Notice Form Of Status Change For Senior And Disabled Deferral
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NOTICE OF STATUS CHANGE FOR
SENIOR AND DISABLED DEFERRAL
If you have any questions, please call 503-945-8348.
•
Deferral Account Number
County Account Number
Name(s) of Taxpayer(s)
Applicant has moved from property.
New address: ________________________________________________________________________________________
_____________________________________________________________________________________________________
Date moved: _________________________________________________________________________________________
Property has been sold or there has been a change of ownership.
New owner(s): ________________________________________________________________________________________
_____________________________________________________________________________________________________
Date sold/transferred: _________________________________________________________________________________
Applicant or spouse is deceased.
Name of deceased: ___________________________________________________________________________________
Date of death: ________________________________________________________________________________________
Property transferred to trust.
Other.
Example—Foreclosure, abandonment: __________________________________________________________________
Date of change: ______________________________________________________________________________________
(Please send a copy of Abandonment or Foreclosure Notice, if available.)
Signature
Date
X
Title
County
150-490-008 (06-07)
503-945-8737
Fax to:
–or–
E-mail to: Deferral.Unit@state.or.us
–or–
Mail to: Oregon Department of Revenue
Deferral Unit
PO Box 14380
Salem OR 97309-5075
If you need additional copies you may photocopy this form as needed.
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