Fillable PTAX-340 2020 Senior Citizens Assessment Freeze Homestead Exemption (McLean County)

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PTAX-340 2020 Senior Citizens Assessment Freeze Homestead Exemption (McLean County)

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PTAX-340 (R-05/20) 1 of 4

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PTAX-340

2020 Senior Citizens Assessment Freeze

Homestead Exemption Application and Afﬁdavit

Last date to apply: ______________________________________

Part 1: Applicant information (Please type or print.)

1 ____________________________________________________________ 3 ____________________________________________

First name MI Last name Tax ID number

2 ____________________________________________________________ 4 ____ ____ /____ ____ /____ ____ ____ ____

Mailing address Date of birth (month, day, year)

____________________________________________________________ 5 ______________________ _____________________

City State ZIP Area code and phone number Email address

Part 2: Property information

1 _____________________________________________________________________________________________________________

Street address of property for which this exemption application is ﬁled Township

__________________________________________ IL

______________

________________________________________________

City ZIP

County

2 ____________________________________________________________

Property (parcel) index number (PIN)

Note: The PIN is shown on your property tax bill. You also may obtain it from your chief county assessment ofﬁcer

(CCAO). If you cannot obtain the PIN, attach a copy of the legal description.

3 Have you or your spouse received this exemption for this property previously? ____ Yes ____ No

If you answered “Yes”, write the base year, if known. ____ ____ ____ ____

4 If your spouse maintains a separate residence, has he or she applied for this exemption? ____ Yes ____ No

Part 3: Household income for 2019

You must include the income of you, your spouse, and all other individuals who live in your household.

1 Social Security and SSI beneﬁts. Include Medicare deductions in this total. 1 __________________|______

2 Railroad Retirement beneﬁts. Include Medicare deductions in this total. 2 __________________|______

3 Civil Service beneﬁts 3 __________________|______

4 Annuities, federally taxable pensions and retirement plan distributions.

4 __________________|______

5 Human Services and other governmental cash public assistance beneﬁts 5 __________________|______

6 Wages, salaries, and tips from work 6 __________________|______

7 Interest and dividends received 7 __________________|______

8 Net rental, farm, and business income or (loss). (See instructions for Line 8.) 8 __________________|______

9 Net capital gain or (loss). (See instructions for Line 9.) 9 __________________|______

10 Other income or (loss). (See instructions for Line 10.) 10 __________________|______

11 Add Lines 1 through 10. 11 __________________|______

12 Certain subtractions. You may subtract only the reported adjustments to income from

U.S. 1040, Schedule 1, Line 22.

Subtraction item Amount

12a _______________________________________________ __________________|______

12b _______________________________________________ __________________|______

Add the amounts on Lines 12a and 12b, and write the result. 12 __________________|______

13 Subtract Line 12 from Line 11, and write the result. This is your total household income

for 2019. If the amount is greater than $65,000, STOP. You do not qualify for this exemption. 13 __________________|______

Do not write in this space.

Date received ___________________ Income veriﬁed

____

Yes

____

Application number ___________________ Base year EAV $__________________

Base year ___ ___ ___ ___ Revised base year EAV $__________________

Revised base year ___ ___ ___ ___ EAV of added improvements $__________________

Approved

____Ye s

____No

Base amount $__________________

Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.

12/31/2020

Part 4: Afﬁdavit

Sworn under oath, I state the following:

1 (Mark the statement that applies.)

On January 1, 2020, the property identiﬁed in Part 2, Line 1, was improved with a permanent structure

a ____ that I used as my principal residence.

b ____ for which I received this exemption previously and is either unoccupied or used as my spouse’s principal residence.

I am now a resident of a facility licensed under the Assisted Living and Shared Housing Act, Nursing Home Care

Act, ID/DD (intellectually disabled/developmentally disabled) Community Care Act, or Specialized Mental Health

Rehabilitation Act of 2013.

_______________________________________ _________________________________________________

Name of facility Mailing address

2 (Mark the statement that applies.)

On January 1, 2020, I

a ____ was the owner of record of the property identiﬁed in Part 2, Line 1.

b ____ had a legal or equitable interest by a written instrument in the property listed in Part 2, Line 1.

c ____ had a leasehold interest in the property identiﬁed in Part 2, Line 1, that was used as a single-family residence.

3 I am liable for paying real property taxes on the property identiﬁed in Part 2, Line 1.

Note: If I have not received this exemption for this property previously, I also met the eligibility requirements listed in Part 4,

Lines 1, 2, and 3 for this property on January 1, 2019.

4 (Mark the statement that applies.)

a ____ In 2020, I am, or will be, 65 years of age or older.

b ____ In 2020, my spouse, who died in 2020, would have been 65 years of age or older. (Complete the following information.)

