Fillable Senior Citizens, Disabled Persons, and Disabled Veterans Property (Kittitas County WA)

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Senior Citizens, Disabled Persons, and Disabled Veterans Property (Kittitas County WA)

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STEVEN J. DREW
Assessor
OFFICE OF THE ASSESSOR
Service, Integrity, Fairness,
Internationally Recognized for Excellence
2000 Lakeridge Drive SW, Olympia, WA 98502-6045
(360) 867-2200 FAX (360) 867-2201 TTY: 7-1-1 or 1-800-833-6388
Senior Citizens, Disabled Persons, and Disabled Veterans
Property Tax Exemption Application
The Senior/Disabled Persons Exemption Program reduces property taxes for qualifying homeowners.
There are 3 criteria you must meet in the Assessment Year for the following year to qualify:
1) Age or disability
• Over 61 years old or
• Disabled and unable to be gainfully employed or
• Veteran with an 80% or greater service-connected disability rating.
2) Be the owner of your home and reside there more than 6 months of the year.
3) Have a total household income of $48,566 or less.
If you feel you qualify, please fill out the attached application with the required supporting
documents by one of the following methods:
In Person at Office Preferrable:
Email or Mail
Drop-Box Next to Voters Box:
Thurston County Assessor
2000 Lakeridge Dr SW, Bldg. 1
Olympia, WA 98502
AsrInfo@co.thurston.wa.us
Thurston County Assessor
2000 Lakeridge Dr SW, Bldg. 1
Olympia, WA 98502
Located in the parking lot of the
Thurston County Courthouse.
Please clearly label envelope:
“ATTN: Assessor’s Office”
When you submit your application packet it should include:
– Your completed and signed application and Combined Disposable Income Worksheet
– A copy of your Current Washington State ID or Driver’s License
– Proof of Disability (if under 61)
o Social Security Award Letter (or Social Security 1099)
o Proof of Disability Statement completed by a licensed physician (Form is available)
o VA Award Letter or Benefit Verification Letter with your combined disability rating
and effective date
– Complete Income & Deductions Information (See Form 63 0036 for Year 2022 Forward)
o This may include, but it not limited to: IRS Tax Return (1040) with all schedules and
attachments, SSA-1099 (Social Security), RRB-1099 (Railroad Retirement), 1099-R,
any other 1099, K-1, W-2, W-2-G, statement from Labor & Industries, or any other
income document
o If you do not file an IRS Tax Return, you need to provide documentation for all income
you (and your spouse, if married) received such as: SSA-1099, RRB-1099, or W-2.
o State law requires non-taxable income, such as Social Security and L&I Pensions, to be
included.
o Provide receipts, invoices, or documentation for deductions
If you need assistance with the application or have additional questions, you can contact our office at
AsrInfo@co.thurston.wa.us
or 360-867-2200.
Senior Citizen and People with Disabilities Exemption from Real Property Taxes
REV 64 0002 (12/09/21) Page 1
County use only
Assessment year:
Tax year: Tax code area:
Approved (date): Exempon level: Parcel number:
Denied (date/reason):    
1 Applicant information
Applicant name: Date of birth:
Spouse/domesc partner or co-tenant name:   Date of birth:
Residence address:
City: State: Zip:
Mailing address (if dierent than residence address):
City: State: Zip:
Home phone: Cell phone: Email:
2 Age/disability
I am or will be 61 years of age or older by December 31 of the assessment year on which this
exempon is based.
I am under 61 years of age and I am rered from regular gainful employment due to a disability.
Disability determinaon date:
I am a veteran with an 80% service-connected evaluaon or compensated at 100% rate due to
service-connected disability.
I am the surviving spouse/domesc partner of a person who was previously receiving this
exempon and I was at least 57 years of age in the year my spouse/domesc partner passed away.
3 Ownership and occupancy
Date property purchased: Date property inially occupied:
I occupy the residence (check one):
More than 6 months in a calendar year. Less than 6 months in a calendar year.
I have received an exempon before. Yes No
If yes, when: Address & county:
Senior Citizen and People with Disabilities
Exemption from Real Property Taxes
Chapter 84.36 RCW
Complete this applicaon in its enrety and le along with all supporng
documents with your county assessor. For assistance, contact your County
Assessor’s oce.
Form 64 0002
To ask about the availability of this publication in an alternate format for the visually impaired, please call
360-705-6705. Teletype (TTY) users may use the WA Relay Service by calling 711.
