Fillable Application for Local Option Disaster Abatements and Credits (Minnesota Department of Revenue)

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Application for Local Option Disaster Abatements and Credits (Minnesota Department of Revenue)

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The Application for Local Option Disaster Abatements and Credits (Minnesota Department of Revenue) form is 2 pages long and contains:

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File type: PDF

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BROWSE MINNESOTA DEPARTMENT OF REVENUE FORMS

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Applicant and Property Information
Signature of Property Owner Date
Last Name First Name M.I. Social Security Number
Mailing Address - Street City/Town State Zip Code
Telephone (Work) Telephone (Home)
Property ID or Parcel Number (found on your property tax statement)
Address of Damaged Property (if different than mailing address)
Legal Description of Property (found on your property tax statement)
Is the property homesteaded? How many months was the property unable to be occupied or used?
Yes No Date you left property: ____________________________________________
Is the property located in a county Date you returned to property: _____________________________________
designated as a disaster or emergency area?
Yes No
Application for Local Option Disaster Abatements and Credits
By signing below, I certify, to the best of my knowledge, the above statements are true and correct.
(Rev. 11/13)
If your property has been damaged or destroyed by a natural disaster or other type of accident, you may be eligible to receive some property tax relief on this
year’s and next year’s property taxes. The type of tax relief you receive will depend on whether your property is homesteaded, whether it is located within a
declared disaster or emergency area, the amount of damage sustained, and a number of other factors. If an assessor has not already reassessed your property,
you should contact your county assessor’s ofce and request that an assessor view the damage for the purpose of receiving disaster relief.
Sign Here
CR-LODA
Statement of Facts
_______________ County
Applicant’s statement of facts. (Please list type of disaster, type of damage, and any other information you deem
relevant.)
Note: Minnesota Statutes, Section 609.41, “Whoever, in making any statement, oral or written, which is required or authorized by law to be made as
a basis of imposing, reducing, or abating any tax or assessment, intentionally makes any statement as to any material matter which the maker of the
statement knows is false may be sentenced, unless otherwise provided by law, to imprisonment for not more than one year or to payment of a ne of
not more than $3,000.00, or both.”
For Ofce Use Only
Approved
Denied
Name of applicant
________________________________Assessment year ____________
Assessor’s signature ______________________________Date _______________________
Use of Information
The information on this form is required by Minnesota Statutes, section 273.1233 to properly identify you and determine if you qualify for a disaster
abatement and/or credit. Your Social Security number is required. If you do not provide the required information, your application may be delayed or
denied. Your County Assessor may also ask for additional verication of qualications. Your Social Security number is considered private data.
For Ofce Use Only
Land Improvements Total Class Tax Capacity Tax Before Other Credits Tax Payable
Credits
Pre-damage
Post-damage
Reduction
Market Value
Signature Date
Final Certication
I hereby report that I have investigated the statements made in this application and nd the facts to be as follows:
Report of investigation
I certify that at a meeting held on
________________ , ___________ , the County Board, took the above ofcial action on
this abatement. This action was duly adopted and entered upon the minutes of its proceedings as a public record, showing
the name(s) of taxpayer(s), other concerned persons and the amounts involved.
Investigator
The following accurately reects both existing and proposed amounts.
Signature Date
Amounts
Tax is Paid Tax is Not Paid Date Local Tax Rate
Approval Certications
Certications of approval. For this abatement to be approved, the assessor, county auditor and the county board of
commissioners must all favorably recommend its adoption.
Assessor’s recommendation
Approved Denied
Signature Date
County auditor’s recommendation
Approved Denied
Signature Date
County board of commissioner’s action (to be completed by the county auditor)
Approved Denied
Signature Date
Certications of nal approval (complete only for approved abatements). This section to be completed by the county auditor.
I further certify that the approval of this abatement has resulted in the following changes:
Reduction of Tax $ ________________________
Reduction of Penalty $ ________________________
Reduction of Interest $ ________________________
Total Reduction/Refund $ ________________________
Total Payable $ ________________________
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Application for Local Option Disaster Abatements and Credits (Minnesota Department of Revenue)

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Completed 20 November 2020

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