Form 150-490-015 - Property Tax Deferral Application For Disabled Citizens / Senior Citizens

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Clear Form
For Official Use Only
Date received at county
Date received at Revenue
Property Tax Deferral Application
Previous years’ taxes
O R E G O N
for
D E PA R T M E N T
Real market value
Disabled Citizens or
Senior Citizens
O F R E V E N U E
Read Me
NOTICE:
• All New Applicants: You must attach a copy of your last year’s property tax statement. And you must com-
plete the Income Worksheet on the back of this application.
• Disabled Citizens: 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
page 11 for county addresses.
APPLICANT SECTION
Type if Applicant
Individual
Husband and wife
Joint ownership
Refiling as surviving spouse
New marriage
(not husband and wife)
Applicant’s Name (last, first, MI)
Social Security Number
Birth Date
Age on April 15 Are you disabled?
Yes
No
Applicant’s Spouse
Social Security Number
Birth Date
Age on April 15 Are you disabled?
Yes
No
Social Security Number
Other joint owner on deed or contract
Birth Date
Age on April 15 Are you disabled?
Yes
No
Mailing Address
Property Address
(if different than mailing address)
City
State
ZIP Code
Telephone Number
NOW GO TO THE BACK OF THE FORM
Do you owe prior years’ property taxes?
Yes
No
COUNTY SECTION
(Do not complete. This section will be completed by the county assessor’s office.)
Model Year
Make
Division of Motor Vehicles ID Number
Serial Number
Manufactured
Structure
Platted
LOT ________________
BLK ________________ _____________________________________________________ ADD
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 Number
Instrument Number
Microfilm Number
Reel
Book
Page
Assessor’s Account Number
Levy Code
Check
here for
split levy
Assessor’s Account Number
Levy Code
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
Assessor’s (or Assessor’s designee’s) signature verifying applicant is the owner of record
Date
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. 9-03)

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