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Senior Citizen and People with Disabilities Exemption from Real Property Taxes
REV 64 0002 (12/09/21) Page 2
I sold my former residence. Yes No
If yes, when: where:    
4 Property description
Type of residence:
Single-family home Single unit of a mul-unit dwelling duplex/condo Housing co-op
Mobile home Year:
Make:
Model:      
• If mobile home, has the cercate of tle been eliminated? Yes No
• If mobile home, do you own the land where the mobile home is located? Yes No
This property includes:
My principal residence and less than or equal to one acre of land.
My principal residence and more than one acre of land.
5 Combined disposable income Year:
Total combined disposable income from the Combined Disposable Income Worksheet: $
(See instrucons. Submit your completed worksheet with this applicaon.)
6 Certification
By signing this form, I conrm that I:
• Have completed the income secon of this form and all proof of income is included.
• Understand it is my responsibility to nofy the county assessor if I have a change in income or
circumstances and that any exempon granted through erroneous informaon is subject to the
correct tax being assessed for the last ve years, plus a 100 percent penalty.
• Declare under penalty of perjury that the informaon in this applicaon packet is true and
complete.
• Request a refund under the provisions of RCW 84.69.020 for taxes paid or overpaid as a result of
mistake, inadvertence, or lack of knowledge regarding exempon from paying real property taxes
pursuant to RCW 84.36.381 through 389.
Signature of applicant: Date:
What to do next:
Send this form to your local county assessor.
Find your county assessors oce here: dor.wa.gov/countycontacts
Senior Citizen and People with Disabilities Exemption from Real Property Taxes
REV 64 0002 (12/09/21) Page 3
Instructions for completing the application
Complete Parts 1 through 6 in their enrety and
include supporng documents to avoid delays in
applicaon processing. If you have quesons, contact
your county assessor’s oce.
Part 1
A co-tenant is someone who lives with you and has an
ownership interest in your home.
Part 2
Check the appropriate box. See the Documents to
Include secon in these instrucons to determine
what to send for proof of age or disability.
Part 3
Enter the date you purchased the residence and the
date you began occupying the residence even if the
dates are the same. If you have qualied and received
an exempon on a Washington residence previously,
indicate when and the address and county where the
previous exempon was granted.
Part 4
Details regarding your specic residence and parcel
can be obtained from your county assessor’s oce.
Part 5
Complete and aach the Combined Disposable
Income Worksheet and enter the total here.
How combined disposable income is calculated
Per RCW 84.36.383(1) “combined disposable income”
is your disposable income plus the disposable income
of your spouse/domesc partner and any co-tenants,
minus expenses for you or your spouse/domesc
partner for:
How disposable income is calculated
“Disposable income” has a specic denion for
the purpose of this program. Per RCW 84.36.383(6),
“disposable income” is adjusted gross income, as
dened in the federal internal revenue code, plus all
of the following that were not included in, or were
deducted from, adjusted gross income:
• Capital gains, other than a gain on the sale of a
principal residence that is reinvested in a new
principal residence.
• Amounts deducted for losses or depreciaon.
• Pensions and annuies.
• Social security act and railroad rerement benet.
• Military pay and benets other than aendant-
care and medical-aid payments.
• Veterans pay and benets other than aendant-
care, medical-aid payments, VA disability benets,
and DIC.
• Dividend receipts.
• Interest received on state and municipal bonds.
These incomes are included in “disposable income”
even when it is not taxable for IRS purposes.
What are deducble expenses
Expenses paid by you or your spouse/domesc
partner (not reimbursed or covered by insurance) for:
• Prescripon drugs.
• Treatment or care of either person in the home or
in a nursing home, boarding home, or adult family
home.
• Heath care insurance premiums for Medicare
Parts A, B, C, and D and Medicare supplemental
(Medigap) policies.
• Durable medical and mobility enhancing
equipment and prosthec devices.
• Medically prescribed oxygen.
• Long-term care insurance.
• Cost-sharing amounts (amounts applied toward
your health plan’s out of pocket maximum).
• Nebulizers.
• Medicines of mineral, animal, and botanical origin
prescribed, administered, dispensed, or used in
the treatment of an individual by a Washington
licensed naturopath.
• Ostomic items.
• Insulin for human use.
• Kidney dialysis devices.
• Disposable devices used to deliver drugs for
human use.
