TOWN OF HOPKINTON – FISCAL YEAR 2021
APPLICATION FOR SENIOR TAX RELIEF
FORM APPROVED BY THE HOPKINTON BOARD OF ASSESSORS
In order to be eligible for this exemption, the following requirements MUST be met:
1. You, or at least one joint applicant, must have owned and occupied a home in Hopkinton as your principal
residence for the last ten (10) consecutive years.
2. You must have filed a 2019 Massachusetts State Tax Form Schedule CB (Circuit Breaker)
3. Primary applicant is 65 and any joint applicant is 60 by December 31, 2019.
THIS APPLICATION MUST BE RECEIVED IN THE ASSESSORS’ OFFICE BY AUGUST 31, 2020.
Incomplete applications or those missing supporting documentation will not be processed. Please provide all of the requested
information.
1. Name of Applicant(s): _____________________________________________________________________
Address: _____________________________________________________________________
City/Town: ____________________________ State: _________ Zip: _______________
Home Phone: ____________________________ Cell/Work Phone: __________________
Email Address: _____________________________________________________________________
2. Applicant Date of Birth: ___________________ Joint Applicant Date of Birth: ______________
Valid Massachusetts ID: ___________________ Valid Massachusetts ID: __________________
3. Assessed Value of Principal Residence (Fiscal 2020): _________________ No. of Units: ______________
4. Date you purchased the property: _____________________________________________________________
If less than 10 years ago, prior address: ______________________________________________________
5. Is property subject to a trust? ________ If yes, please attach trust document and all schedules.
6. Do you own any other real estate? ________ If yes, please provide address: __________________
__________________________________________________________________________________________
7. Have you been granted any tax exemption in any other city or town? _____ Where? __________________
8. Provide your Circuit Breaker Income Tax Credit amount from 2019: $_______________________________
Please attach a copy of your 2019 State Income Tax filing, and the MA Schedule CB.
Subscribed this ____ day of _________________________, 2020, under the pains and penalties of perjury.
Signature of Applicant: ___________________________________________________________________________
The filing of this application does not stay the collection of your real estate tax obligation. A credit will be applied or a refund
issued if the exemption is allowed.
BOARD OF ASSESSORS ACTION
APPROVE: _____ EXEMPTION AMOUNT: $___________________________
DENY: _____ SIGNATURES: ____________________________
____________________________
____________________________
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