Form 150-490-014 - Property Tax Deferral Application For 61 Or Younger And Disabled Or 62 Or Older - 2013 Page 3

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County section
(Do not complete. This section will be completed by the county assessor’s office.)
Platted
LOT ________________
BLK ________________
________________________________________________ Legal Desc
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 (date) __________________________
Contract recorded (date) ____________________________
Current
Deed
Document/instrument number
Microfilm number
Reel
Book/volume
Page
Earliest Deed showing ownership
Recorded (date)
Document/instrument number
Assessor’s account number
Levy code
Check
here for
Levy code
Assessor’s account number
split levy
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
Date
Assessor’s (or Assessor’s designee’s) signature verifying applicant is the owner of record
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
11
Property Tax Deferral for Disabled and Senior Citizens
150-490-014 (Rev. 12-12)

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