For addional informaon, review the instrucons for
the Combined Disposable Income Worksheet.
Senior Citizen and People with Disabilities Exemption from Real Property Taxes
REV 64 0002 (12/09/21) Page 4
Income thresholds
The income threshold to qualify for this exempon is
the greater of $40,000 or 65% of the county median
household income. County specic thresholds can be
found at dor.wa.gov/incomethresholds.
Part 6
Sign and date the applicaon. You are signing under
oath acknowledging all informaon is true and
accurate. You understand it is your responsibility to
nofy the county assessor if you have a change in
circumstances.
Documents to include
You must provide documentaon to your county
assessor’s oce to support the informaon reported
on the applicaon.
Proof of age or disability, ownership, and occupancy
Include copies of documentaon showing you meet
the age or disability, ownership, and occupancy
requirements such as:
• A copy of your driver’s license or state issued
photo id.
• A copy of your voter registraon.
• A copy of your birth cercate.
• If your eligibility is based on a disability: a copy
of your disability award leer from SSA or VA, or
a Proof of Disability statement completed and
submied by your physician.
• A complete copy of the trust documents, if
applicable.
• A copy of your deed.
• Any other documents your county assessor
requests.
Proof of income
Aach a completed Combined Disposable Income
Worksheet and supporng documents. For addional
detail on what to include, see the instrucons for the
Combined Disposable Income Worksheet.
Combined Disposable Income Worksheet
REV 63 0036 (11/9/21) Page 1 of 5
Instrucons (worksheet is on the last page)
The terms disposable income and combined disposable income for the purpose of Washington’s property
tax relief programs for individuals are dened in RCW 84.36.383 and WAC 458-16A-100. Use this
worksheet to calculate your combined disposable income and enter the result on your property tax relief
applicaon(s).
Enter the calendar year of the income you are reporng.
If you, your spouse/domesc partner, and/or co-tenants are required to le a federal income tax return,
mark yes even if they have not been led yet. Note: if federal income tax returns are required to be led,
you will need to provide a complete copy of the federal income tax returns submied to the IRS. Your
county assessor may require you to wait to complete your applicaon(s) unl the federal income tax
returns have been led with the IRS.
Disposable income: Include amounts for you and your spouse or domesc partner as well as amounts of
anyone living in the residence that has an ownership interest in the residence.
Line 1 If you led a federal income tax return enter your federal Adjusted Gross Income (AGI) on Line 1 and
include a complete copy of your federal income tax return. If you did not le a federal income tax return
enter zero.
Line 2 If you led a federal income tax return, enter the amount of capital gains exempted or not reported
on your federal income tax return. If you did not le a federal income tax return, enter all your capital
gains from all sources. This includes the gain on the sale of a primary residence to the extent the gain was
not used to purchase a replacement primary residence. Do not use losses to oset gains. Include copies of
1099’s and year-end account statements.
Line 3 If you led a federal income tax return and reported losses, you must add back the losses to the
extent they were used to oset or reduce income. Ex1: On Schedule D, you reported a $10,000 loss but the
loss was limited to $3,000. Enter $3,000 on Line 3. Ex2: You led two Schedule C’s – one with a $10,000
loss and one with a $5,000 net income. A net loss of $5,000 was reported on your federal income tax
return. Enter $10,000 on Line 3. If you did not le a federal income tax return, enter zero.
Combined Disposable Income Worksheet
Form 63 0036
To request this document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest
or call 360-705-6705. Teletype (TTY) users please dial 711.
Aach and submit the completed worksheet with your property tax
relief applicaon.
Reset formReset form
Print form
Print form
Combined Disposable Income Worksheet
REV 63 0036 (11/9/21) Page 2 of 5
Line 4 If you led a federal income tax return and reported depreciaon and the net result was a loss, you
must recalculate the net income/loss without the depreciaon expense. If there is sll a net loss enter
zero on Line 4. If the result is net income, enter the net income on Line 4. If you did not le a federal
income tax return, calculate any business, rental, etc. net income/loss without a deducon for depreciaon
expense. Include copies of all supporng documents.
Line 5 If you led a federal income tax return, enter the amount of nontaxable wages you received. If all
your wages were taxable and included on your federal income tax return, enter zero. If you did not le
a federal income tax return, enter the total wage income you received. Include copies of W-2’s or wage
statements.
