Fillable SENIOR CITIZEN/DISABLED/VETERAN PERSON(S) LAND OCCUPATION USE TAX 60% (The Tulalip Tribes)

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SENIOR CITIZEN/DISABLED/VETERAN PERSON(S) LAND OCCUPATION USE TAX 60% (The Tulalip Tribes)

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  • 6 signatures
  • 10 check-boxes
  • 36 other fields

Country of origin: US
File type: PDF

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SENIOR CITIZEN/DISABLED/VETERAN PERSON(S) 60% DEFERRAL APPLICATION Page 1 of 4
SENIOR CITIZEN/DISABLED/VETERAN PERSON(S)
LAND OCCUPATION USE TAX – 60% DEFERRAL APPLICATION
FOR TAXES DUE IN 2015
Attached is a 2015 Land Occupation Use Tax (LOUT) deferral of sixty percent (60%) tax application.
Eligibility is
based on your 2014 income.
This LOUT 60% deferral reduces your property taxes. Please complete this application with your 2014
income & your personal information. Instructions are
attached
to help complete the application.
DOCUMENTATION REQUIRED
You must provide documentation for all income and/or expenses listed, or this application
will be
returned to you.
If
you file a tax return, this documentation must include a full copy of your tax return, and all
documents used to prepare your return, such as Social Security
statements, retirement or pension
statements, disability payments, W-2 forms, 1040 forms and 1099
forms.
If
you do not file a tax return, this documentation must include copies of your
Social Security
statement, retirement or pension statement, W-2 form and any 1099 forms.
You must also include documentation for any allowed out-of-pocket expenses you are
deducting from your income.
If you have any questions, please contact the Tax & Licensing Division at (360) 716.4209
2015 INSTRUCTIONS
This claim is being filed with the Tulalip Tribes Tax & Licensing Division for LOUT payable in 2015
under the requirements of Title 12.30.
IF YOUR APPLICATION IS INCOMPLETE, OR IF YOU HAVE NOT INCLUDED ALL REQUIRED 2014
DOCUMENTATION, YOUR APPLICATION WILL BE RETURNED TO YOU FOR COMPLETION OR
ADDITIONAL DOCUMENTATION.
NUMBERS LISTED BELOW CORRESPOND TO THE NUMBER ON THE APPLICATION
1.
Type of Residence:
Mark the box that applies to you. If your residence is a mobile home, enter
the year and the make
or model of your mobile home.
2. Type of Ownership: Mark the box that applies to you.
If
you have a life estate you must attach
a
copy of that portion of the deed, lease or trust that shows the life estate.
3. Claimant’s Information:
4. Parcel or Account Number: You can find your parcel or account number in the upper left comer
of your most recent
tax statement.
5. 2014 Income and Expenses of Claimant/Spouse/Co-tenant/Domestic Partner:
DOCUMENTATION REQUIRED.
SENIOR CITIZEN/DISABLED/VETERAN PERSON(S) 60% DEFERRAL APPLICATION Page 2 of 4
Maximum allowed $35,000. You must report from all income sources
-
Taxable and Non-
Taxable.
(Co-tenant income information must be provided if they reside with the claimant.)
6. Certification of age and/or disability: Mark the boxes that apply to you. (If you are disabled
and under 61 years of age, you MUST supply this office with either a copy of your Social
Security award of disability letter, your Veterans
Administration award of disability letter, or a
current, physician signed, disability form noting the year the disability
occurred and whether the
disability is temporary or permanent.
7.
Fill in the claimant's birth date, the spouse or domestic partner's birth date, the year you
purchased your property and
the year you first occupied your property.
For assistance please call the Tax & Licensing Division at 360.716.4209
SENIOR CITIZEN/DISABLED/VETERAN PERSON(S) 60% DEFERRAL FROM LOUT
Use
2014
Income to Determine Eligibility your filing for deferral on Taxes Payable in
2015
1.
Type of Residence
(Check one) :
☐
Single Family Dwelling
☐
Non-residential Structure
☐
Mobile Home Year built: _____ Make/Model: ____________
Tax & Licensing Division Use Only
2015 Assessment Taxes
Date Entered:
Tax Year: 2015
Tax amount $
Deferral amount: $
Initial:
2.
