Form Otc994 - Application For Property Valuation Limitation And Additional Homestead Exemption

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State of Oklahoma
Tax Year
Applicants Social Security Number
OTC
Application for Property Valuation
Limitation and Additional Homestead Exemption
994
Co-applicants Social Security Number
___________________________________ County
Revised
Return to County Assessor by March 15
10-2013
First Name and Initial (if joint application, give first names and initials of both)
Last Name
Applicants Date of Birth
Present Home Address (number and street, apartment/condo number, or rural route)
Co-applicants Date of Birth (if joint application)
City and State
Zip Code
Phone Number
(
)
Part I - Legal Description -
School
Address / Legal Description of Homestead Property:
District
A. Was applicant domiciled on the homestead property January 1st of the current year? ....................................................................Yes
No
B. Was the applicant age 65 or over as of January 1st of the current year? .........................................................................................Yes
No
C. Was the applicant age 65 or over as of March 15 of current year or previously qualified for additional homestead exemption? .... Yes
No
Part II -
Enter Total Gross Income / Assistance received by ALL members or your household in the previous calendar year.
(Round to nearest whole dollar)
1.
Enter total wages, salaries, fees, commissions, bonuses, tips, dividends, royalties,
Gross Household Annual Income
income from partnerships, estates and trusts, and gains from the sale or exchange
1
of property (taxable and nontaxable) ....................................................................................................................1.
00
1
2.
Enter gross rental, business and farm income ....................................................................................................2.
00
1
3.
Enter total interest income received .....................................................................................................................3.
00
1
4.
Other (Specify) ________________________________ ..................................................................................4.
00
5.
All other household income (Include all other income received from each of the
sources listed below:
a. Social Security Payments (Total including Medicare) ....................................................................................5.a.
1
00
b. Veteran’s Disabiltiy Payments ..........................................................................................................................b.
1
00
c. Railroad Retirement Benefits ............................................................................................................................ c.
1
00
1
00
d. Other Pensions and Annuities ..........................................................................................................................d.
e. Workmen’s Compensation / Loss of Time Insurance .......................................................................................e.
1
00
1
f. Support Money ..................................................................................................................................................f.
00
1
00
g. Alimony .............................................................................................................................................................g.
h. Public Assistance (Including Housing Assistance) ...........................................................................................h.
1
00
1
00
i. Gross Income from out-of-state sources ........................................................................................................... i.
1
j. Unemployment ..................................................................................................................................................j.
00
1
00
k. Earned Income Credit received in calendar year ............................................................................................. k.
l. Total Dependents Income .................................................................................................................................. l.
1
00
1
00
m. Wages Paid in Cash .......................................................................................................................................m.
n. Other (Specify) ______________________________ ..................................................................................n.
1
00
18
Total Gross Household Income (Add line 1 thru 5 n) ........................................................................................6.
00
6.
Signature -
I understand that if the applicant is not age 65 or over as of March 15th, the application for additional homestead exemption
must be filed each year.
Owner (or Agent) Signature: ________________________________________________________
Date: _________________________________
Part III -
Valuation Limitation - (To Be Completed by the County Assessor)
Approved
Denied
The records of
County indicate this property value is $
as of
January 1,
.
Parcel ID Number or Account Number:
Valuation Limitation Authorized by
Date
Part IV -
Additional Homestead - (To Be Completed by the County Assessor)
Approved
Denied
00
1. Enter the amount of gross household income from Part I, line 6 above ..................................................................1.
2. Additional exemption authorized by:
Date
Amount 2.
00

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