Fillable Statutory Abatement Application For Hardship State Tax Form 3ABC Assessors’ Use only

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Statutory Abatement Application For Hardship State Tax Form 3ABC Assessors’ Use only

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State Tax Form 98
The Commonwealth of Massachusetts
Assessors’ Use only
Issued 7/2009
Date Received
Application No.
Name of City or Town
Parcel Id.
FINANCIAL HARDSHIP: ACTIVATED MILITARY – AGE AND INFIRMITY
FISCAL YEAR _______ APPLICATION FOR STATUTORY EXEMPTION
General Laws Chapter 59, § 5, CLAUSE 18
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 December 15 or 3
months after actual (not preliminary) tax bills are mailed for
fiscal year if later.
INSTRUCTIONS: Complete all sections that apply. Please print or type.
A. IDENTIFICATION. Complete this section fully.
Name of Applicant _________________________________________ Occupation
__________________________________
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 $
Financial condition Board of Assessors
Date voted/Deemed denied
Certificate No.
Date Cert./Notice sent
Date:
FILING THIS FORM DOES NOT STAY THE COLLECTION OF YOUR TAXES
THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE
GREENFIELD
B. EXEMPTION STATUS. Check the status that applies to you and complete the questions that follow.
ACTIVATED MILITARY PERSONNEL
Initially enlisted in the armed forces.
Military status changed to active duty.
Date of activation to active duty. _______________________________ Attach copy of orders.
GO ON TO SECTION D
OLDER AND INFIRM PERSON
You must meet both age and infirmity requisites to qualify.
Date of Birth _________________________________________ Attach a copy of birth certificate.
Provide a detailed description of the physical or mental illness, disability or impairment.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Attach a physician’s letter documenting your infirmity.
GO ON TO SECTION C
C. EMPLOYMENT STATUS.
Are you able to work? Yes No If no, your physician’s letter must confirm this status.
If unemployed, state date of last employment _________________________________________________________
GO ON TO SECTION D
D. INSURANCE BENEFITS. Complete this section if you are a surviving spouse.
Date and place of spouse’s death _______________________________________________________________________________
Total amount of insurance received
_____________________________________________________________________________
Name of insurance company or fraternal society _________________________________________________________________
GO ON TO SECTION E
E. FAMILY ASSISTANCE. Complete this section if you are receiving any financial assistance from family members.
Name Relationship Residence Occupation Wages Assistance given
____________________ __________________ __________________ ________________ _____________ ______________
____________________ __________________ __________________ ________________ _____________ ______________
____________________ __________________ __________________ ________________ _____________ ______________
____________________ __________________ __________________ ________________ _____________ ______________
Continue list on attachment in same format as necessary.
GO ON TO SECTION F
F. FINANCIAL STATEMENT. Complete this section fully. Copies of your federal and state tax returns and other
documentation may be requested to verify your income and assets.
ASSETS LIABILITIES
REAL ESTATE
Domicile value $ Mortgage outstanding balance $
Other value
PERSONAL ESTATE
Motor vehicle values (year/make/model)
Car loan balances
Bank account balances (Bank name & address)
Other (specify) Other outstanding debts (personal loans, credit
cards, etc.)
TOTAL $ TOTAL $
INCOME
Monthly
EXPENSES
Monthly
Wages & salaries –Annual $ $ Mortgage payments (including taxes) ........$
Unemployment compensation................... Food...................................................................
Social Security .............................................. Utilities:
Other pension/retirement .......................... Electricity .....................................................
Public assistance: Gas ................................................................
AFDC........................................................ Heating fuel.................................................
Food stamps............................................. Telephone ....................................................
Fuel assistance ......................................... Water/sewer ...............................................
Other ......................................................... Debt payments:
Rental income ............................................... Car loans ......................................................
Business/professional profits .................... Credit cards .................................................
Interest/dividends....................................... Personal loans .............................................
Other (specify) Fixed expenses:
Car insurance ..............................................
House insurance .........................................
Other (specify)
TOTAL $ TOTAL $
GO ON TO SECTION G
G. 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 FINANCIAL HARDSHIP EXEMPTION
FINANCIAL HARDSHIP EXEMPTION. You may be able to reduce all or a portion of the taxes assessed on
your domicile if you do not have the financial resources to pay them because (1) you were called into active
military service (not including initial enlistment), or (2) you are older and suffer some physical or mental
illness, disability or impairment. Qualifications are established locally by the board of assessors. More
detailed information may be obtained from your assessors.
WHO MAY FILE AN APPLICATION. You may file an application if you owned and occupied the property
and meet all qualifications for a financial hardship exemption as of July 1.
WHEN AND WHERE APPLICATION MUST BE FILED. Your application must be filed with the board of
assessors by December 15 or 3 months after the actual bills were mailed for the fiscal year, whichever is later.
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. AN APPLICATION IS FILED WHEN RECEIVED BY
THE ASSESSORS.
PAYMENT OF TAX. Filing an application does not stay the collection of your taxes. Failure to pay the tax
when due may also subject you to interest charges and collection action. To avoid any additional charges, you
should pay the tax as assessed if possible. 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. If you are unable to make your
payments, inform the assessors when you file your application.
ASSESSORS DISPOSITION. Upon applying for a financial hardship 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. In order to obtain a review of the assessors’ decision on your application for a financial hardship
exemption, you must bring a civil action in the Superior Court or Supreme Judicial Court. This action must be
brought within 60 days of the decision.
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Completed 12 July 2020

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