Application For Property Tax Reduction - Idaho County Assessor - 2009

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APPLICATION FOR PROPERTY TAX REDUCTION FOR 2009
ALL OF THE FOLLOWING QUESTIONS MUST BE COMPLETED. ATTACH SUPPORTING DOCUMENTS.
County
Code Area
Parcel Number
Section A.
1. Ownership Information (Name, address and ZIP code)
Section B.
Eligibility Status
As of January 1, 2009, I was (check all that apply)
65 or older
Blind
Former P.O.W.
Fatherless or Motherless Minor
Widow(er): Spouse Name___________________ Date of Death________________
Veteran 10-30% Service-connected disability
Veteran 40-100% Service-connected disability
Veteran Nonservice-connected disability with pension
Entity recognizing the disability:
Soc. Sec. Adm.
Fed. Civil Svc.
R/R Retirement
2. Social Security Number (Claimant)
Social Security Number (Spouse)
Section C.
Income
Household Income and Qualified Expenses
January 1 - December 31, 2008
3. Birth Date (Claimant)
Birth Date (Spouse)
Subsection 1
1. Federal adjusted gross income.......................... $ ______________________
4. As of January 1, 2009, you were:
Extension filed
Yes
No
Single
Married
Widow(er)/Not remarried
Subsection 2
Include all income from all sources not included in Section 1
5. Physical address of the property if different than ownership information.
(taxable and nontaxable)
2. Social Security income/SSI (Claimant) .............. $ ______________________
6. Did you receive a Property Tax Reduction in 2008?
Yes
No
3. Social Security income/SSI (Spouse) ................ $ ______________________
7. Have you filed a claim on a different primary residence between January 1,
4. Capital gains ...................................................... $ ______________________
2009 and now?
Yes
No
5. Wages, workers’ compensation, and/or
Where? ________________________________________________________
unemployment .................................................. $ ______________________
8. Did you occupy your home as your primary residence before April 15, 2009?
6. Pensions, retirements, annuities, and/or IRAs
$ ______________________
Yes
No
9. Did you or your spouse stay in a care facility in 2008?
7. VA pension or compensation ............................ $ ______________________
Yes
No
8. Interest and dividends........................................ $ ______________________
10. Did you receive rental income for all or any part of this property in 2008?
9. Railroad retirement ............................................ $ ______________________
If yes, please attach a copy of your rental agreement.
10. Other income
Yes
No
(Received from ________________________) $ ______________________
11. If you used any part of this property for business or commercial use in 2008, list
11. Subtotal (add lines 1 through 10) ...................... $ ______________________
the percent used for business or commercial use (See
instructions.) _____________%.
12. Principal of annuity (Attach contract.) ................ $ (_____________________)
12. Did you sell real estate, stocks, or other capital assets in 2008?
13. Total of nonreimbursed, paid medical expenses
Yes
No
and medical insurance premiums ...................... $ (_____________________)
13. This year, you or your spouse will file: (Check all that apply.)
14. Total of paid or prepaid funeral expenses
Federal Income Tax Return (Attach a copy of this return.) (If your tax
$ (_____________________)
(Attach receipt - maximum allowable amount: $5,000.)
information is incomplete, please contact your county assessor for instruc-
15. Subtotal of deductions (Add lines 12, 13, and 14) $ ______________________
tions on completing this form.)
16. Total net income (Subtract line 15 from line 11) $ ______________________
State income tax return (List state, if other than Idaho:______________.)
If you would like information about property tax deferral for any
Idaho grocery credit form
remaining taxes, ask your assessor or contact the State Tax
14.
Claimant Spouse
Commission for a brochure explaining this program.
I certify that my Social Security number and birthdate are correct.
FOR COUNTY USE ONLY
I certify that I am a citizen or legal permanent resident of the
United States, OR
Check all that apply:
I certify that I am in the United States legally.
Single family
Sole owner
Under penalty of perjury, I certify that to the best of my knowledge
the information I have provided here is true, correct, and complete.
Multi dwelling ___________%
Community property
I grant permission to any government agency and contractor to con-
Multi use _______________%
Partial ownership ____________%
firm my status and to reveal to the Idaho State Tax Commission the
total monetary payments made to me or my spouse during 2008.
Trust or life estate
LP, LLC, or Corp.
(Check one)
Yes
No
Overall claimant percentage of ownership/use ______________________%
I _____________________________________, certify that Property Tax
County Assessor or Deputy Assessor
Reduction benefits are only applied to the claimant’s eligible portion of the net taxable
Claimant(s) (Please print.)
Date
value.
Tax reduction not to exceed:
Date
Approved and verified by Assessor or
Disapproved and verified by Assessor
Signature(s) and Relationship
Telephone Number
Deputy Assessor:
Yes
No
or Deputy Assessor:
Yes
No
THIS APPLICATION MUST BE FILED WITH YOUR
COUNTY ASSESSOR BY APRIL 15, 2009
EFO00002:12/2008

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