State Tax Form 97 - Seniors 65 And Older Application For Property Tax Deferral - 2009
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1
2
3The Commonwealth of Massachusetts
Assessors’ Use only
State Tax Form 97
Date Received
Revised 7/2009
Application No.
Parcel Id.
Name of City or Town
SENIORS 65 AND OLDER
FISCAL YEAR _______ APPLICATION FOR PROPERTY TAX DEFERRAL
General Laws Chapter 59, § 5, CLAUSE 41A
THIS APPLICATION IS NOT OPEN TO PUBLIC INSPECTION
(See General Laws Chapter 59, § 60)
Return to:
Board of Assessors
Must be filed with assessors on or before December 15 or 3
months after actual (not preliminary) tax bills are mailed for
fiscal year if later. Tax Deferral and Recovery Agreement
(Form 97-1) must accompany application unless already on
file and persons with interest in property remain the same.
INSTRUCTIONS: Complete all sections fully. Please print or type.
A. IDENTIFICATION.
Name of Applicant:
Marital Status:
Date of birth
Telephone Number _______________________________________
If first year of application, attach copy of birth certificate.
Legal residence (domicile) on July 1, __________
Mailing address
(if different)
No.
Street
City/Town
Zip Code
Location of property:
No. of dwelling units: 1
2
3
4
Other
Did you own the property on July 1,
and for the prior 10 years? Yes
No
If no, list the other properties you owned and/or occupied during the past 10 years.
Address
Dates
Owned
Occupied
Continue list on attachment in same format as necessary.
Have you been granted any exemption in any other city or town (MA or other) for this year? Yes
No
If yes, name of city or town
Amount exempted $
Amount of tax you are seeking to defer this year $ _____________________________
DISPOSITION OF APPLICATION (ASSESSORS’ USE ONLY)
Ownership
GRANTED
Assessed Tax
$
Occupancy
DENIED
Deferred Tax
$
Age
DEEMED DENIED
Adjusted Tax
$
Income
Board of Assessors
Date Voted/Deemed Denied
Certificate No.
Date Cert./Notice Sent
Date:
FILING THIS FORM DOES NOT STAY THE COLLECTION OF YOUR TAXES
THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE
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