State Tax Form 99 - Financial Hardship Fiscal Year - Application For Property Tax Deferral Page 2
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4B. 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, 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. REASON FOR HARDSHIP. Check the reason that applies and provide requested information.
ACTIVATED MILITARY PERSONNEL
Initially enlisted in the armed forces.
Military status changed to active duty.
Date of activation to active duty. _______________________________ Attach copy of orders.
UNEMPLOYMENT
Provide employment history over the last two years, including employer(s), dates, salaries, reasons for leaving.
ILLNESS OR DISABILITY
Provide a detailed description of the physical or mental illness, disability or impairment.
Attach a physician’s letter documenting the illness or disability.
OTHER
Provide a detailed explanation.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
D. FAMILY ASSISTANCE. Complete this section if you are receiving any financial assistance from family members.
Name
Relationship
Residence
Occupation
Wages
Assistance given
____________________ __________________ __________________ ________________ _____________ ______________
____________________ __________________ __________________ ________________ _____________ ______________
Continue list on attachment in same format as necessary.
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