Application for Settlement or Deferral
of Delinquent Property Tax
UCA §59-2-1109 & 1347
Form PT-33
PT-033-1.ai Rev. 11/00
This form should be used in conjunction with Form PT-33A “Agreement of Lien Holder For Deferral or Settle-ment of Delinquent Taxes”. One Form PT-33A should be attached for each lien holder. A deferral may not be granted without the written consent of the holder of any mortgage or trust deed outstanding on the property.
Property Owner Information
| Property owner name | Home phone number | Work phone number |
| Property owner address | ||
| City | State | Zip |
Property Information
| Parcel, serial, or account number | Type of property (e.g., commercial, primary residential, etc.) |
| Location or address | |
| Legal description (including acreage) | |
Property Value and Tax Information
|
Year(s) of Delinquency
(May go back five years)
|
Taxes | Penalty | Interest | Total |
|---|---|---|---|---|
| Total |
|
Current year market value of property (Attach copy of most recent valuation/tax notice)
|
$ |
|
Amount received from home owner/mobile home owner (circuit breaker) tax credits
|
$ |
|
Amount owner offers in settlement (Attach proposed payment schedule)
|
$ |
|
Amount to be deferred
|
$ |
I/we have exhausted efforts to obtain funds to pay the delinquent taxes. I/we have contacted the lending institutions and other potential sources of funds, such as friends and relatives, identified below:
1.
2.
3.
Attach the following:
1.Owner’s statement of circumstances and request for relief.
2.Most recent valuation/tax notice.
3.Proposed payment schedule.
4.Financial Summary (back of this form)
5.Copies of last 5 years’ filings with I.R.S.
6.Form PT-33A, “Agreement of Lien Holder for Deferral or Settlement of Delinquent Taxes”.
7.Other documentation as required.
Signature
I certify to the best of my knowledge and understanding, that this information is true, correct, and complete.
X
Signature of property owner(s)
Date
X