Clear This Page Clear all pages 2024 Form OR-PTDA For official use only Date received at county Date received at Revenue Page 1 of 3, 150-490-014 17492401010000 (Rev. 09-13-23 ver. 01) Property Tax Deferral Application (ORS 311.666-701) Oregon Department of Revenue Complete this application in full and attach a copy of your 2023–24 property tax statement and, if applicable, your Social Security Disability award letter (see instructions). File your completed ap- plication with the county assessor’s office after January 1 and by April 15. See the instructions for more information. Applicant section Type of applicant Individual* *If individual applicant: Are you married? No Yes Spouse’s name/SSN: _____________________________________ Joint spouse Joint other Refiling as surviving spouse. Spouse’s SSN/Deferral account number: ___________________________________________ Downsizing Add a spouse Filing as a disabled heir Applicant’s name (last, first, MI) Social Security number (SSN) Date of birth Age on April 15 Are you disabled? – – Yes No Joint applicant’s name (last, first, MI) Spouse Other Joint applicant’s SSN Date of birth Age on April 15 Are you disabled? – – Yes No Current residence address (where you currently receive your mail) City State ZIP code OR Property’s physical address City State ZIP code OR If property’s physical address is different than your current residence, explain why: Phone Email Additional family or friend’s name Family or friend’s phone Family or friend’s email If you own a manufactured structure (mobile home), complete this section: Model year Make Home ID number Serial number 1. Have you previously been approved for Property Tax Deferral on this property? ............. Yes No If yes, was this property under the program prior to 2011? .............................................. Yes No 2. Does your property contain multiple units? Yes No If yes, how many units?_______________ What is the purpose of the other unit(s)? ________________________________________________________________________ Describe which homestead (unit) you live in _____________________________________________________________________ 3. As of April 15, 2024, how many years have you owned the home? _______________ years As of April 15, 2024, how many years have you lived in the home? _______________ years If your answer to either of the above questions is less than five years, see Form OR-PDTA Instructions. If you have been on deferral and feel you meet the criteria for the Downsizing Provision, contact us for the Downsizing Provision worksheet. 4. Do you have a reverse mortgage that is secured by this home? ...................................... Yes No If you answered “yes,” to the above question Stop here, and refer to Form OR-RMI for further instructions before you complete your application. 5. Is the home insured for fire and other casualty? ............................................................... Yes No If your answer to the above question is no, Stop here. You don’t qualify for the Property Tax Deferral program. Insurance carrier (Required) Policy number (Required) 6. Is the property owned in a trust? ....................................................................................... Yes No If yes, attach a copy of the trust documents. 7. Do you owe prior years’ property taxes? Yes (See Delay of Foreclosure application) No Go to the next page ➛ |
Clear This Page Clear all pages 17492401020000 2024 Form OR-PTDA Oregon Department of Revenue Page 2 of 3, 150-490-014 (Rev. 09-13-23 ver. 01) Applicant’s last name First name and MI SSN – – Joint applicant’s last name Joint applicant’s first name and MI Joint applicant’s SSN – – Annual 2023 combined household income worksheet (Required) 1. Wages, salaries, and other pay for work ............................................................ 1 00 2. Interest and dividends (total taxable and nontaxable)........................................ 2 00 3. Business net income (loss limited to $1,000) ..................................................... 3 00 4. Farm net income (loss limited to $1,000) ........................................................... 4 00 5. Total gain on property sales (loss limited to $1,000) .......................................... 5 00 6. Rental net income (loss limited to $1,000) ......................................................... 6 00 7. Other capital gains (such as, stocks and bonds) (loss limited to $1,000) .......... 7 00 8. Total Social Security, Supplemental Security Income (SSI), and railroad retirement before Medicare premium deductions ................................................ 8 00 9. Pensions and annuities before health insurance premium deductions (total taxable and nontaxable) ......................................................... 9 00 10. Unemployment benefits ..................................................................................... 10 00 11. Child support ...................................................................................................... 11 00 12. Veteran’s and military benefits ............................................................................ 12 00 13. Gambling winnings ............................................................................................. 13 00 14. All other sources. Identify: ______________________________________............. 14 00 15. Your total household income. Add lines 1–14 ................................................................................... • 15 00 If your 2023 total household income (line 15) is more than $58,000, Stop here. You don’t qualify for the Property Tax Deferral program. Net worth asset worksheet ($500,000 limit, not including your home) 1. Cash, savings, and checking account balances as of Dec. 31, 2023 ................. 1 00 2. Amount of investments in retirement plans and individual retirement accounts as of Dec. 31, 2023 ............................................ 2 00 3. Net worth of other investments as of Dec. 31, 2023 ........................................... 3 00 (Net worth means current value minus debt. Investments include real estate, trust funds, stocks, stock options, bonds, other securities, commodities, etc.) 4. Your total assets. Add lines 1–3 ...................................................................................................... • 4 00 If your 2023 total assets on line 4 exceed $500,000, Stop here. You don’t qualify for the Property Tax Deferral Program. Declaration I declare under penalties for false swearing that I have examined all documents and to the best of my knowledge, they are true, correct, and complete (ORS 305.990). I understand a lien will be placed on this property and I will be charged lien recording and/or security interest fees. I understand that 6 percent interest accrues on each years’ deferred tax amount (ORS 311.666-701). I understand that heirs or other transferees receiving the homestead following my death may be found liable for any unpaid debt accrued under the deferral program. Applicant’s signature Date Joint applicant’s signature Date X X |
17492401030000 2024 Form OR-PTDA Oregon Department of Revenue Page 3 of 3, 150-490-014 (Rev. 09-13-23 ver. 01) County section (Don’t complete. This section will be completed by the county assessor’s office.) Property Platted description • LOT ________________ BLK ________________ ________________________________________________ Legal description (Please Unplatted For all unplatted properties attach a copy of the recorded deed or contract. choose only one selection • Parcel in: T ______________________ R ___________________________ SEC_____________________________ as platted or unplatted.) As described in _____________________________________________ County Containing ________________________ acres Current deed Deed recorded (date) ________________________________________ Deed information • Document/instrument number Microfilm number Reel Book/volume Page information Earliest deed showing Recorded (date) Document/instrument number ownership by the taxpayer(s) • Assessor’s account number Levy code Check here for • • split levy Assessor’s account number Levy code code Assessor’s • • certification Property described above contains If the property contains multiple units, what is the percentage Asingle unit Multi-units of value allocated to the taxpayer’s unit (percent to be deferred)? •___________ % Late filing Fee paid Assessor’s (or Assessor’s designee’s) signature verifying applicant is the owner of record Date County number X |