Sd Eform 1295 V12 - Application For Property Tax Reduction From Municipal Taxes For The Elderly And Disabled
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SD EForm - 1295
V12
PT 38A - APPLICATION FOR PROPERTY TAX REDUCTION FROM MUNICIPAL TAXES
FOR THE ELDERLY AND DISABLED - (SDCL 10-6B)
(ATTACH – INFORMATION FOR TAX RELIEF PROGRAMS IN SOUTH DAKOTA FORM)
Applicant’s Name
Applicant’s Mailing Address
_________________________________________
_________________________________________
====================================================================================
HOUSEHOLD INFORMATION
====================================================================================
List all others living in the household. If you are applying as part of a multiple member household, you must
include their income as well as your own. Please list other members of the household below.
---------------------------------------------------------------------------------------------------------------------------------------------------
Last Name
First Name & Middle Initial
Age
Relationship
Social
Security No.
====================================================================================
PROPERTY INFORMATION
====================================================================================
Legal description of property for which application is being made:
_______________________________
====================================================================================
ELIGIBILITY
====================================================================================
A. Were you 65 on or before January 1, 2012 or disabled at anytime during 2011
YES
NO
Proof of disability is required each year. Year disabled ______________
Did you turn 65 or become disabled in or prior to 1981?
YES
NO
(Base year assessment to be frozen - 1977)
B. Have you owned a single family dwelling for at least five years?
YES
NO
C. Have you lived in your single family dwelling for at least five years
YES
NO
D. Do you live alone and have a yearly income under $ 5,758
YES
NO
OR Do you live in a household whose members'
combined income is under $ 7,765?
YES
NO
I have examined this claim and it is correct to the best of my knowledge. I authorize any person holding official
social security records, official public aid records, official veteran’s administration records or any other records
containing information relative to this claim to disclose the information contained on the records to county
treasurer.
Claimant's signature
date
Preparer's signature
_______________________________
Address
City
_______________________________
PT 38A (12/11)
Telephone Number
st
REMINDER – Application to be made on an annual basis on or before April 1
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