Fillable APPLICATION FOR REAL ESTATE TAX RELIEF FOR ELDERLY (City of Winchester)

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APPLICATION FOR REAL ESTATE TAX RELIEF FOR ELDERLY (City of Winchester)

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Page 1 of 5
Creamery Building, 21 South Kent St, Suite 100, Winchester VA 22601 Telephone: (540) 667-1815
Email: cor@winchesterva.gov FAX: (540) 667-8937
Website: www.winchesterva.gov
APPLICATION FOR REAL ESTATE TAX RELIEF FOR ELDERLY OR
PERMANENTLY/TOTALLY DISABLED HOMEOWNERS – 2021
The City of Winchester is pleased to offer this program. Please read the requirements carefully, and submit all
information requested by the deadline. We encourage you to file early so that we may review your application
and advise you of any additional information needed.
PLEASE NOTE OUR NEW ADDRESS:
The Commissioner of the Revenue office is now located in the Creamery Building, 21 South Kent Street,
Suite 100, with ground-level access through the glass entry. Convenient parking is available along Kent
Street, or you are welcome to use the courtesy visitor spaces just inside the parking lot.
Mailing address: Commissioner of the Revenue
21 South Kent Street, Suite 100
Winchester VA 22601
COVID-19 PRECAUTIONS:
While our office is open to the public, under the current pandemic conditions we encourage you to submit
applications by mail, by email, or using our external secure drop box in the glass entry wall. You are
welcome to call us for assistance at 540-667-1815, Option 4. If you feel it necessary to meet in person,
please call in advance to schedule an appointment.
TAX RELIEF
PROGRAM:
Filing Deadline: Must file a complete, signed application with all supporting documentation by April 1 of each
year (or the next business day if April 01 falls on a weekend). This is a firm deadline. Even if you already receive
tax exemption, you must file anew each year. The Commissioner may accept later filings under very limited
circumstances, including purchase of a home.
Ownership: Applicant must own and occupy dwelling as sole residence, unless forced to live elsewhere for
health reasons and dwelling is not rented out. If you own and occupy a commercial or multi-unit property, the
City will consider only that portion used as your residence and may require a site visit to determine the
appropriate percentage comprising your dwelling.
Filing Deadline
April 01
City of Winchester, Tax Relief Application: _________________________________________________________________
Page 2 of 5
Age: Must be at least 65 on December 31 of previous year, unless permanently disabled.
Disability: If filing based upon disability, must provide disability certification upon initial filing and every five (5)
years thereafter. Certification for persons on Social Security Disability is available by calling 1-800-772-1213 and
requesting Benefits Identification Letter
or Awards Letter. Contact our office if you need to know when you last
sent in a certification form.
Net Financial Worth: Not exceeding $75,000 as of December 31 of previous year. Value of primary residential
dwelling and lot, up to one acre, are not included. (Contact financial advisor for list/value of stocks, bonds, etc.)
Income: Total combined income from all sources of owners, relatives and non-relatives living in the household
(other than necessary caretaker or bona fide tenant), may not exceed $40,000.
Qualifying Exemption Percentages:
Income Level Exemption
$ 0-$25,000 100%
$25,001-$30,000 75%
$30,001-$35,000 50%
$35,001-$40,000 25%
At any qualifying level, the maximum relief amount shall be $1,500.
We look forward to serving you.
Sincerely,
Ann Burkholder
Commissioner of the Revenue
City of Winchester, Tax Relief Application: _________________________________________________________________
Page 3 of 5
Required Attachments: You must include this information for your application to be complete
List of Vehicles with Make, Model and Year
List of Other Real Estate Owned (if applicable)
Proof of all Income and Assets
Proof of Liabilities (if applicable)
Power of Attorney (if applicable) Attached: _____ To Follow: _____ Provided in Year: _______
Federal/State Tax Return for previous year (If you do not file, please mark here ____)
If under 65, you must provide certification of disability every 5 years. Please mark status of certification(s)
Social Security Awards Letter Attached: _____ To Follow: _____ Provided in Year: _______
Veterans Administration Attached: _____ To Follow: _____ Provided in Year: _______
Railroad Retirement Board Attached: _____ To Follow: _____ Provided in Year: _______
Affidavit of Two Physicians Attached: _____ To Follow: _____ Provided in Year: _______
APPLICANT: ______________________________________________________________________________________
(Property Owner) (Last Name) (First Name) (Middle Name)
Property Street Address: _____________________________________________________________________________
