Tax Deferral For Low-Income And Low-Income Senior Property Owners Application - Goverment Of The District Of Columbia Page 2

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3.
Do you own 50% or more of the property?
Yes
No
4.
Yes
Do you own a condominium parking space in the condominium?
No
If YES, complete reverse side (Part III).
5.
Yes
Do you own an additional lot abutting this property?
No
If YES, complete reverse side (Part III).
6.
Yes
Is the total household AGI less than $50,000 (aggregate income of all persons
No
residing in household, excluding tenants) for the prior calendar year?
7.
Please provide the date you moved into the property.
(mmddyyyy)
8.
Do you file District of Columbia individual income tax returns
Yes
No
List the name and social security number of each person living in the home other than you and tenants. If more than three
people live in the home, attach a sheet of paper with the same information for them as shown below.
First Name
Last Name
MI
Social Security Number
PART III – Low-Income and Low-Income Senior Owners Application for Abutting Lot(s)
To be eligible for the tax deferral, an abutting lot must: 1) have exactly the same ownership as the parent lot (house or condominium
unit); and 2) be immediately adjacent to the parent lot or be a parking space in the same condominium as the parent lot. List only lot
numbers for:
Parking Space(s):
Abutting Lot(s):
PART IV – Affidavit
The applicant who is an owner of record of the property must sign and date this application. Only the applicant/owner may
§§
sign. Making a false statement is punishable by criminal penalties under DC Official Code
47-4106 and 22-2405.
If you fail to complete Part IV, you will not be eligible for the tax deferral for which you are applying.
Last Name
First Name
MI
Social Security Number
Home Telephone
Work Telephone
Signature: _______________ ________
Date: _____________________________
Your Responsibility to Notify the Real Property Tax Administration/Homestead Audit Unit: If your property no longer qualifies for
Tax Deferral Program, you must notify in writing and within 30 days the Real Property Tax Administration/Homestead Audit Unit,
th Street,
, Washington, DC 200 . If you fail to notify us as required, you may be subject to a penalty of 10% of the
amount of tax deferred and 1.5% interest on such tax for each month the property wrongfully received the deferral. NOTE: This
application and the continued eligibility for these tax benefits are subject to periodic audit. Please keep all supporting documentation
.
Rev. /20
2

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