Fillable 2021 Tax Relief Application Fillable (Montgomery County, Virginia)

Fill Online, Printable, Fillable, Blank 2021 Tax Relief Application Fillable (Montgomery County, Virginia) Form

Use Fill to complete blank online MONTGOMERY COUNTY, VIRGINIA (VA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

2021 Tax Relief Application Fillable (Montgomery County, Virginia)

On average this form takes 37 minutes to complete

The 2021 Tax Relief Application Fillable (Montgomery County, Virginia) form is 2 pages long and contains:

  • 1 signature
  • 12 check-boxes
  • 139 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Montgomery County, Virginia

BROWSE MONTGOMERY COUNTY, VIRGINIA (VA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
MONTGOMERY COUNTY
HELEN P. ROYAL, MASTER COMMISSIONER OF THE REVENUE
755 ROANOKE ST SUITE 1A CHRISTIANSBURG, VA 24073
2020
APPLICATION FOR TAX RELIEF FOR THE ELDERLY AND DISABLED
Parcel ID:
PPID:
M0#:
Senior
Disabled
1. APPLICANT INFORMATION (Please Print Clearly)
Name of Applicant
Last, First, Middle
Social Security Number
Date of Birth
Name of Spouse
Last, First, Middle
Social Security Number
Date of Birth
Property Address
Street, City, Zip code
Phone Number
If you are retired, Where are you retired from?
A.
Do you own and live at the above address?
Yes
No
B.
Does anyone live in the house other than the spouse?
Yes
No
C.
Is any portion of the house rented to another person?
Yes
No
D.
Do you have a live in caregiver?
Yes
No
E.
Do you own any real estate other than this house?
Yes
No
F.
Have you sold or transferred any real estate, stocks, bonds,
bank account or personal property the previous year?
Yes
No
2. OTHER PERSONS LIVING AT THE ABOVE ADDRESS (If no other persons live with you, write "NONE")
Name
Social Security
Relationship to owner
Date of Birth
PERSON 1
PERSON 2
3. TOTAL ANNUAL COMBINED GROSS HOUSEHOLD INCOME-JANUARY 1, 2019 TO DECEMBER 31, 2019
Income From:
Applicant
Spouse
Person 1
Person 2
Wages / Unemployment
$
$
$
$
Social Security
$
$
$
$
Railroad Retirement
$
$
$
$
Veteran's Benefits
$
$
$
$
Pensions
$
$
$
$
Interest
$
$
$
$
Dividends
$
$
$
$
Rental Income
$
$
$
$
Fuel Assistance
$
$
$
$
Food Stamps
$
$
$
$
Other: _____________
$
$
$
$
Total Income:
$
$
$
$
GRAND TOTAL:
$
Office Use – Income
Office Use – Net Worth
Office Use – Levy
Office Use – Abatement
Office Use – MH
2021
4. ASSETS - BALANCES OF ACCOUNTS OR VALUES OF ASSETS ON DECEMBER 31, 2019
Applicant
Spouse
Please Attach Copies of
Proof of Income and
Proof of Bank Accounts.
Real Estate
$
$
Checking Accounts
$
$
Savings Accounts
$
$
CD's
$
$
Cash Value of Life Insurance
$
$
Stocks
$
$
Address of other Real Estate:
Bonds
$
$
IRA's/401k's/Annuities
$
$
Other Real Estate
$
$
Other: ______________________
$
$
OTHER ASSETS: Auto, Boat, Camper and similar
Type
Year
Make
Model
Value
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Boat/RV
Boat/RV
Trailer
Trailer
Camper
Camper
5. AFFIDAVIT
In order for your application to be processed, you must complete all sections of this application and sign on the
applicant signature line. The Exemption is granted on an annual basis and a new application must be filed each year.
Please be advised that submission of an incomplete application may result in your application being denied. The
information you provide is confidential and not open for public inspection. Applications are subject to audit for up to
three years.
I hereby request real estate tax relief and certify that the foregoing statements are true and correct to the best of my
knowledge and belief. I understand that any person falsely requesting tax relief shall be guilty of a Class 3 misdemeanor (NN
§ 40-54). I agree to notify the Office of the Commissioner of the Revenue immediately if any changes occur in respect to my
income, financial worth, or ownership of the property.
I authorize the Commissioner of the Revenue to obtain any verification necessary to both determine and review financial
assistance eligibility. This authorizes release of information to the Commissioner of the Revenue's Office.
Signature
Date
YOU MUST PROVIDE PROOF OF INCOME
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

2021 Tax Relief Application Fillable (Montgomery County, Virginia)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 22 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document