Form 150-490-015 - Property Tax Deferral Application For Disabled Citizens Or Senior Citizens - 2008
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1
2Clear Form
2008
For Official Use Only
Date received at county
Date received at Revenue
Property Tax Deferral Application
Previous years’ taxes
•
for
O R E G O N
D E PA R T M E N T
Disabled Citizens or
Senior Citizens
Real market value
O F R E V E N U E
•
NOTICE:
• All New Applicants: You must attach a copy of your last year’s property tax statement. You must complete the
Income Worksheet on the back of this application.
• Individuals with disabilities: You must be determined to be eligible to receive or be receiving federal Social
Security benefits due to disability or blindness on or before April 15 of the year in which the claim is filed. You must
attach proof of your eligibility.
• Remember to sign your application.
• Mail your completed application to your county assessor’s office between January 1 and April 15. See pages
15 and 16 for county addresses.
APPLICANT SECTION
If you are applying as joint owners, each joint owner must be age 62 on or before April 15. If you are married and applying for senior defer-
ral jointly with your spouse, you both must be 62 years old on or before April 15. If only one spouse is 62 you must file as an individual.
Type of Applicant
Individual
Joint ownership
Refiling as surviving spouse
New marriage
Divorce
Applicant’s name (last, first, MI)
Social Security number
Birth date
Age on April 15 Are you disabled?
•
•
–
–
•
Yes
No
Joint applicant’s name (last, first, MI)
Social Security number
Birth date
Age on April 15 Are you disabled?
•
•
•
–
–
Yes
No
Other joint owner on deed or contract
Birth date
Age on April 15 Are you disabled?
Social Security number
•
•
–
–
Yes
No
Mailing address
Property address
(if different than mailing address)
•
City
State
ZIP code
Telephone number
Message number or e-mail address
(
)
Do you owe prior years’ property taxes?
Yes
No
(see page 13)
➛
NOW GO TO THE BACK OF THE FORM
COUNTY SECTION
(Do not complete. This section will be completed by the county assessor’s office.)
Model year
Make
Home number
Manufactured home park name
Manufactured
•
Structure
Platted
LOT ________________
BLK ________________
________________________________________________ Legal Desc
For all unplatted properties attach a copy of the recorded deed or contract.
T ______________________
R ___________________________
SEC_____________________________
Parcel in:
Unplatted
As described in _____________________________________________ County
Containing ________________________ acres
Deed information
Deed recorded in (year) __________________________
Contract recorded in (year) ____________________________
Deed
Document/instrument number
Microfilm number
Reel
Book/volume
Page
Assessor’s account number
Levy code
Check
here for
Levy code
Assessor’s account number
split levy
Assessor’s
de
co
Certification
Type of residential property described above
If a multi-family building, or business on the property, give percentage
•
of value allocated to the applicant’s unit (percent to be deferred):
___________ %
Single family
Multi-family
Date
Assessor’s (or Assessor’s designee’s) signature verifying applicant is the owner of record
County Number
X
— THIS SPACE FOR DEPARTMENT OF REVENUE USE ONLY —
Approved by (initials)
Date approved
Denied by (initials)
Date denied
Application denied
Application approved
150-490-015 (Rev. 9-07)
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