Name
Age
Relationship
Name
Age
Relationship
Do you own any other Real Estate?
[ ]YES
[ ] NO
If yes, please list location:
Do you own any other assets including; savings account, certificate of deposits, etc.? [ ] YES [ ] NO
If yes, please list type of assets, current balances, and institute where asset is held.
VETERAN WITH DISABILITES EXEMPTION – Must be a service connected disability
A form from the VA or military branch showing % of disability or unemployable rating must be filed with our office.
I am a veteran, disabled as a result of military service.
I am an unmarried spouse or minor orphan of a deceased veteran with disabilities who served in the military forces of the United States or of this State (must provide a death certificate).
Enter your service related/unemployable disability rating.
%
| Parcel/Account Number |
Real/Personal Property |
Taxable Value |
Exempt Taxable Value |
Taxable Value Balance |
Exempt Tax Dollars |
|---|---|---|---|---|---|
ACTIVE or RESERVE MILITARY SERVICE EXEMPTION
Applicant must have served on active duty outside of the State Of Utah for 200 days in a calendar year or 200 consecutive days outside of the State Of Utah beginning in the prior year.
You must file on or before Sept 1 of the year after the year of qualifying service. Qualifying service begins on Jan. 1, 2013.
Verifying military documentation including orders for qualifying active duty service must accompany this application.
| Real/Personal Property |
Parcel/Account Number |
Taxable Value |
Exempt Taxable Value |
Taxable Value Balance |
Exempt Tax Dollars |
|---|---|---|---|---|---|
BLIND EXEMPTION
A signed statement by a licensed ophthalmologist for verification must be on file in our office.
I am legally blind in both eyes.
I am an unmarried spouse or minor orphan of a deceased blind person (must provide a death certificate).
| Real/Personal Property |
Parcel/Account Number |
Taxable Value |
Exempt Taxable Value |
Taxable Value Balance |
Exempt Tax Dollars |
|---|---|---|---|---|---|
FILING DEADLINE IS SEPTEMBER 1ST EVERY YEAR
Check one (providing false information subjects the signer to penalties for perjury):
1.
I am a U.S. citizen and have provided my Social Security Number on the front of this form.
2.
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.
I-94 Number*:
Under penalties of perjury, I declare that I am a U.S. citizen OR that I qualify under 8 U.S.C 1641 and am present in the United States lawfully. I also declare under penalties of perjury, to the best of my knowledge and understanding, this information is true, correct and complete.
Applicant/ Preparer’s Information
| Signature of Applicant | Date |
| Preparer’s Name & Address (If not applicant) | Telephone Number |