Form 150-490-014 - Property Tax Deferral Application For 61 Or Younger And Disabled Or 62 Or Older - 2014 Page 3

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County section
(Don’t 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.
Unplatted
Legal
•
T ______________________
R ___________________________
SEC_____________________________
description
Parcel in:
As described in _____________________________________________ County
Containing ________________________ acres
Current deed information
•
Deed recorded (date)
__________________________
Contract recorded (date) ____________________________
Document/instrument number
Microfilm number
Reel
Book/volume
Page
Deed
•
information
Earliest deed showing ownership by the taxpayer(s)
Recorded (date)
Document/instrument number
Assessor’s account number
Levy code
Check
•
•
here for
split levy
Levy code
Assessor’s account number
Assessor’s
code
•
•
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
Identified cohort
New applicant
HB 4039
HB 2510
Reapplying, not under a house bill
150-490-014 (Rev. 12-13)

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