_____________________________________________ __________________________________________________

Deceased spouse’s name Tax ID number

____ ____ /____ ____ /____ ____ ____ ____ ____ ____ /____ ____ /____ ____ ____ ____

Date of birth (month, day, year) Date of death (month, day, year)

5 The property identiﬁed in Part 2, Line 1, is the only property for which I am applying for a senior citizens assessment freeze

homestead exemption for 2020.

6 The amount reported in Part 3, Line 13, of this form includes the income of my spouse and all persons living in my household

and the total household income for 2019 is $65,000 or less.

7 On January 1, 2020, the following individuals also used the property identiﬁed in Part 2, Line 1, for their principal residence.

My spouse is included if he or she used the property as his or her principal dwelling place on January 1, 2020. The total

income of all individuals and my spouse (regardless of his or her principal residence) are included in Part 3. (Attach an

additional sheet if necessary.)

First and last name Tax ID number

a __________________________________________________ __________________________________________________

b __________________________________________________ __________________________________________________

8 (Mark the statement that applies.)

On January 1, 2020, I was

a ____ single, widow(er), or divorced. b ____ married and living together. c ____ married, but not living together.

My spouse’s name and address

_____________________________________________________________________________

First name MI Last name

_____________________________________________________________________________________________________________

Street Address City State ZIP

Under penalties of perjury, I state that, to the best of my knowledge, the information contained in this afﬁdavit is true, correct, and complete.

_______________________________________ ____ ____/____ ____/____ ____ ____ ____

Signature of applicant Date (month, day, year)

Note: The CCAO may conduct an audit to verify that the taxpayer is eligible to receive this exemption.

Mail your completed Form PTAX-340 to: If you have any questions, please call:

_________________Co. Chief County Assessment Ofﬁcer

(_________)_________ _________________________________

_______________________________________________________ Last date to apply ___ ___/___ ___/___ ___ ___ ___

Mailing address Month Day Year

____________________________________IL _________________

City

ZIP

—

2 of 4 PTAX-340 (R-05/20)

This form is authorized in accordance with the Illinois Property Tax Code. Disclosure of this information is required.

Failure to provide information may result in this form not being processed and may result in a penalty.

Printed by the authority of the

state of Illinois-Web only-1

McLean

309

888

5130

115 E Washington St., PO Box 2400

Bloomington

6 1 7 0 2

1 2

3 1

2 0 2 0

Reset

• cash assistance from the Illinois Department of Human

Services and other governmental cash public assistance

• cash winnings from such sources as rafﬂes and lotteries

• Civil Service beneﬁts

• damages awarded in a lawsuit for nonphysical injury or

sickness (for example, age discrimination or injury to

reputation)

• dividends

• farm income

• Illinois Income Tax refund (only if you received Form 1099-G)

• interest

• interest received on life insurance policies

• long term care insurance (federally taxable portion only)

• lump sum Social Security payments

• miscellaneous income, such as from rummage sales,

recycling aluminum, or baby sitting

• military retirement pay based on age or length of service

• monthly insurance beneﬁts

• pension and IRA beneﬁts (federally taxable portion only)

•

Railroad Retirement beneﬁts (including Medicare deductions)

• rental income

• Social Security income (including Medicare deductions)

• Supplemental Security Income (SSI) beneﬁts

• all unemployment compensation

• wages, salaries, and tips from work

• Workers’ Compensation Act income

• Workers’ Occupational Diseases Act income

What is not included in household income?

Some examples of income that are not included in household

income are listed below. (For speciﬁc income questions, see

Part 3 on Page 4.)

• cash gifts

• child support payments

• COBRA subsidy payments

• damages awarded in a lawsuit for a physical personal injury or

sickness

• Energy Assistance payments

• federal income tax refunds

• IRA’s “rolled over” into other retirement accounts, unless

“rolled over” into a Roth IRA

• lump sums from inheritances

• lump sums from insurance policies

• money borrowed against a life insurance policy or from any

ﬁnancial institution

• reverse mortgage payments

• spousal impoverishment payments

•

stipends from Foster Parent and Foster Grandparent programs

• Veterans’ beneﬁts

What if I have a net operating loss or capital

loss carryover from a previous year?

You cannot include any carryover of net operating loss or capital

loss from a previous year. You can include only a net operating

loss or capital loss that occurred in 2019.

Will my information remain conﬁdential?

All information received from your application is conﬁdential and

may be used only for ofﬁcial purposes.

When must I ﬁle?

File Form PTAX-340 with the CCAO by the due date printed on

the bottom of Page 2. You must ﬁle Form PTAX-340 every year

and meet the qualiﬁcations for that year to continue to receive the

exemption.

