Short Form: Property Tax Exemption For Seniors - 2017
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3SHORT FORM: PROPERTY TAX EXEMPTION FOR SENIORS
Montezuma County Assessors Office
CONFIDENTIAL
140 W. Main St., Suite 3
Cortez, Colorado 81321
2017
15-DPT-AR
Phone: (970) 565-3428 Fax: (970) 565-1247
SE-003-01/17
1. Identification of Applicant and Property
Applicant's First Name, Middle Initial, and Last Name
Social Security Number
Date of Birth
Property Address (number & street name)
Schedule or Parcel Number
City or Town
State
Zip Code
Telephone Number
CO
Mailing Address (if different from property address)
Check box if ownership is
held in a life estate.
2. Age, Occupancy, and Ownership Requirements
Each question must be answered "True" to qualify using this form.
As of January 1 of this year, I am at least 65 years old.
True
False
The owner of record for the property described above is either a) me, b) my spouse, or c) both of us. The
property has been owned by one or both of us for at least 10 consecutive years prior to January 1 of this year.
During periods when the property was owned by my spouse and not by me, my spouse and I were married, and
my spouse occupied the property as his or her primary residence.
True
False
I occupy the property described above as my primary residence, and I have done so for at least
10 consecutive years prior to January 1 of this year.
True
False
3. Each additional person who occupies the property as his or her primary residence must be listed here.
(Attach an additional sheet if necessary.)
Person who also occupies property as primary residence
Spouse
Social Security Number
Yes
No
Person who also occupies property as primary residence
Social Security Number
Person who also occupies property as primary residence
Social Security Number
4. Affidavit and Signature
I declare, under penalty of perjury in the second degree (§ 18-8-503, C.R.S.), that the
information I provided on this form and on any attachments is correct.
Signature:____________________________________________________________
Date:___________________
Signer is:
Applicant
Spouse
Guardian*
Conservator*
Attorney-in-fact*
* Authorization in the form of a court order or power of attorney is required.
Other Contact:________________________________________________Telephone Number:__________________
(relative, personal representative, etc.)
The assessor must be informed of any change in ownership or occupancy of the property
within 60 days of when the change occurs.
Mail or deliver this form to your county assessor by July 15. We recommend you obtain a receipt
when delivering the form in person, or mail the form by certified mail. You may also call the assessor
prior to July 15 to ensure that it was received.
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