Applicant Birth Date: ___________________________ Social Security Number: ________________________________
SPOUSE \ CO-OWNER: ____________________________________________________________________________
(Note if “None” or “Deceased”) (Last Name) (First Name) (Middle Name)
Spouse Birth Date: ____________________________ Social Security Number: _______________________________
Applicant Telephone_______________________________________
Name on Real Estate Tax Bill, if different from Applicant Name: _____________________________________________
Applicant is: ____ Sole Owner
____ Partial Owner, Property legally held as: __________________________________________________
If property is multi-unit or mixed use, portion used as applicant’s dwelling: ___________________________ %
*Optional: Friendly Contact Name: _________________________________ Phone: _________________________
Other Contributing Members of Household:
List the name, relationship, age and social security number of all contributing members of the dwelling, whether
related or not.
Name
Relation to Applicant
Age
Social Security
Number
City of Winchester, Tax Relief Application: _________________________________________________________________
Page 4 of 5
Gross Income for the Past Calendar Year:
Enter the gross income before deduction from all sources, for calendar year 2020, of the applicant, spouse,
and all other relatives/ contributing members living in the dwelling. (Other than necessary caretaker or bona fide
tenant) List each person’s income separately. Use additional sheets if necessary. You must attach supporting
documentation for each amount listed.
Yearly Gross Income
Applicant
Spouse
Other
Salaries, Wages, etc.
Social Security
Pensions
Rental Income
Interest and Dividends
Social Services (Welfare)
Capital Gains
Alimony and Child Support
Other Income
Total Yearly Gross Income:
Total Combined Gross Income of Applicant, Spouse and Other Contributing Members: $ _________________
IF THE ABOVE TOTAL EXCEEDS $40,000 YOU DO NOT QUALIFY THIS YEAR. Please return this form or
notify the Commissioner of the Revenue office if you wish to receive an application next year.
Net Financial Worth at End of Past Calendar Year:
Assets
Applicant’s Value
Spouse’s Value
Cash – on hand and in banks
(Checking and Savings)
Stocks, bonds, IRAs, CDs, Trusts
(Attach listing)
Real estate other than primary dwelling
(Attach listing)
Other personal property
(excluding household)
Cash value of life insurance/ annuities
Amounts owed to you
Other assets (Attach listing)
Automobiles (OFFICE USE ONLY)
Non-qualifying portion of primary
dwelling (OFFICE USE ONLY)
Total Assets:
(a) Total Combined Assets of Applicant and Spouse: $ ____________________________________________
If Total Combined Assets exceed $75,000, please complete the following Liabilities section.
City of Winchester, Tax Relief Application: _________________________________________________________________
Page 5 of 5
Liabilities Against Assets
Applicant’s Value
Spouse’s Value
Mortgage (other than primary residence)
Taxes Due (other than primary residence)
Other Debts Against Assets included in
this application
Total Liabilities Against Assets:
(b) Total Combined Liabilities of Applicant and Spouse: $ __________________________________________
Net financial worth is computed by listing all assets of applicant and spouse (excluding value of residence with
up to one acre of land), then subtracting all liabilities against assets.
Total Combined Net Financial Worth of Applicant and Spouse (“a” minus “b”): $ ________________________
Applicant’s Certification of Qualification
I declare under the penalties provided by law that the information contained in this application for Real
Estate Tax Relief for the Elderly or Disabled, including any accompanying schedules or statements, is
true, correct and complete. I certify that I meet all qualifications listed on Page 1 of this application. I
understand that I must meet all filing requirements and deadlines.
_______________ __________________________________ _________________________________
Date Signature of Applicant Signature of Spouse (if applicable)
Reference: Code of the City of Winchester §27-19 et seq.
------------------------------------------ OFFICE USE ONLY ------------------------------------------
Tax Acct No: _____________________ Total Income: $ ________________
Tax Map No: _____________________ Total Net Worth: $ ________________
Application Status:
_____ APPROVED
Property Value $
x Dwelling %
x Tax Rate
x Exemption %
=Total Exemption
_____ DENIED for reason ___________________________________________________________________________
City Official Signature: ___________________________________________ Date: _____________________________
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APPLICATION FOR REAL ESTATE TAX RELIEF FOR ELDERLY (City of Winchester)

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Completed 22 March 2021

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