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Form AV-9 Web

Rev. 6-06

STATE OF NORTH CAROLINA

YEAR 2007

COUNTY OF______________

APPLICATION FOR EXCLUSION UNDER G.S. 105-277.1

PROPERTY TAX RELIEF FOR ELDERLY AND PERMANENTLY DISABLED PERSONS

North Carolina excludes from property taxes the greater of twenty thousand dollars ($20,000) or fifty

percent (50%) of the appraised value of a permanent residence owned and occupied by a qualifying

owner. A qualifying owner is an owner who meets all of the following requirements as of January 1

preceding the taxable year for which the benefit is claimed:

(1) Is at least 65 years of age or totally and permanently disabled.

(2) Has an income for the preceding calendar year of not more than twenty thousand five hundred

dollars ($20,500).

(3) Is a North Carolina resident.

Income is defined as the adjusted gross income, as defined in section 62 of the Internal Revenue Code,

plus all other moneys received from every source other than gifts or inheritances received from a

spouse, lineal ancestor, or lineal descendant. For married applicants residing with their spouses, the

income of both spouses must be included, whether or not the property is in both names.

Income Example:

If a claimant’s adjusted gross income for 2006 was $4,000.00 and this person had $6,000.00 in

social security benefits which were not taxable, his income for 2006 would be $10,000.00. Both of

these numbers may be found on the claimant’s 2006 Individual Federal Income Tax Return.

Assuming this was all the claimant’s income for 2006 and he was at least 65 years of age or totally

and permanently disabled, he would qualify for the Elderly Exclusion for tax year 2007.

CLAIMANT

SPOUSE

Full name (as shown on abstract):

_____________________

______________________

Residence Address:

_____________________

______________________

_____________________

______________________

Social Security Number:

_____________________

______________________

Social Security Number information is mandatory and will be used to establish the identification of the applicant. The authority to require this number

is given by U.S. Code Title 42, Section 405(c)(2)(C)(i). The Social Security Number and all income information will be kept confidential.

Date of Birth:

_____________________

______________________

Telephone #

_____________________

______________________

Description of property: _________________________________________________________

What percentage of ownership does claimant have in property?________. If not 100%, list the

name of other owner(s). _________________________________________________________

Is the property the claimant’s permanent residence? ___________________________________

If claimant is not at least 65 years old but is totally and permanently disabled, attach a certificate

(AV-9A) from a physician licensed to practice medicine in North Carolina or from a government

agency authorized to determine qualification for disability benefits and place an “X” in the space

rovided.______

Form Must Be Signed On Back.

Form Av-9 Web - Application For Exclusion Under G.s. 105-277.1 - State Of North Carolina

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