Application Form For Property Tax Reduction For 2006 - State Of Idaho printable pdf download

APPLICATION FOR PROPERTY TAX REDUCTION FOR 2006

ALL OF THE FOLLOWING QUESTIONS MUST BE COMPLETED. ATTACH SUPPORTING DOCUMENTS.

County

Code Area

Parcel Number

1. Ownership Information (Name, Address and Zip Code)

As of January 1, 2006, I was (check all that apply)

65 or older

Blind

Former P.O.W.

Fatherless or Motherless Minor

Widow(er): Spouse Name___________________ Date of Death________________

Veteran 10-30% Service-connected disability

Veteran 40-100% Service-connected disability

Veteran Nonservice-connected disability with pension

Recognized disabled:

Soc. Sec. Adm.

Fed. Civil Svc.

R/R Retirement

2. Social Security Number (Claimant)

Social Security Number (Spouse)

Household Income and Qualified Expenses

January 1 - December 31, 2005

3. Birth Date (Claimant)

Birth Date (Spouse)

1. Federal Adjusted Gross Income .................... $ ____________________

Extension filed

4. Telephone Number

2. Social Security Income (Claimant) ................ $ ____________________

3. Social Security Income (Spouse) .................. $ ____________________

5. As of January 1, 2006, I was (check only if applicable)

4. S.S.I. (Claimant) ............................................ $ ____________________

Married

Widow(er)/Not remarried

5. S.S.I. (Spouse) .............................................. $ ____________________

6. Physical address of the property if different than Block 1

6. Pensions, Retirements, Annuities, and

IRA’s not included on line 1............................ $ ____________________

7. Are you a new applicant?

Yes

7. VA Pension or Compensation ........................ $ ____________________

8. Interest (Bank, Escrow, Dividends, etc)

8. Did you receive a Property Tax Reduction in 2005?

Yes

Taxable and Nontaxable not included

on line 1 ........................................................ $ ____________________

9. If you live in a mobile home, do you own the land?

Yes

9. Railroad Retirement not included on line 1 .. $ ____________________

10. Have you filed a claim on a different primary residence

10. Other income not included on line 1

between January 1, 2006 and now?

Yes

(Received from ..............................................) $ ____________________

11. Did you occupy your home as your primary residence

11. Subtotal (add lines 1 through 10) .................. $ ____________________

before April 15, 2006?

Yes

12. Capital Gains only if included on line 1 .......... $ (___________________)

12. Did you or your spouse stay in a care facility in 2005?

Yes

13. Total of non-reimbursed paid medical expenses

13. Do you receive rental income for all or any part of this property?

and medical insurance premiums .................. $ (___________________)

(If yes, please attach a copy of your rental agreement.)

Yes

14. Total of paid or prepaid funeral expenses

14. Is any portion of this property used for commercial use?

Yes

...... $ (___________________)

(Attach receipt - amount cannot exceed $5,000.)

15. Total Net Income ............................................ $ ____________________

15. This year will you or your spouse file:

Federal Income Tax Return (If yes, please attach a copy.

Yes

FOR COUNTY USE ONLY

If your tax information is incomplete, please contact your

county assessor for instructions on completing this form.)

Verification of Partial Ownership:

I __________________________________________________________

State Income Tax Return (Which State?_______________)

Yes

County Assessor or Deputy Assessor

certify that___________________________________________________

Idaho Grocery Credit Form _________________________

Yes

Name of Claimant

is a partial owner (excluding community interest) with ________% ownership

16. I grant permission to any government agency and contractor

in this property and the Property Tax Reduction benefits only apply to the

to confirm my status and to reveal to the Idaho State Tax

claimant’s portion of the net taxable value.

Commission the total monetary payments made to me or my

spouse during 2005.

1. Approved and verified by Assessor

2. Date:

or Deputy Assessor:

(Check one)

Yes

3. Tax reduction not to exceed:

Under penalty of perjury, I certify that to the best of my knowledge

the information I have provided here is true, correct, and complete.

The following section should be completed if the claimant is receiving

benefits on a prorated taxable value:

Claimant(s)

Date

4. Land taxable value (one acre or less)

$ ____________________

5. Improvement(s) full value (one residence)

$ ____________________

Signature(s) and Relationship

Telephone Number

6. Homeowner’s exemption

$ (___________________)

7. Net taxable (lines (4+5) – 6)

$ ____________________

RETURN TO YOUR COUNTY ASSESSOR BY

WHITE-TAX COMMISSION

YELLOW - ASSESSOR

PINK - CLAIMANT

APRIL 17, 2006

Application Form For Property Tax Reduction For 2006 - State Of Idaho

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