Line 6 If you led a federal income tax return, enter the amount of nontaxable interest and dividends
received. Include nontaxable interest on state and municipal bonds. If you did not le a federal income tax
return, enter the total interest and dividend income you received including interest on state and municipal
bonds. Include copies of 1099’s or other tax statements.
Line 7 If you led a federal income tax return, enter the amount of nontaxable pension and annuity
distribuons you received. Ex: You received $10,000 in pensions and annuies. The taxable amount was
$6,000. Enter the nontaxable $4,000 on Line 6. If you did not le a federal income tax return, enter the
gross pension and annuity distribuon amounts on Line 6. Do not include nontaxable IRA distribuons.
Include copies of 1099’s.
Line 8 If you led a federal income tax return, enter the amount of nontaxable military pay and benets,
including Combat Related Special Compensaon (CRSC), you received. Do not include aendant-care and
medical-aid payments. If you did not le a federal income tax return, enter the amount of all military pay
and benets regardless of whether it is subject to federal income tax. Do not include aendant-care and
medical-aid payments. Include copies of award leers or other supporng documents.
Line 9 If you led a federal income tax return, enter the amount of nontaxable veteran pay and benets
you received. Do not include aendant-care and medical-aid payments, disability compensaon, or
dependency and indemnity compensaon paid by DVA. If you did not le a federal income tax return,
enter the total amount of veteran pay and benets you received. Do not include aendant-care and
medical-aid payments, disability compensaon, or dependency and indemnity compensaon paid by DVA.
Include copies of award leers or other supporng documents.
Line 10 If you led a federal income tax return, enter the amount of nontaxable social security and railroad
rerement benets. Ex: Your gross Social Security benet was $10,000 and $4,000 was subject to federal
income tax, enter the nontaxable $6,000 on Line 9. If you did not le a federal income tax return, enter
the gross social security and railroad rerement benets you received. Include copies of 1099’s.
Combined Disposable Income Worksheet
REV 63 0036 (11/9/21) Page 3 of 5
Line 11 If you led a federal income tax return, enter the amount of business, rental, or farming income
not reported on your federal income tax return or related schedules. If you did not le a federal income
tax return enter the total amount of business, rental, or farming income. You can deduct normal expenses,
except depreciaon, but do not use losses to oset income. Include copies of all supporng documents.
Line 12 If you led a federal income tax return, enter the amount of any other income you received not
reported on your federal income tax return or disclosed on a previous line including money contributed
to household expenses from other residents. If you did not le a federal income tax return, enter the
amount of any other income you received not reported on a previous line including money contributed to
household expenses from other residents.
Deducons: Include amounts paid by you and your spouse or domesc partner that were not reimbursed
by insurance or other organizaons or providers.
Line 14 Enter nursing home, assisted living facility, or adult family home expenses incurred. Provide
copies of invoices or equivalent documents for the amounts entered.
Line 15 Enter home health care expenses incurred. Home health care means the treatment or care
received in the home that is similar to the type of care provided in the normal course of treatment or
cane in a nursing home. The providers of home health care do not have to be licensed for the cost to
be deducble under this provision. Qualifying expenses may be: physical therapy received in the home,
medical treatments or care received in the home, aendant care, light housekeeping tasks, meals-on-
wheels, or life alert. Provide copies of invoices or equivalent documents for the amounts entered.
Line 16 Enter the amounts paid for prescripon drugs. Provide a summary from your pharmacies or
equivalent documents for the amounts entered.
Line 17 Enter the amounts paid for Medicare Parts A, B, C, or D insurance premiums. Provide copies of
SSA-1099, invoices, or equivalent documents for amounts entered.
Line 18 Enter the amounts paid for approved Medicare supplemental insurance premiums. Provide copies
of statements idenfying insurance company, plan number, and premiums paid.
Line 19 Enter amounts paid for durable medical equipment, mobility enhancing equipment, and prosthec
devices. Deducble amounts include for purchase, rental, repair, cleaning, replacement parts, etc. Review
WAC 458-20-18801 tables 1, 3, and 5 for qualifying items. Provide receipts or invoices for amounts
entered.
Line 20 Enter amounts paid for medically prescribed oxygen, including but not limited to, oxygen
concentrator systems, oxygen enricher systems, liquid oxygen systems, and gaseous, boled oxygen
systems prescribed. Provide receipts or invoices for amounts entered.
