Fillable FISCAL YEAR APPLICATION FOR STATUTORY EXEMPTION VETERAN (Town of Montague)

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FISCAL YEAR APPLICATION FOR STATUTORY EXEMPTION VETERAN (Town of Montague)

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22
State Tax Form 96-4
The Commonwealth of Massachusetts
Assessors’ Use only
Revised
11/2016
Date Received
Application No.
Name of City or Town
Parcel Id.
VETERAN
FISCAL YEAR APPLICATION FOR STATUTORY EXEMPTION
General Laws Chapter 59, § 5
THIS APPLICATION IS NOT OPEN TO PUBLIC
INSPECTION
(See General Laws Chapter 59, §
60)
Return to: Board of Assessors
Must be filed with assessors on or before April 1,
or 3 months after actual (not preliminary) tax bills are
mailed for fisca
l year if later.
INSTRUCTIONS: Complete the following. Please print or type.
A. IDENTIFICATION. Complete this section fully.
Name of Applicant
Telephone Number
Legal Residence (Domicile) on July 1,
Marital Status
Mailing Address (If different)
No. Street City/Town Zip Code
Location of Property
:
No. of Dwelling Units: 1 2 3 4 Other
Did you own the property on July 1, ? Yes No
If yes, were you: Sole Owner Co-owner with Spouse Only Co-owner with Others
Was the property subject to a trust as of July 1, ? Yes No
If yes, please attach trust instrument including all schedules.
Have you been granted any exemption in any other city or town (MA or other) for this year? Yes No
If yes, name of city or town Amount exempted $
DISPOSITION OF APPLICATION (ASSESSORS’ USE ONLY)
Ownership
GRANTED
Occupancy
DENIED
Status
DEEMED DENIED
Income
Assets
Date Voted/Deemed Denied
Certificate No.
Date Cert./Notice Sent
Exemption: Clause
Assessed Tax $
Exempted Tax $
Adjusted Tax $
Board of Assessors
Date:
FILING THIS FORM DOES NOT STAY THE COLLECTION OF YOUR
TAXES
THIS FORM APPROVED BY THE COMMISSIONER OF
REVENUE
B. EXEMPTION STATUS. Check the status that applies to you and complete the questions that follow.
VETERAN
VETERAN’S SPOUSE
Veteran’s
Name
Was
the property the veteran’s domicile as of July 1, ?
Yes
No
If
no,
where
does
the
veteran
reside?
VETERAN’S/SERVICEMEMBER’S/
NATIONAL
GUARD MEMBER’S SURVIVING SPOUSE or
SERVICEMEMBER’S SURVIVING PARENT
Deceased
Veteran’s/Servicemember’s/National
Guard
member’s
Name
If first year of application, attach copy of death certificate.
If you are surviving spouse, have you remarried? Yes
No
Date Enlisted/Inducted
Type
of
Discharge
Date
Discharged
If first year of application, attach copy of discharge papers.
Military Decorations or
Awards
Did
the
veteran/servicemember/national
guard member live in Massachusetts for at least 6 months before entering the
service? Yes No If no, list places and dates where veteran or member lived during the last 6 years or if deceased, the 6
years before death (2 years if local option adopted - See Assessors)
Address Dates
Continue list on attachment in same format as necessary.
If yes to any of the next 2 questions and if first year of application, (1) attach documentation from U.S. Dept. of Veterans Affairs,
branch of service or doctor and (2) list above places and dates where surviving spouse has lived during the last 6 years (2 years if local
option adopted – See Assessors)
Was the servicemember or national guard member killed or presumed killed in a combat zone? Yes No
Was the servicemember’s or national guard member’s death a proximate result of a combat injury or disease? Yes No
If yes to any of the next 3 questions and
If first year of application, attach Certificate of Disability from U.S. Dept. of Veterans Affairs or branch of service.
If exemption granted previously, attach certificate only if disability rating is 100% or has changed.
Does the veteran have a service-connected disability? Yes No
Has the veteran acquired “specially adapted housing?” Yes No
Is the veteran a paraplegic? Yes No
C. SIGNATURE. Sign here to complete the application.
This application has been prepared or examined by me. Under the pains and penalties of perjury, I declare that to the best
of my knowledge and belief, this return and all accompanying documents and statements are true, correct and complete.
Signature Date
If signed by agent, attach copy of written authorization to sign on behalf of taxpayer.
7$;3$<(5,1)250$7,21$%2873(5621$/(;(037,216
3(5621$/(;(037,216 You may be eligible to reduce all or a portion of the taxes assessed on your
domicile if you meet the qualifications for one of the personal exemptions allowed under Massachusetts law.
Qualifications vary, but generally relate to age, ownership, residency, disability, income or assets.
You may be eligible for an exemption if you fall into any of these categories:
Legally blind person
Veteran with a service-connected disability
Surviving spouse of a servicemember or
national guard member who died in combat
or from combat injury or disease
Surviving spouse
Minor child of a deceased parent
Senior citizen age 70 and older (65 and older
by local option)
More detailed information about the qualifications for each exemption may be obtained from your board of
assessors.
:+20$< ),/($1$33/,&$7,21 You may file an application if you meet all qualifications for a personal
exemption as of July 1. You may also apply if you are the administrator or executor of a person who qualified
for a personal exemption on July 1.
:+(1$1':+(5($33/,&$7,210867%(),/(' Your application must be filed with the assessors on
on or before April 1, or 3 months after the actual bills were mailed for the fiscal year, whichever is later.
An application is filed when (1) received by the assessors on or before the filing deadline, or (2) mailed by
United States mail, first class postage prepaid, to the proper address of the assessors, on or before the filing
deadline, as shown by a postmark made by the United States Postal Service. THIS DEADLINE CANNOT BE
EXTENDED OR WAIVED BY THE ASSESSORS FOR ANY REASON. IF YOUR APPLICATION IS NOT
TIMELY FILED, YOU LOSE ALL RIGHTS TO AN E
XEMPTION AND THE
ASSESSORS CANNOT BY LAW
GRANT YOU ONE.
3$<0(172)7$; Filing an application does not stay the collection of your taxes. In some cases, you must
pay all preliminary and actual installments of the tax
when due to appeal the assessors’ disposition of your
application. Failure to pay the tax when due may also subject you to interest charges and collection action.
To avoid any loss of rights or additional charges, you should pay the tax as assessed. If an exemption is
granted and you have already paid the entire year’s tax as exempted, you will receive a refund of any overpayment.
$66(66256',6326,7,21 Upon applying for an exemption, you may be required to provide the assessors
with further information and supporting documentation to establish your eligibility. The assessors have 3
months from the date your application is filed to act on it unless you agree in writing before that period
expires to extend it for a specific time. If the assessors do not act on your application within the original or
extended period, it is deemed denied. You will be notified in writing whether an exemption has been granted
or denied.
$33($/ You may appeal the disposition of your application to the Appellate Tax Board, or if applicable, the
County Commissioners. The appeal must be filed within 3 months of the date the assessors acted on your
application, or the date your application was deemed denied, whichever is applicable. The disposition notice
will provide you with further information about the appeal procedure and deadline.
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FISCAL YEAR APPLICATION FOR STATUTORY EXEMPTION VETERAN (Town of Montague)

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Completed 14 July 2020

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