non-Reimbursed Prescription Costs/Co-Pays

In-Home Care Expenses (oxygen, Meals on Wheels, special needs furniture, attendant care, housekeeping)

Medicare Insurance Premiums under Title XVIII of the Social Security Act.

Documentation – please block out your Social Security number and financial account numbers.

□ Yes

□ No

Do you own more than one property?

Provide the address, state or country for ALL properties.

□ Yes □ No

Are you required to file a federal tax return?

Provide a complete copy of your IRS tax return, including all pages and schedules and all supporting documents such

as W-2, year end 1099 statements etc.

If you are not required to file a tax return, please provide copies of all year-end statements (1099’s, W2’s, etc.) and

information on ALL financial resources that are used to finance your daily living expenses.

All income information must be disclosed whether federally taxable or not and whether reported on your tax return

Name/Address/Signature:

Complete name(s), address, and phone number

Sign and date the form

Obtain 2 witness signatures

Miscellaneous Application Notes:

While the IRS may allow you to claim capital losses, neither your Short or Long term capital losses are allowed as a deduction

to reduce your capital gain income for the purpose of this relief program.

Only Insurance premiums for Medicare under Title XVIII of the social security act or amounts paid for prescription drugs are

allowable medical deductions. Dental plans, optical plans, company insurance policies DO NOT qualify as deductions.

With the acknowledgement that home ownership and daily living has expenses associated with it, you must provide

documentation on how you meet your daily expenses. Claiming zero ($0) income or very low income, without supporting

documentation, will result in a denial of your application.

The maximum combined disposable income limit is $40,000.

Once on the program, it is your responsibility to provide change of address, change of income or change of relationship status

information to our office. Please call 206-296-3920 or go to our website at

for change forms.

Failure to comply may result in back taxes and penalties.

If your application is approved, your taxable value will be frozen at the market value for the first year of qualification. Your

market value may change and you will receive notification of any changes but your taxable value cannot increase above the

initial frozen value. Any new construction or remodeling performed on your home may change your frozen value.

Senior Citizen And Disabled Persons Reduction In Property Taxes Page 2

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