Fill - Application for Property Tax Relief

Application for Property Tax Relief

Elderly or Disabled Exclusion (G.S. 105-277.1),

Disabled Veteran Exclusion (G.S. 105-277.1C), or

Circuit Breaker Tax Deferment Program (G.S. 105-277.1B)

County of , NC

Year 2022

AV-9

Web

7-21

Do you and your spouse (if applicable) own 100% interest in the property? If you answer No, list all owners and their ownership

percentage (round to the nearest 0.1%):

Owner

% %

Owner

% %

Owner

Note: Separate applications are required for each owner that is claiming property tax relief. If husband and wife own the

property, only one application is required.

Yes No

►

Are you or your spouse (if applicable) currently residing in a health care facility? If you answer Yes, ll in applicable circle

and indicate current length of stay:

Yes No

►

If married, does your spouse live with you in the residence? If you answer No, provide your spouse’s address.

Addresses of spouse:

Yes No

►

Fill in applicable boxes:

Yes No Is this property your permanent legal residence?

Addresses of secondary residences (if any):

►

Instructions

Application Deadline: This application must be led by June 1st to be timely led. You may submit additional information separately if needed.

Where to Submit

Application: Submit this application to the county tax assessor where this property is located. County tax assessor

addresses and telephone numbers can be found online at: https://www.ncdor.gov/documents/north-carolina-county-assessors-list. DO NOT

submit this application to the North Carolina Department of Revenue.

- Ofce Use Only:

Property ID Number

Middle Name

Residence Address

City

Home Telephone Number

Middle Name

Last Name of Applicant First Name

Last Name of Spouse First Name

Date of Birth (MM-DD-YY)

E-mail Address

Mailing Address (if different from residence address)

City

Zip Code

State

Work Telephone Number Cell Phone Number

Applicant Spouse

Ext.

✖

CLEAR

Page 2, AV-9, Web, 7-21

Part 1. Selecting the Program

Each owner may receive benet from only one of the three property tax relief programs, even though you may meet the

requirements for more than one program.

However, it is possible that the tax rates or tax values may not be established until some time after the ling of this application. This

can make it difcult for you to determine which program you prefer. The following procedures will help to resolve this situation.

Applying for One Program

If you know that you only wish to apply for one program, indicate only that program at the bottom of this section. The assessor will

review your application and send you a notice of decision. The notice of decision will also explain the procedures to appeal if you do

not agree with the decision of the assessor.

Applying for More Than One Program

Each owner is eligible to receive benet from only one program. However, if you think you meet the requirements for more than

one program but, as a result of the uncertainty of tax rates or values at the time of application, you are unable to make a decision

on which one program you wish to choose, indicate all of the programs at the bottom of this section for which you wish to receive

consideration. When the tax rates and values are determined, the assessor will review your application and will send you a letter

notifying you of your options. If the letter indicates that you do not qualify or if you disagree with any decision in the letter, you may

appeal. You must respond to the option letter within the specied time period or it will be assumed that you do not wish

to participate in any of the property tax relief programs. In that case, you will be so notied and you will have the chance to

appeal.

Please read the descriptions and requirements of the three programs on the following pages and

then select the program(s) for which you are applying:

Fill in applicable circles: You Must Complete:

Elderly or Disabled Exclusion Parts 2, 5, 6

Disabled Veteran Exclusion Parts 3, 6

Circuit Breaker Tax Deferment Program Parts 4, 5, 6

If you select more than one program, please read ALL of the information on this page!

Part 2. Elderly or Disabled Exclusion

As of January 1, were either you or your spouse (if applicable) at least 65 years of age? If you answer Yes, you do

not have to le Form AV-9A Certication of Disability.

As of January 1, were you and your spouse (if applicable) both less than 65 years of age and at least one of you

was totally and permanently disabled? If you answer Yes, you must le Form AV-9A Certication of Disability.

Requirements: 1. File Form AV-9A Certication of Disability if required above.

2. Complete Part 5. Income Information.

3. Complete Part 6. Afrmation and Signature.

Short Description: This program excludes the greater of the rst $25,000 or 50% of the appraised value of the permanent residence

of a qualifying owner. A qualifying owner must either be at least 65 years of age or be totally and permanently disabled. The

owner cannot have an income amount for the previous year that exceeds the income eligibility limit for the current year, which for

the 2022 tax year is $31,900. See G.S. 105-277.1 for the full text of the statute.

