Form 150-490-015 - Property Tax Deferral Application For Disabled Citizens Or Senior Citizens - 2005
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1
2Clear Form
2005
For Official Use Only
Date received at county
Date received at Revenue
Property Tax Deferral Application
Previous years’ taxes
•
O R E G O N
for
D E PA R T M E N T
Real market value
Disabled Citizens or
Senior Citizens
O F R E V E N U E
•
NOTICE:
• All New Applicants: You must attach a copy of your last year’s property tax statement. You must com plete the In-
come Worksheet on the back of this application.
• Disabled Citizens: You must be de ter mined to be eligible to receive or be receiving federal Social Security
ben e fits 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 your application.
• Mail your completed application to your county assessor’s office between January 1 and April 15. See page
11 for county addresses.
APPLICANT SECTION
If you are applying as joint owners, each joint owner must be age 62 on or before April 15. If you are married and applying for senior defer-
ral jointly with your spouse, you both must be 62 years old on or before April 15. If only one spouse is 62 you must file as an individual.
Type of Applicant
Individual
Joint ownership
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
Other joint owner on deed or contract
Birth Date
Age on April 15 Are you disabled?
Social Security Number
•
–
–
•
Yes
No
Mailing Address
Property Address
(if different than mailing address)
•
City
State
ZIP Code
Telephone Number
Message Number
(
)
(
)
Do you owe prior years’ property taxes?
Yes
No
➛
NOW GO TO THE BACK OF THE FORM
COUNTY SECTION
(Do not complete. This section will be completed by the county assessor’s office.)
Model Year
Make
Division of Motor Vehicles ID Number
Serial Number
Man u fac tured
Structure
•
Platted
LOT ________________
BLK ________________ _____________________________________________________ ADD
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 Number
Microfilm Number
Reel
Book
Page
Assessor’s Account Number
Levy Code
Check
here for
split levy
Assessor’s Account Number
Levy Code
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. 10-04) Web
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