Page 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 below all income for 2006. Include income earned in other states or countries. Your income el i gi bil i ty is
determined by Oregon law. Your household income must be less than $36,500 (taxable and non tax able in come)
to qualify for the 2007–2008 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
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
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. Income of other joint owners (both taxable and nontaxable) ................
13
00
14. Adult and Family Services (welfare) ......................................................
14
00
15. Unemployment benefits ........................................................................
15
00
16. Child support ........................................................................................
16
00
17. Support from others not in your household. Identify:______________ ..
17
00
18. Veteran’s and military benefits ..............................................................
18
00
19. Gifts and grants. Total amount minus $500 .........................................
19
00
20. Gambling winnings................................................................................
20
00
21. Other sources. Identify: ____________________________________ .......
21
00
22. Add lines 13 through 21 ............................................................................................................ 22
00
23. Your total household income. Add lines 9, 12, and 22 .......................................................... 23
If the amount on line 23 is more than the household income limit allowed ($36,500 for 2006), you do not qual i fy
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 knowl edge,
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 Sig na ture
Date
X
X
150-490-015 (Rev. 9-06)