Type of Ownership
(Check one): PLEASE NOTE:
You must
own
AND
occupy the residence currently (2015) AND
as of 12/31/14
to qualify for the tax deferral.
☐
Owner (In total, or by Mortgage or Contract Purchase)
☐
Life Estate (must be created by deed)
3.
Claimant(s) Information – All Lines MUST Be Completed
Have you received in the past, the Senior Citizen/Disabled/Veteran Person(s) LOUT
60% deferral or
exemption on this parcel?
☐
No
☐
Yes
-
Most recent year received
Claimant'
s
Full Name:
First
Middle
Last
Other Party:
First
Middle
Last
Physical Address:
Address City Zip
Mailing Address (if different than above):
4.
Parcel or Account Number:
SENIOR CITIZEN/DISABLED/VETERAN PERSON(S) 60% DEFERRAL APPLICATION Page 3 of 4
Documentation Required For All Income and/or Deductions
5.
All 2014 Gross Annual Income and/or Deductions of Claimant, Spouse, Co-Tenant or Domestic Partner.
INCOME:
A.
Social Security
[ Box 5 of your SS l099's)
$ ______________
$ ______________
B.
Pension, Annuities
and/or
Retirement bonds
$ ______________
Parts A, B, C or D & Medicare
$ ______________
C.
Interest, Exempt
Interest Dividends and/or
IRA withdrawals
$ ______________
Home
Wages
or Adult Family
Home Costs
$ ______________
D. Wages
$ ______________
your
Tax Return (line 36) except
penalties for
early withdrawals.
$ ______________
E. Capital Gains
-
Includes all
gains from
Schedule D or 1099's.
Losses cannot offset gains.
$ ______________
E.
Prescription Drug Expenses
$ ______________
$ ______________
F.
Net Rental and/or
Business
Income
-
Excluding Depreciation
No Losses allowed
$ ______________
$ ______________
G.
Disability Income (other
than VA Benefits or Social
Security payments)
H.
Any other income
$ ______________
$ ______________
(Income Less Deductions) Maximum Allowed Income $35,000
$ ______________
6. I, or each of us (if joint owners are filing) apply for 60% deferral on this property and certify the following
(please check the appropriate box(es):
☐
I am 61 years of age or older.
☐
I am under 61 years of age, and disabled and unable to work because of my disability. Attach a
current physician'
s
statement attesting to your disability or attach a copy of your
SS
award letter.
☐
I am a veteran with a 100% service-connected disability. Attach a copy of your VA award letter.
7.
Claimants Birth date:
Other Party Birth date: _________________________
Year Property Purchased: Year Property Occupied: _____________________
Any 60% deferral granted through erroneous information shall be subject to the correct tax being
assessed for
the last two years, plus a 100 (100%) percent penalty.
SENIOR CITIZEN/DISABLED/VETERAN PERSON(S) 60% DEFERRAL APPLICATION Page 4 of 4
THE CLAIMANT(S) MUST SIGN THE APPLICATION AND INCLUDE A PHONE NUMBER. THE
CLAIMANTS’ SIGNATURE MUST BE WITNESSED. (You must have two people witness your signature.
If you have no one to witness your signature, you may present your application in person and an
Employee of the Tax & Licensing Division Office will be witness to your signature.) If someone other than
the claimant is signing this document, please attach proof of authority, such as Power of Attorney.
( )
Signature of Claimant
Date
Phone Number of Claimant
I swear under the penalties of perjury that all of the foregoing statements are true.
Witness or Date Witness Date
Power of Attorney (if applicable)
Other Party
Date Witness Date
Witness Date
Tax & Licensing Division Date
Please refer to the Instructions sheets for assistance in completing this application.
You may access tax information on our Internet home page at http://www.tulaliptribes-
nsn.gov/Home/Government/Departments/CommunityDevelopment.aspx.
If you have questions, please call
the Tax & Licensing Division Office at (360) 716-4209.
Return your completed application and all required
documentation to:
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SENIOR CITIZENDISABLEDVETERAN PERSON(S) LAND OCCUPATION USE TAX 60% (The Tulalip Tribes)

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Completed 20 July 2020

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