Form 150-303-084 - Oregon Active Duty Military Service Member'S Exemption Claim

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Oregon Active Duty Military Service Member’s Exemption Claim
[Oregon Revised Statute (ORS) 307.286-307.289]
Instructions
For assessor’s use only
• Complete either Part 1 or Part 2 of this claim form, not both. See the
Date received
Received by
Late filing fee paid
Check number
back of this form for further filing instructions.
$
• If you are claiming an exemption on your primary residence, file this
Map
Account number
Approved
form and attachments with the county assessor on or before August
Denied
1 following the end of the tax year for which you’re claiming.
Briefly give reason for denial
• If you are a service member, you must attach your military orders
showing your federal active duty service under Title 10 or deployment
under the Emergency Management Assistance Compact. See Part 1 of the instructions on the back of this form for more information.
• If you are a lawful occupant, you must attach proof of occupancy and documentation showing the deceased service member’s
active duty service and the date the service member died. See Part 2 of the instructions on the back of this form for more
information.
Claimant section
I am claiming an exemption for tax year(s) 20____________________________________.
Name of claimant
County where home is located
Mailing address
City
State
ZIP code
Location of property for which exemption is sought (street address)
City
State
ZIP code
Part 1—Claim for exemption by a qualified service member
ORS 307.286(1) requires the service member to be serving in the Oregon National Guard or military reserve and then perform at least
179 consecutive days of service under Title 10 or under the Emergency Management Assistance Compact (EMAC). You may claim
exemption for each tax year during which you served at least one day of your qualified service. You must be serving in the Guard or
reserves and be ordered to federal active duty or deployed under EMAC to qualify for this exemption. If you are in regular active enlist-
ment or on a regular tour of duty, you don’t qualify for this exemption.
1. I am serving:
In the Oregon National Guard
In the military reserve
2. I will perform or have performed service for more than 178 consecutive days:
Under Title 10 of the U.S. Code
Under the Emergency Management Assistance Compact
3. I was ordered to federal active duty (Title 10 status) or deployed under the Emergency Management Assistance Compact on or after
January 1, 2005.
*Beginning date of service: ___________________ Actual (from DD-214) or scheduled ending date of service: ___________________
*Note: Use your “Report to Home Station” date for your beginning date of federal active duty service under Title 10.
4. I have attached my military orders or other documentation (for example, a letter on military letterhead) to show evidence of the required
number of active service days. I have attached my:
Military orders
Other: ________________________________________________________________________________
Part 2—Claim for exemption by a lawful occupant of the homestead of a qualifying active duty service member
1. Name of the deceased active duty service member who owns the home you are occupying: ________________________________
2.
Check to indicate that you are lawfully occupying this home. You must attach proof of occupancy (for example, a copy of your
current driver’s license, property tax statement, voter registration card, etc.).
3. You must attach documentation (for example, service member’s DD – 214, a letter on military letterhead, or other military-issued
report) to this claim. Check to indicate that you have attached the required documentation to show both of the following:
The deceased service member’s federal active duty service under Title 10, or service under the Emergency Management
Assistance Compact; and
The date the qualifying service member died while performing qualified service.
Declaration
I declare under penalties of false swearing [ORS 305.990(4)] that I have examined this document and attachments, and to the best of my
knowledge, they are true, correct, and complete.
Signature of service member
Date
Telephone number
(
)
X
/
/
Signature of lawful occupant of homestead
Date
Telephone number
/
/
(
)
X
150-303-084 (Rev. 01-12)

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