Form 150-490-014 - Property Tax Deferral Application For 61 Or Younger And Disabled Or 62 Or Older - 2016

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For official use only
Date received at county Date received at Revenue
17491601010000
Property Tax Deferral Application for
2016
2015–16 Net property taxes
County #
61 or younger and disabled or
62 or older
2015–16 Real market values
(ORS 311.666-701)
• You must attach a copy of your 2015–16 property tax statement.
• You must complete the household income and asset worksheets on the back of this application.
• Individuals with disabilities: Attach proof of eligibility of federal Social Security Disability benefits received before April 15
(we won’t accept your 1099 SSA statement or new benefit statement).
• Remember to sign and date your application.
• File your completed application with the county assessor’s office after January 1 and by April 15.
Applicant section
Type of applicant
Individual*
*If individual applicant: Are you married?
No
Yes Spouse’s name/SSN: ________________________________________
Joint spouse
Joint other
Refiling as surviving spouse. Spouse’s SSN/Deferral account number: ____________________________________________
Applicant’s name (last, first, MI)
Social Security number (SSN)
Date of birth
Age on April 15 Are you disabled?
Yes
No
Joint applicant’s name (last, first, MI)
Joint applicant’s SSN
Date of birth
Age on April 15 Are you disabled?
Spouse
Other
Yes
No
Current residence address
City
State
ZIP code
Property address (if different than residence address)
City
State
ZIP code
If property address is different than current residence address, explain why:
Phone (or message phone)
Email
If you own a manufactured structure (mobile home), complete this section:
Model year
Make
Home ID number
Square footage
# of bedrooms
# of bathrooms Roofing material
Siding type
Heating system
Cooling system
1.
Have you previously been approved for Property Tax Deferral on this property? .............
Yes
No
If yes, was this property under the program prior to 2011? ..............................................
Yes
No
2.
Does your property contain multiple units?
Yes
No
If yes, how many units?_______________
What is the purpose of the other unit(s)? ________________________________________________________________________
Describe which homestead (unit) you live in _____________________________________________________________________
As of April 15, 2016, how many years have you owned the home? _______________ years
3.
As of April 15, 2016, how many years have you lived in the home? _______________ years
If your answer to either of the above questions is less than five years, please see instructions on page 3. If you feel you meet the
criteria for the Downsizing Provision, please contact us for the Downsizing Provision worksheet.
4.
Do you have a reverse mortgage that is secured by this home? ......................................
Yes
No
If your answer to the above question is yes and the property wasn’t in the Property Tax Deferral program prior to 2011,
STOP HERE. You don’t qualify for the Property Tax Deferral program.
5.
Is the home insured for fire and other casualty? ...............................................................
Yes
No
If your answer to the above question is no, STOP HERE. You don’t qualify for the Property Tax Deferral program.
6.
Is the property owned in a trust? .......................................................................................
Yes
No
If yes, provide a copy of the trust documents.
Insurance carrier
Policy number
Do you owe prior years’ property taxes?
Yes
No
(See Delay of Foreclosure application)
Go to the next page
150-490-014 (Rev. 12-15)

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