Fillable Fy21-17d State Tax Form 3ABC______Assessors’ Use only

Fill Online, Printable, Fillable, Blank Fy21-17d State Tax Form 3ABC______Assessors’ Use only Form

Use Fill to complete blank online TOWN OF DRACUT (MA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Fy21-17d State Tax Form 3ABC______Assessors’ Use only

On average this form takes 24 minutes to complete

The Fy21-17d State Tax Form 3ABC______Assessors’ Use only form is 3 pages long and contains:

  • 0 signatures
  • 26 check-boxes
  • 82 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Dracut

BROWSE TOWN OF DRACUT (MA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
17
41
42&43
State Tax Form 96-6
The Commonwealth of Massachusetts
Assessors’ Use only
Revised 7/2017
Date Received
Application No.
Name of City or Town
Parcel No.
SENIOR -- SURVIVING SPOUSE OR MINOR
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 fiscal year if later.
INSTRUCTIONS: Complete all sections that apply. If you qualify under more than one category, you will receive the
exemption that provides the greatest amount of assistance. Please print or type.
A. IDENTIFICATION. Complete this section fully.
Name of Applicant ________________________________________________________________________________________
Telephone Number _________________________
Marital Status ________________________________
Legal Residence (Domicile) on July 1, _______
No. Street City/Town Zip Code
Location of Property:
Mailing Address (If different)
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
Assessed Tax $
Occupancy
DENIED
Exempted Tax $
Status
DEEMED DENIED
Adjusted Tax $
Income
Assets
Board of Assessors
Date Voted/Deemed Denied
Certificate No.
Date Cert./Notice Sent
Exemption: Clause
Date:
FILING THIS FORM DOES NOT STAY THE COLLECTION OF YOUR TAXES
THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE
2020
2020
2020
Town of Dracut
2021
B. EXEMPTION STATUS. Check each status that applies to you and complete the questions that follow.
SURVIVING SPOUSE
Deceased Spouse’s Name
Date of Death
Have you remarried? Yes No If yes, date of remarriage ____________
MINOR WITH PARENT DECEASED
Deceased Parent’s Name
Date of Death
If first year of application, attach a copy of death certificate.
Are you a surviving spouse or a minor child of a firefighter or a police officer killed in the line of duty?
Yes No
IF NO, AND NO OTHER STATUS APPLIES TO YOU, GO ON TO SECTION D
If yes, and this is the first year of application, provide circumstances of death.
GO ON TO SECTION E
SENIOR 70 OR OLDER (65 or older by local option- See Assessors)
Date of Birth
If first year of application, attach copy of birth certificate.
Have you owned and occupied the property as your domicile for at least 11 years?
(6 years if local option under Clause 41C½ adopted - See Assessors)
Yes No
If no, list the other properties you owned and/or occupied during the past 11 years (6 years
if local option under Clause 41C½ adopted - See Assessors.)
Address
Dates
Owned Occupied
Continue list on attachment in same format as necessary.
GO ON TO SECTION C
C. GROSS RECEIPTS FROM ALL SOURCES IN PRECEDING CALENDAR YEAR. Complete this section if you are a
senior. Copies of your federal and state income tax returns, and other documentation, may be requested to verify your
income.
Applicant &
Spouse
Co-owner(s) &
Spouse(s)
Retirement Benefits (Social Security, Railroad, Federal, MA & Political Subdivisions).…..
Other Pensions and Retirement Allowances ....................................................................... .…..
Wages, Salaries and other Compensation ........................................................................... .…..
Net Profits from Business, Profession or Property Rental ................................................. .…..
Interest and Dividends ........................................................................................................... …...
Other Receipts (Capital Gains, Public Assistance, etc.) ..................................................... …...
TOTALS
GO ON TO SECTION D
D. VALUE OF ALL PROPERTY OWNED ON JULY 1 THIS YEAR. Documentation may be requested to verify your
assets.
Real Estate
Assessed Valuation
Amount Due on Mortgage
Value
Domicile
Other
Personal Estate
Bank Accounts: Name & Address of Bank
Stocks, Bonds, Securities, etc.: Description & Amount
Motor Vehicles & Trailers: Year, Make & Model
Other Non-exempt Personal Property: Kind & Description
TOTAL
GO ON TO SECTION E
E. 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.
TAXPAYER INFORMATION ABOUT PERSONAL EXEMPTIONS
PERSONAL EXEMPTIONS. 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,
national guard member or veteran who
died from combat active duty injury or
illness
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.
WHO MAY FILE AN APPLICATION. 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 personal representative of the estate, or trustee
under the will, of a person who qualified for a personal exemption on July 1.
WHEN AND WHERE APPLICATION MUST BE FILED. Your application must be filed with the assessors 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 EXEMPTION AND THE ASSESSORS CANNOT BY LAW
GRANT YOU ONE.
PAYMENT OF TAX. 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.
ASSESSORS DISPOSITION. 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.
APPEAL. 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.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Fy21-17d State Tax Form 3ABC______Assessors Use only

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 12 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document