Multiple Owners: Benet limitations may apply when there are multiple owners. Each owner must le a separate application (other

than husband and wife). Each eligible owner may receive benets under either the Elderly or Disabled Exclusion or the Disabled

Veteran Exclusion. The Circuit Breaker Property Tax Deferment cannot be combined with either of these two programs.

Fill in applicable boxes:

Yes No

Page 3, AV-9, Web, 7-21

Part 3. Disabled Veteran Exclusion

I am a disabled veteran. (See denition of disabled veteran above.)

I am the surviving spouse of either a disabled veteran or a servicemember who met the conditions in the

description above. If you answer Yes, complete the next question.

I am currently unmarried and I have never remarried since the death of the veteran.

Requirements: 1. File Form NCDVA-9 Certication for Disabled Veteran’s Property Tax Exclusion. This form must rst be certied

by the United States Department of Veterans Affairs, and then led with the county tax assessor.

2. Complete Part 6. Afrmation and Signature.

Short Description: This program excludes up to the rst $45,000 of the appraised value of the permanent residence of a disabled

veteran. A disabled veteran is dened as a veteran whose character of service at separation was honorable or under honorable

conditions and who has a total and permanent service-connected disability or who received benets for specially adapted housing

under 38 U.S.C. 2101. The applicant must have been disabled as of January 1 of the year in which the benefit is requested. There is

no age or income limitation for this program. This benet is also available to a surviving spouse (who has not remarried) of either (1) a

disabled veteran as dened above, (2) a veteran who died as a result of a service-connected condition whose character of service at

separation was honorable or under honorable conditions, or (3) a servicemember who died from a service-connected condition in the

line of duty and not as a result of willful misconduct. See G.S. 105-277.1C for the full text of the statute.

Multiple Owners: Benet limitations may apply when there are multiple owners. Each owner must le a separate application

(other than husband and wife). Each eligible owner may receive benets under either the Disabled Veteran Exclusion or the

Elderly or Disabled Exclusion. The Circuit Breaker Property Tax Deferment cannot be combined with either of these two programs.

Fill in applicable boxes:

Yes No

Part 4. Circuit Breaker Property Tax Deferment

As of January 1, were either you or your spouse (if applicable) at least 65 years of age? If you answer Yes, you do

not have to le Form AV-9A Certication of Disability.

As of January 1, were you and your spouse (if applicable) both less than 65 years of age and at least one of you

was totally and permanently disabled? If you answer Yes, you must le Form AV-9A Certication of Disability.

Have you owned the property for the last ve full years prior to January 1 of this year and occupied the property for

a total of ve years?

Do all owners of this property qualify for this program and elect to defer taxes under this program? If you answer

No, the property cannot receive benet under this program.

Requirements: 1. File Form AV-9A Certication of Disability if required above.

2. Complete Part 5. Income Information.

3. Complete Part 6. Afrmation and Signature.

Short Description: Under this program, taxes for each year are limited to a percentage of the qualifying owner’s income. A

qualifying owner must either be at least 65 years of age or be totally and permanently disabled. For an owner whose income amount

for the previous year does not exceed the income eligibility limit for the current year, which for the 2022 tax year is $31,900, the

owner’s taxes will be limited to four percent (4%) of the owner’s income. For an owner whose income exceeds the income eligibility

limit ($31,900) but does not exceed 150% of the income eligibility limit, which for the 2022 tax year is $47,850, the owner’s taxes

will be limited to ve percent (5%) of the owner’s income.

However, the taxes over the limitation amount are deferred and remain a lien on the property. The last three years of

deferred taxes prior to a disqualifying event will become due and payable, with interest, on the date of the disqualifying

event. Interest accrues on the deferred taxes as if they had been payable on the dates on which they would have originally become

due. Disqualifying events are death of the owner, transfer of the property, and failure to use the property as the owner’s permanent

residence. Exceptions and special provisions apply. See G.S. 105-277.1B for the full text of the statute.

YOU MUST FILE A NEW APPLICATION FOR THIS PROGRAM EVERY YEAR!!

Multiple Owners: Each owner (other than husband and wife) must le a separate application. All owners must qualify and elect

to defer taxes under this program or no benet is allowed under this program. The Circuit Breaker Property Tax Deferment

cannot be combined with either the Elderly or Disabled Exclusion or the Disabled Veteran Exclusion.