Note: The CCAO may require additional documentation

(i.e., birth certiﬁcates, tax returns) to verify the information in this

application.

What if I need additional assistance?

If you have questions about this form, please contact your CCAO,

also known as the supervisor of assessments, or county assessor,

at the address and phone number printed at the bottom of Page 2.

What is the Senior Citizens Assessment Freeze

Homestead Exemption (SCAFHE)?

The Senior Citizens Assessment Freeze Homestead Exemption

(35 ILCS 200/15-172) allows you, as a qualiﬁed senior citizen, to

have your home’s equalized assessed value (EAV) “frozen” at a

base year value and prevent or limit any increase due to inﬂation.

The base year generally is the year before the year you ﬁrst qualify

and apply for the exemption. For example, if you ﬁrst qualify and

apply in 2020,

your property’s

EAV will be “frozen” at the 2019 EAV.

The amount of the exemption is the difference between your base

year EAV and your current year EAV. For Cook County only, the

amount of the exemption is the difference between your base

year EAV and your current year EAV or $2,000, whichever is

greater. Freezing your property’s EAV does not mean that your

property taxes will not increase, however. Other factors also affect

your tax bill. For example, your tax bill could increase if the tax

rate, which is based on the amount of revenues taxing districts

request, increases. Your EAV and tax bill may also increase if you

add improvements to your home. However, if your home’s EAV

decreases in the future, you will beneﬁt from any reduction.

Who is eligible?

The senior citizens assessment freeze homestead exemption

qualiﬁcations for the 2020 tax year (for the property taxes you will

pay in 2021), are listed below.

• You will be 65 or older during 2020.

• Your total household income in 2019 was $65,000 or less.

• On January 1, 2019, and January 1, 2020, you

— used the property as your principal place of residence,

—

owned the property, or had a legal or equitable interest in

the property as evidenced by a written instrument, or had a

leasehold interest in the property used as a single-family

residence, and

— were liable for the payment of property taxes.

You do not qualify for this exemption if your property is assessed

under the mobile home privilege tax.

Surviving spouse — Even if you are not 65 or older during

2020, you are eligible for this exemption for 2020 (and possibly

2019) if your spouse died in 2020 and would have met all of the

qualiﬁcations.

Residents in a health facility — Even if you did not use the

property as your principal place of residence on January 1,

2020, you qualify for this exemption if you are a resident of a

facility licensed under the Assisted Living and Shared Housing

Act, Nursing Home Care Act, ID/DD (intellectually disabled/

developmentally disabled) Community Care Act, or Specialized

Mental Health Rehabilitation Act of 2013 and you meet all other

requirements, have received this exemption previously, and your

property is either unoccupied or is occupied by your spouse.

Residents of cooperatives —

If you are a resident of a

cooperative apartment building or cooperative life-care facility,

you qualify for this exemption if you are liable for the payment of

the property taxes on your residence and meet the other eligibility

requirements.

What is a household?

A household includes you, your spouse, and all other persons

who used your residence as a principal dwelling place on

January 1, 2020.

What is included in household income?

Household income includes your income, your spouse’s income,

and the income of all individuals living in the household. Examples

of income that must be included in your household income are

listed below. (For speciﬁc questions, see Part 3 on Page 4.)

• alimony or maintenance received

• annuities and other pensions

• Black Lung beneﬁts

• business income

• capital gains

PTAX-340 (R-05/20) 3 of 4

Form PTAX-340 General Information

Form PTAX-340 Step-by-Step Instructions

Part 1: Applicant information

Lines 1 through 5 — Type or print the requested information.

Part 2: Property information

Lines 1 and 2 — Identify the property for which this

application is ﬁled.

Lines 3 and 4 — Answer the questions by marking an “X”

next to your statement. If you answered “Yes” to the question

on Line 3 and you know the base year, write it in the space

provided.

Part 3: Household income for 2019

“Income” for this exemption means 2019 federal adjusted gross

income, plus certain items subtracted from or not included in

your federal adjusted gross income (320 ILCS 25/3.07). These

include tax-exempt interest, dividends, annuities, net operating

loss carryovers, capital loss carryovers, and Social Security

beneﬁts. Income also includes public assistance payments from

a governmental agency, SSI, and certain taxes paid. These

Step-by-Step Instructions provide federal return line references

and reporting statement references, whenever possible.

The amounts written on each line must include the 2019 income

for you, your spouse, and all the other individuals living in the

household.

Line 1 — Social Security and Supplemental Security

Income (SSI) beneﬁts

Write the total amount of retirement, disability, or survivor’s

beneﬁts (including Medicare deductions) the entire household

received from the Social Security Administration (shown on

Form SSA-1099, box 3 or use box 5 only if there is a reduction

of beneﬁts). You also must include any Supplemental Security

Income (SSI) the entire household received and any beneﬁts

to dependent children in the household. Do not include

reimbursements under Medicare/Medicaid for medical expenses.

