State Tax Form 97 - Seniors 65 And Older Application For Property Tax Deferral - 2009 Page 2
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3B. PERSONS WITH INTEREST IN PROPERTY.
Did you own the property on July 1, _________ as
Sole owner
Co-owner with spouse only
Co-owner with others?
Was there a mortgage on the property as of July 1, ________? Yes
No
If yes, amount due on mortgage $__________________
Name of mortgagee(s) ______________________________
Was the property subject to a life estate as of July 1, _______? Yes
No
If yes, name(s) of Remaindermen (person(s)receiving property after your death)
Was the property subject to a trust as of July 1, _________ Yes
No
If yes, please attach trust instrument including all schedules.
C. GROSS RECEIPTS FROM ALL SOURCES IN PRECEDING CALENDAR YEAR. Copies of your federal and state
income tax returns, and other documentation, may be requested to verify your income.
Applicant & Spouse
Retirement Benefits (Social Security, Railroad, Federal, MA & Political Subdivisions).……………...
Other Pensions and Retirement Allowances .......................................................................……………...
Wages, Salaries and other Compensation............................................................................ ……………...
Net Profits from Business, Profession or Property Rental....................................................……………
Interest and Dividends ...........................................................................................................……………...
Other Receipts (Capital Gains, Public Assistance, etc.)……………………………………………...…...
TOTALS
D. SIGNATURE. Sign here to complete the application.
This application has been prepared or examined by me. Under the pains and penalties of perjury, I declare that to the
best of my knowledge and belief, this return and all accompanying documents and statements are true, correct and
complete.
Signature
Date
If signed by agent, attach copy of written authorization to sign on behalf of taxpayer.
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