Fill in applicable boxes:

Yes No

Page 4, AV-9, Web, 7-21

Part 5. Income Information (complete only if you also completed Part 2 or Part 4)

Social Security Number (SSN) disclosure is mandatory for approval of the Elderly or Disabled Exclusion and the Circuit Breaker Property

Tax Deferment Program and will be used to establish the identication of the applicant. The SSN may be used for verication of

information provided on this application. The authority to require this number is given by 42 U.S.C. Section 405(c)(2)(C)(i). The SSN

and all income tax information will be kept condential. The SSN may also be used to facilitate collection of property taxes if you do not

timely and voluntarily pay the taxes. Using the SSN will allow the tax collector to claim payment of an unpaid property tax bill from any

State income tax refund that might otherwise be owed to you. Your SSN may be shared with the State for this purpose. In addition, your

SSN may be used to garnish wages or attach bank accounts for failure to timely pay taxes.

Applicant’s Social Security Number Spouse’s Social Security Number

Requirements:

1. You must provide a copy of the rst page of your individual Federal Income Tax Return for the previous calendar year (unless you

do not le a Federal Income Tax Return). Married applicants ling separate returns must submit both returns. If you have not led

your Federal Income Tax Return at the time you submit this application, submit a copy of the rst page when you le your return.

Your income tax returns are condential and will be treated as such. Your application will not be processed until the income tax

information is received. Please check the appropriate box concerning the submission of your Federal Income Tax Return.

Federal Income Tax Return submitted with this application.

Federal Income Tax Return will be submitted when led with the IRS.

I will not le a Federal Income Tax Return with the IRS for the previous calendar year.

2. Provide the income information requested below for the previous calendar year. Provide the total amount for both spouses. If

you do not le a Federal Income Tax Return, you must attach documentation of the income that you report below (W-2,

SSA-1099, 1099-R, 1099-INT, 1099-DIV, nancial institution statements, etc.).

a. Wages, Salaries, Tips, etc ........................................................................................$

b. Interest (Taxable and Tax Exempt) ............................................................................ $

c. Dividends ................................................................................................................... $

d. Capital Gains ............................................................................................................. $

e. IRA Distributions ........................................................................................................ $

f. Pensions and Annuities ..............................................................................................$

g. Disability Payments (not included in Pensions and Annuities) ..................................$

h. Social Security Benets (Taxable and Tax Exempt) ..................................................$

i. All other moneys received (Describe in Comments section.) .....................................$

Total ...............................................................................................................................$

Comments:

INFORMATION IS SUBJECT TO VERIFICATION WITH THE NORTH CAROLINA DEPARTMENT OF REVENUE.

Fill in applicable box:

Page 5, AV-9, Web, 7-21

Part 6. Afrmation and Signature

AFFIRMATION OF APPLICANT – Under penalties prescribed by law, I hereby afrm that, to the best of my knowledge and belief, all

information furnished by me in connection with this application is true and complete. Furthermore, I understand that if I participate

in the Circuit Breaker Property Tax Deferment Program, liens for the deferred taxes will exist on my property, and that when

a disqualifying event occurs, the taxes for the year of the disqualifying event will be fully taxed and the last three years of

deferred taxes prior to the disqualifying event will become due and payable, with all applicable interest.

Applicant’s Name (please print) Applicant’s Signature Date

Spouse’s Name (please print) Spouse’s Signature Date

Refer to the Instructions on Page 1 for ling information and ling location.*

Approved: Y / N Elderly/Disabled Disabled Veteran Circuit Breaker: 4% 5%

Date: ___________/________/_________ By: ________________ Comments: _________________________________________________

AV-9A Received: ___________/________/_________ NCDVA-9 Received: ___________/________/_________

FITR Received: ___________/________/__________ Income: $______________________________________

Ofce Use Only

*All applications must be submitted by June 1 to be timely led.

Late Applications: Upon a showing of good cause by the applicant for failure to make a timely application, an application for

exemption or exclusion led after the [due date] may be approved by the Department of Revenue, the board of equalization

and review, the board of county commissioners, or the governing body of a municipality, as appropriate. An untimely

application for exemption or exclusion approved under this subsection applies only to property taxes levied by the

county or municipality in the calendar year in which the untimely application is led. [N.C.G.S. 105-282.1(a1)]

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