Application for Real Estate Tax Exemption for Elderly and Handicapped Homeowners

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Back to The Commissioner of the Revenue

COUNTY OF CAROLINE

COMMISSIONER OF THE REVENUE

P.O. BOX 531      BOWLING GREEN, VIRGINIA 22427       PHONE: 633-9834
Application for Real Estate Tax Exemption
for Elderly and Handicapped Homeowners

The information required on this application must be filled out entirely and returned to the Commissioner of the Revenue. Applications must be filed by March 1st of the taxable year for whch the exemption is applied. Complete all spaces on the application that are applicable. Questions that cannot be answered within the spaces may be answered by attaching additional sheets to this application. This exemption is granted on an annual basis and a new application must be filed each year. All information on the application is confidential and not open to public inspection.
APPLICANT:
Last NameFirstMiddle
BIRTHDATE:          SOCIAL SECURITY NO.
Mo.DayYearAge

SPOUSE:
Last NameFirstMiddle
BIRTHDATE:          SOCIAL SECURITY NO.
Mo.DayYearAge
ADDRESS: PHONE NO.

FOR OFFICE USE ONLY
INCOME


TAXABLE YEAR

PARCEL NUMBER

DATE RECEIVED		 Percentage of Relief Granted______________________%

Current Value $_______________________

Amount of Relief Granted $_______________________

Taxable Value $____________________________

  1. Is this dwelling occupied by the applicant as the sole dwelling? Yes No

  2. Is the applicant? Elderly      Handicapped

  3. Is the applicant? Sole Owner      Partial Owner

    If partial ownership, explain how the ownership is legally held and the proportion owned by applicant.


  4. List the names, relation, ages and social security numbers of all persons who occupy the dwelling other than the owners. Do not list occupants with no income.

    NAME
    RELATION
    		AGE SOCIAL SECURITY NO.
    1.
    2.
    3.
    4.
    5.

    GROSS INCOME SCHEDULE
    Please complete the Gross Income schedule for the prior calendar year. Included in this statement should be the total gross income from all sources of the applicant and spouse. Also income of each person living in the dwelling.

    GROSS INCOMEAPPLICANTSPOUSEOCCUPANT-1OCCUPANT-2OCCUPANT-3
    Salaries, Wages, Etc.
    Pensions or Retirement
    Social Security
    Interest
    Dividends
    Rent(s)
    Public Assistance
    Capital Gains
    Trust Fund Income
    All other Sources
    Less Occupants
    Income Exemption
    Total For Each Column


    Total Gross Income of Applicant, Spouse and Occupants $

    If gross combined income is over $35,000.00, no exemptiom is allowed.

    NET VALUE OF ASSETS

    Please complete this Scheule of net financial worth as of prior year December 31st. Net financial worth is computed by subtracting liabilities from assets and shall include all assets, including equitable interest, of the owner of the dwelling and the spouse, for which exemption is claimed, and shall exclude the fair market value of the dwelling and the land, not exceeding ten acres upon which the dwelling is situated.
    NET VALUE OF ASSETSAPPLICANTSPOUSE
    Real Estate (other than residence)
    Automobiles (Fair Market Value)
    Savings Account(s)
    Checking Account(s)
    Cash On Hand
    Stocks & Bonds
    Life Insurance and Annuity (Cash Value)
    Property In Trust
    Other Assets
    TOTAL - ASSETS (LINE A)
    Less-LIABILITIES
    Notes Payable
    Accounts Payable
    Mortgages Payable (Other than Residence)
    Taxes Due - Federal, Local & State
    All Other Debts
    NET WORTH (SUBTRACT LINE B FROM LINE A) (LINE C)


    COMBINED NET WORTH (APPLICANT & SPOUSE - LINE C)

    If combined net worth is over $85,000.00, no exemption is allowed.

    EXEMPTION PERCENTAGE SCHEDULE
    Annual Household Income (after exclusions)Maximum Assets (Excluding Value of
    Residence And 10 Acres Of Land)
    $0 - $45,000 $45,001 - $85,000
    $0 - $12,00095% 80%
    $12,001 - $22,00075% 60%
    $22,001 - $30,00055% 40%
    $30,001 - $35,00035% 20%


    "Any change in respect to total combined income, net combined financial worth, ownership of the dwelling exempted, or other factors, which occur during the taxable year for which the affidavit is filed, and which has the effect of exceeding or violating the limitations and conditions of this article, shall nullify any exemption for the then current taxable year, and the taxable year immediately following."


    AFFIDAVIT
    By clicking on the submit button you are certifying that under penalties provided by law, that this application for Real Estate Tax Relief for the Elderly or Handicapped including accompanying achedules or statements, to the best of your knowledge and belief are true, correct and complete.

    Date
    Signature of Applicant

    Date
    Signature of Spouse


    If unable to contact applicant, name and phone number of nearest relative:

    Name:
    Phone #: