Application For Property Tax Reduction For 2005 - State Of Idaho

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APPLICATION FOR PROPERTY TAX REDUCTION FOR 2005
ALL OF THE FOLLOWING QUESTIONS MUST BE COMPLETED. ATTACH SUPPORTING DOCUMENTS.
County
Code Area
Parcel Number
A.
B.
1.
As of January 1, 2005, I was (check all that apply)
PLEASE NOTE:
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65 or older
Blind
Former P.O.W.
Fatherless or Motherless Minor
THIS APPLICATION IS NO LONGER VALID.
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Widow(er): Spouse Name___________________ Date of Death________________
PLEASE CHECK BACK AFTER JANUARY 1,
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Veteran 10-30% Service-connected disability
2006 FOR THE PROPERTY TAX
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Veteran 40-100% Service-connected disability
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REDUCTION APPLICATION FOR 2006.
Veteran Nonservice-connected disability with pension
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Recognized disabled:
Soc. Sec. Adm.
Fed. Civil Svc.
R/R Retirement
2. Social Security Number (Claimant)
Social Security Number (Spouse)
C.
Household Income and Qualified Expenses
January 1 - December 31, 2004
3. Birth Date (Claimant)
Birth Date (Spouse)
1. Federal Adjusted Gross Income .................... $ ____________________
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Extension filed
4. Telephone Number
2. Social Security Income (Claimant) ................ $ ____________________
3. Social Security Income (Spouse) .................. $ ____________________
5. As of January 1, 2005, I was (check only if applicable)
4. S.S.I. (Claimant) ............................................ $ ____________________
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Married
Widow(er)/Not remarried
5. S.S.I. (Spouse) .............................................. $ ____________________
6. Physical address of the property if different than Block 1
6. Pensions, Retirements, Annuities, and
IRA’s not included on line 1............................ $ ____________________
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7. Are you a new applicant?
Yes
No
7. VA Pension or Compensation ........................ $ ____________________
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8. Did you receive a Property Tax Reduction in 2004?
Yes
No
8. Interest (Bank, Escrow, Dividends, etc)
Taxable and Nontaxable not included
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on line 1 ........................................................ $ ____________________
9. If you live in a mobile home, do you own the land?
Yes
No
9. Railroad Retirement not included on line 1 .. $ ____________________
10. Have you filed a claim on a different primary residence
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10. Other income not included on line 1
between January 1, 2005 and now?
Yes
No
(Received from ..............................................) $ ____________________
11. Did you occupy your home as your primary residence
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11. Subtotal (add lines 1 through 10) .................. $ ____________________
before April 15, 2005?
Yes
No
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12. Capital Gains only if included on line 1 .......... $ (___________________)
12. Did you or your spouse stay in a care facility in 2004?
Yes
No
13. Total of non-reimbursed paid medical expenses
13. Do you receive rental income for all or any part of this property?
and medical insurance premiums .................. $ (___________________)
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(If yes, please attach a copy of your rental agreement.)
Yes
No
14. Total of paid or prepaid funeral expenses
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14. Is any portion of this property used for commercial use?
Yes
No
...... $ (___________________)
(Attach receipt - amount cannot exceed $5,000.)
15. Total Net Income ............................................ $ ____________________
15. This year will you or your spouse file:
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Federal Income Tax Return (If yes, please attach a copy.
Yes
No
D.
FOR COUNTY USE ONLY
If your tax information is incomplete, please contact your
county assessor for instructions on completing this form.)
Verification of Partial Ownership:
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I __________________________________________________________
State Income Tax Return (Which State?_______________)
Yes
No
County Assessor or Deputy Assessor
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certify that___________________________________________________
Idaho Grocery Credit Form _________________________
Yes
No
Name of Claimant
is a partial owner (excluding community interest) with ________% ownership
16. I grant permission to any government agency and contractor
in this property and the Property Tax Reduction benefits only apply to the
to confirm my status and to reveal to the Idaho State Tax
claimant’s portion of the net taxable value.
Commission the total monetary payments made to me or my
spouse during 2004.
1. Approved and verified by Assessor
2. Date:
or Deputy Assessor:
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(Check one)
Yes
No
3. Tax reduction not to exceed:
Under penalty of perjury, I certify that to the best of my knowledge
the information I have provided here is true, correct, and complete.
The following section should be completed if the claimant is receiving
Claimant(s)
Date
benefits on a prorated taxable value:
4. Land taxable value (one acre or less)
$
____________________
5. Improvement(s) full value (one residence)
$
____________________
Signature(s) and Relationship
Telephone Number
6. Homeowner’s exemption
$ (___________________)
7. Net taxable (lines (4+5) – 6)
$
____________________
RETURN TO YOUR COUNTY ASSESSOR BY
WHITE-TAX COMMISSION
YELLOW - ASSESSOR
PINK - CLAIMANT
APRIL 15, 2005

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