Note: The amount deducted for Medicare ($1,608.00 yearly or

$134.00 per month, per person) is already included in the amount

in box 3 of Form SSA-1099.

Line 2 — Railroad Retirement beneﬁts

Write the total amount of retirement, disability, or survivor’s

beneﬁts (including Medicare deductions) the entire household

received under the Railroad Retirement Act (shown on Forms

SSA-1099 and RRB-1099).

Line 3 — Civil Service beneﬁts

Write the total amount of retirement, disability, or survivor’s

beneﬁts the entire household received under any Civil Service

retirement plan (shown on Form 1099-R).

Line 4 — Annuities and other retirement income

Write the total amount of income the entire household

received as an annuity from any annuity, endowment, life

insurance contract, or similar contract or agreement (shown

on Form 1099-R). Include only the federally taxable portion of

pensions, IRAs, and IRAs converted to Roth IRAs (shown on

U.S. 1040, Line 4b). IRAs are not taxable when “rolled over,”

unless “rolled over” into a Roth IRA.

Line 5 — Human Services and other governmental

cash public assistance beneﬁts

Write the total amount of Human Services and other

governmental cash public assistance beneﬁts the entire

household received. If the ﬁrst two digits of any member’s Human

Services case number are the same as any of those in the

following list, you must include the total amount of any of these

beneﬁts on Line 5.

01 aged 04 and 06 temporary assistance to

02 blind needy families (TANF)

03 disabled 07 general assistance

To determine the total amount of the household beneﬁts, multiply

the monthly amount each person received by 12. You must

adjust your ﬁgures accordingly if anyone in the household did not

receive 12 equal checks during this period.

Food stamps and medical assistance beneﬁts anyone in the

household may have received are not considered income and

should not be added to your total income.

Line 6 — Wages, salaries, and tips from work

Write the total amount of wages, salaries, and tips from work for

every household member (shown in box 1 of Form W-2).

Line 7 — Interest and dividends received

Write the total amount of interest and dividends the entire

household received from all sources, including any government

sources (shown on Forms 1099-INT, 1099-OID, and 1099-DIV).

You must include both taxable and nontaxable amounts.

Line 8 — Net rental, farm, and business income or (loss)

Write the total amount of net income or loss from rental, farm,

business sources, etc., the entire household received, as allowed

on U.S. 1040, Schedule 1, Lines 3, 5, and 6. You cannot use any

net operating loss (NOL) carryover in ﬁguring income.

Line 9 — Net capital gain or (loss)

Write the total amount of taxable capital gain or loss the entire

household received in 2019, as allowed on U.S. 1040, Line 6 and

U.S. 1040, Schedule 1, Line 4. You cannot use a net capital loss

carryover in ﬁguring income.

Line 10 — Other income or (loss)

Write the total amount of other income or loss not included in

Lines 1 through 9, that is included in federal adjusted gross

income, such as alimony received, unemployment compensation,

taxes withheld from oil or gas well royalties. You cannot use any

net operating loss (NOL) carryover in ﬁguring income.

Line 11 — Add Lines 1 through 10.

Line 12 — Subtractions

You may subtract only the reported adjustments to income totaled

on U.S. 1040, Schedule 1, Line 22. For example

• IRA deduction • Educator expenses

• Archer MSA deduction • Tuition and fees

• moving expenses • Domestic production

• alimony or maintenance paid activities deduction

• health savings account deduction

• student loan interest deduction

• jury duty pay you gave to your employer

• deductible part of self-employment tax

• self-employed health insurance deduction

• self-employed SEP, SIMPLE, and qualiﬁed plans

• penalty on early withdrawal of savings

Line 13 — Total household income

Subtract Line 12 from Line 11. If this amount is greater than

$65,000, you do not qualify for this exemption. See Page 3.

Part 4: Afﬁdavit

Lines 1 through 4 — Mark the item that applies. Read the

afﬁdavit carefully. The statements must apply.

Line 7 — Write the names and tax identiﬁcation numbers of the

individuals, other than yourself, who used the property for their

principal residence on January 1, 2020. Attach an additional

sheet if necessary.

Line 8 — Follow the instructions on the form. If your spouse

does not reside at this property, be sure to write his or her name

and address.

Note: You must sign your Form PTAX-340 before you ﬁle it with

your CCAO. Return your completed Form PTAX-340 to your

CCAO’s ofﬁce or mail it to the address printed on the bottom of

Page 2.

4 of 4 PTAX-340 (R-05/20)

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PTAX-340 2020 Senior Citizens Assessment Freeze Homestead Exemption (McLean County)

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