Application-Limitation On Increase In Value For Single Family Dwellings Occupied By Low Income Owners 65 Years Of Age Or Older Or Disabled - State Of New Mexico - 2018

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STATE OF NEW MEXICO - 2018 TAX YEAR
APPLICATION-LIMITATION ON INCREASE
IN VALUE FOR SINGLE FAMILY
Pursuant to 7-36-21.3 NMSA 2000
Application Form
DWELLINGS OCCUPIED BY LOW INCOME
as Amended in 2013
Revised 11/2017
OWNERS 65 YEARS OF AGE OR OLDER OR
DISABLED
INSTRUCTIONS ON REVERSE SIDE
PLEASE READ CAREFULLY
County
County Assessor's
Tax Year
Name
Phone Number
Applicant's First Name
Middle
Last Name
Initial
Present Mailing Address ( Number & Street,
P. O. Box or Rural Route )
City & State
Zip Code
Phone Number
Driver's License or Personal ID
Date of
Certificate ( Number & State )
Birth
Uniform Property
Physical Address / Legal Description of Property
PART I
Code (UPC)
A
Is the property the applicant's primary residence?
YES
NO
Is the property occupied by the applicant and is he or she the current owner?
B
YES
NO
Will the applicant be age 65 or over during the current tax year?
C
YES
NO
Is the applicant disabled?
D
YES
NO
Enter "Modified Gross Income", all income received by the applicant, applicant's spouse and dependants.
PART II
Please see section 7-2-2 (L) of the Income Tax Act.
( Round to nearest whole dollar amount.)
Gross Annual Income
1
Compensation
1
.00
2
Net profit derived from business
2
.00
3
Gains derived from dealings in property
3
.00
4
Interest
4
.00
5
Net rents
5
.00
6
Royalties
6
.00
7
Dividends
7
.00
8
Alimony and separate maintenance payments
8
.00
9
Annuities
9
.00
10
Income from life insurance and endowment contracts
10
.00
11
Pensions
11
.00
12
Discharge of indebtedness
12
.00
13
Distributive share of partnership
13
.00
14
Income in respect of a decedent
14
.00
15
Income from an interest in an estate or trust
15
.00
16
Social Security benefits
16
.00
17
Unemployment compensation
17
.00
18
Workers' compensation benefits
18
.00
19
Public assistance and welfare benefits
19
.00
20
Cost-of living allowances
20
.00
21
Gifts
21
.00
Total Modified Gross Income (Add lines 1 thru 21.)
.00
CERTIFICATION BY PROPERTY OWNER - (To be signed by Applicant)
PART III
I certify that I am the legal owner of this property, I am living on this property and the income and age statements made are true and accurate. I understand that false statements
made intentionally on this application may be penalized as provided for in 7-38-92 and 7-38-93 of the Property Tax Code.
Amended income tax returns shall be reported within 30 days of filing.
Applicant Signature:
Date:
VALUATION LIMITATION
Qualifies?
PART IV
YES
NO
(To be completed by the County Assessor)
County indicate the property value is $
as of the Tax Year
The records of
Notice of Value
Valuation Limitation Determined by:
Date:

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