Form 150-490-015 - Property Tax Deferral Application For Disabled Citizens Or Senior Citizens - 2008 Page 2
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2Page 2—Property Tax Deferral Application
Applicant’s last name
First name and initial
Social Security number
–
–
Joint applicant’s last name
First name and initial
Social Security number
–
–
List all income for 2007. Include income earned in other states or countries. Your income eligibility is
determined by Oregon law. Your household income must be less than $37,500 (taxable and nontaxable income)
to qualify for the 2008–2009 property tax year.
Income Worksheet
Work and Investment Income
00
1. Wages, salaries, and other pay for work ...............................................
1
00
2. Interest and dividends (total taxable and nontaxable) ..........................
2
00
3. Business net income (loss limited to $1,000) ........................................
3
a. Do you have a business located on this property?
Yes
No
If yes, explain type of business and percentage of property used for
business purposes ____________________________________________
00
4. Farm net income (loss limited to $1,000) ..............................................
4
00
5. Total gain on property sales (loss limited to $1,000) .............................
5
00
6. Rental net income (loss limited to $1,000) ............................................
6
a. Is part of your home or property used as a rental?
Yes
No
If yes, what percentage? _______________________________________
00
7. Other capital gains (i.e., stocks and bonds (loss limited to $1,000) .....
7
00
8. Other income from your federal return. Identify:__________________ ..
8
00
9. Add lines 1 through 8 .................................................................................................................. 9
Retirement Income
10. Total Social Security, Supplemental Security Income (SSI),
00
and railroad retirement ..........................................................................
10
00
11. Pensions and annuities (total taxable and nontaxable) .........................
11
00
12. Add lines 10 and 11 .................................................................................................................. 12
Other Income
00
13. Unemployment benefits ........................................................................
13
00
14. Child support ........................................................................................
14
00
15. Support from others not in your household. Identify:______________ ..
15
00
16. Veteran’s and military benefits ..............................................................
16
00
17. Gifts and grants. Total amount minus $500 .........................................
17
00
18. Gambling winnings................................................................................
18
00
19. Other sources. Identify: ____________________________________ .......
19
00
20. Add lines 13 through 19 ............................................................................................................ 20
21. Your total household income. Add lines 9, 12, and 20 .......................................................... 21
00
If the amount on line 21 is more than the household income limit allowed ($37,500 for 2007), you do not qualify
for either the Disabled Citizens’ or the Senior Citizens’ Property Tax Deferral.
DECLARATION
I declare under penalties for false swearing that I have examined all documents and to the best of my knowledge,
they are true, correct, and complete. I understand a lien will be placed on this property and I will be charged lien
recording fees. I understand that 6 percent simple interest accrues on each years’ deferred tax amount.
Applicant’s signature
Date
Joint applicant’s signature
Date
X
X
150-490-015 (Rev. 9-07)
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