Combined Disposable Income Worksheet
REV 63 0036 (11/9/21) Page 4 of 5
Line 21 Enter amounts paid for long-term care insurance premiums. Provide invoices or equivalent
documents for amounts entered.
Line 22 Enter amount paid for cost-sharing. Cost-sharing amounts included deducbles, co-insurance,
co-payments for enrollees in health plan; the amounts counted toward the plans out-of-pocket maximum.
Provide a coverage summary that idenes the amount of out-of-pocket maximum incurred.
Line 23 Enter amounts paid for nebulizers; a device, not a building xture, that converts a liquid medicaon
into a mist so that it can be inhaled. Provide receipts or invoices for amounts entered.
Line 24 Enter amounts paid for medicines of mineral, animal, and botanical origin prescribed,
administered, dispensed, by a naturopath licensed under Washington law. Provide the receipts or invoices
for amounts entered, a copy of the treatment plan, and the name of the naturopath and their Washington
license number.
Line 25 Enter the amounts paid for ostomic items; disposable medical supplies used by colostomy,
ileostomy, and urostomy paents, and includes bags, belts to hold up bags, tapes, tubes, adhesives,
deodorants, soaps, jellies, creams, germicides, and other like supplies. Does not include undergarments,
pads, and shields to protect undergarments, sponges, or rubber sheets. Provide receipts or invoices
idenfying items and amounts paid.
Line 26 Enter amounts paid for insulin for human use. Provide receipts or invoices idenfying items and
amounts paid.
Line 27 Enter amounts paid for kidney dialysis devices. Provide receipts or invoices idenfying items and
amounts paid.
Line 28 Enter amounts paid for disposable devices used to deliver drugs such as syringes, tubing, or
catheters. Does not include a stand or device that holds the tubing or catheter. Provide receipts or
invoices idenfying items and amounts paid.
Line 29 If you led a federal income tax return, enter zero. The amount you entered on Line 1 accounts
for adjustments to income if you led a federal income tax return. If you did not le a federal income
tax return, review federal form Schedule 1 (Form 1040) and federal form Schedule 1 instrucons for
valid adjustments to income. If any adjustments are applicable, enter the amounts. Provide supporng
documents for all amounts entered.
Line 31 Combined disposable income. Enter this amount on your main applicaon; Senior Cizen and
People with Disabilies Exempon from Real Property Taxes, Deferral Applicaon for Senior Cizens
and People with Disabilies, Deferral Applicaon for Homeowners with Limited Income, or Property Tax
Assistance Applicaon for Widows/Widowers of Veterans.
Combined Disposable Income Worksheet
REV 63 0036 (11/9/21) Page 5 of 5
Income year:
Are you required to le a federal income tax return?
Yes No
Disposable income Amount
1. Federal adjusted gross income from Federal Form 1040
2. Capital gains not reported on your federal income tax return
3. Losses reported on your federal income tax return
4. Depreciaon reported on your federal income tax return
5. Wage income: nontaxable and/or not reported on your federal income tax return
6. Dividend or interest income: nontaxable and/or not reported on your federal income tax return
7. Pension and annuity income:nontaxable and/or not reported on your federal income tax return
8. Military pay and benets: nontaxable and/or not reported on your federal income tax return
9. Veterans pay and benets: nontaxable and/or not reported on your federal income tax return
10. Social security or railroad rerement benets: nontaxable and/or not reported on your federal
income tax return
11. Business, rental, or farming income not reported on your federal income tax return
12. Other income not included in amounts on Lines 1-11, provide the source, type and amount
13. Add lines 1-12 This is your total disposable income:
Deducons
14. Nursing home, assisted living or adult family home
15. Home health care
16. Prescripon drugs
17. Medicare parts A,B,C, D insurance premiums
18. Medicare supplemental/Medigap insurance premiums
19. Durable medical and mobility enhancing equipment and prosthec devices
20. Medically prescribed oxygen
21. Long-term care insurance
22. Cost-sharing amounts
23. Nebulizers
24. Medicines of mineral, animal and botanical origin prescribed, administered, dispensed, by a
naturopath licensed under Washington law
25. Ostomic items
26. Insulin for human use
27. Kidney dialysis devices
28. Disposable devices used to deliver drugs for human use
29. Adjustments to income
30. Add lines 14-29 This is your total deducons:
31. Subtract line 30 from line 13 This is your total combined disposable income:
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Completed 31 March 2022

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