Form 150-490-015 - Property Tax Deferral Application For Disabled Citizens Or Senior Citizens - 2011
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2011
For Official Use Only
Date received at county
Date received at Revenue
Property Tax Deferral Application
Previous years’ taxes
for
•
Disabled Citizens or
Senior Citizens
Real market value
•
(ORS 311.666-701)
NOTICE:
• All new applicants: You must attach a copy of your last year’s property tax statement. You must complete the
Income Worksheet on the back of this application.
• Individuals with disabilities: 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 and date your application.
• File your completed application with the county assessor’s office after January 1 and on or before April 15.
See county addresses.
Applicant Section
Type of Applicant
Individual
Joint
RDP
Refiling as surviving spouse
New marriage
Divorce
Applicant’s name (last, first, MI)
Social Security number
Birth date
Age on April 15 Are you disabled?
•
•
•
–
–
Yes
No
Joint applicant’s name (last, first, MI)
Social Security number
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/message no.
E-mail for program updates/contact
(
)
Model year
Make
Home number
# of bedrooms
Square footage
Manufactured
•
Structure
# of bathrooms Roofing material
Siding type
Heating system
Cooling system
(Mobile Home)
(See Delay of
Foreclosure
Do you owe prior years’ property taxes?
Yes
No
➛
NOW GO TO THE BACK OF THE FORM
application)
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 in (year) __________________________
Contract recorded in (year) ____________________________
Deed
Document/instrument number
Microfilm number
Reel
Book/volume
Page
Assessor’s account number
Levy code
Check
here for
Assessor’s account number
Levy code
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
150-490-015 (Rev. 10-10)
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