Form 150-490-014 "Property for Ors Tax Deferral Application" - Oregon

What Is Form 150-490-014?

This is a legal form that was released by the Oregon Department of Revenue - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2018;
  • The latest edition provided by the Oregon Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 150-490-014 by clicking the link below or browse more documents and templates provided by the Oregon Department of Revenue.

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Download Form 150-490-014 "Property for Ors Tax Deferral Application" - Oregon

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For official use only
Date received at county Date received at Revenue
Property Tax Deferral Application
2019
(ORS 311.666-701)
• You must attach a copy of your 2018–19 property tax statement.
• You must complete the household income and asset worksheets on the back of this application.
• Individuals with disabilities: Attach proof of eligibility of federal Social Security Disability benefits received before April 15
(we won’t accept your 1099 SSA statement or new benefit statement).
• Remember to sign and date your application.
• File your completed application with the county assessor’s office after January 1 and by April 15.
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: ____________________________________________
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)
Joint applicant’s SSN
Date of birth
Age on April 15 Are you disabled?
Spouse
Other
Yes
No
Mailing address
City
State
ZIP code
OR
Property address of home
City
State
ZIP code
OR
If property address is different than current residence address, explain why:
Phone
Email
Additional contact phone: (optional)
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, 2019, how many years have you owned the home? _______________ years
As of April 15, 2019, how many years have you lived in the home? _______________ years
If your answer to either of the above questions is less than five years, please see instructions on page 3. 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 your answer to the above question is yes and the property wasn’t in the Property Tax Deferral program prior to 2011,
Stop here.
You don’t qualify for the Property Tax Deferral program.
5.
Is the home insured for fire and other casualty? ...............................................................
Yes
No
Stop here.
If your answer to the above question is no,
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
No
(See Delay of Foreclosure application)
Go to the next page
150-490-014 (Rev. 08-18)
Clear All Pages
For official use only
Date received at county Date received at Revenue
Property Tax Deferral Application
2019
(ORS 311.666-701)
• You must attach a copy of your 2018–19 property tax statement.
• You must complete the household income and asset worksheets on the back of this application.
• Individuals with disabilities: Attach proof of eligibility of federal Social Security Disability benefits received before April 15
(we won’t accept your 1099 SSA statement or new benefit statement).
• Remember to sign and date your application.
• File your completed application with the county assessor’s office after January 1 and by April 15.
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: ____________________________________________
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)
Joint applicant’s SSN
Date of birth
Age on April 15 Are you disabled?
Spouse
Other
Yes
No
Mailing address
City
State
ZIP code
OR
Property address of home
City
State
ZIP code
OR
If property address is different than current residence address, explain why:
Phone
Email
Additional contact phone: (optional)
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, 2019, how many years have you owned the home? _______________ years
As of April 15, 2019, how many years have you lived in the home? _______________ years
If your answer to either of the above questions is less than five years, please see instructions on page 3. 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 your answer to the above question is yes and the property wasn’t in the Property Tax Deferral program prior to 2011,
Stop here.
You don’t qualify for the Property Tax Deferral program.
5.
Is the home insured for fire and other casualty? ...............................................................
Yes
No
Stop here.
If your answer to the above question is no,
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
No
(See Delay of Foreclosure application)
Go to the next page
150-490-014 (Rev. 08-18)
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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
This section must be completed. List your yearly household income for 2018. Household income consists of
all income of the applicant(s) and their spouse(s) that reside in the home. Include income earned in other states
or countries. Your household income must be less than $45,500 (taxable and nontaxable income) to qualify for
the 2019–2020 property tax year. We may require verification of the information you provide in this section.
Annual combined household income worksheet (Required)
00
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
8. Total Social Security, Supplemental Security Income (SSI), and railroad
00
retirement before Medicare premium deductions ......................................... 8
9. Pensions and annuities before health insurance premium
00
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
Stop here.
If your total household income (line 15) is more than $45,500,
You don’t qualify for the Property Tax Deferral program.
List the total net worth of all applicants. Net worth means the sum of the current market value of all assets, including
real property, cash, savings accounts, bonds, and other investments after deducting outstanding liabilities. We may
require verification of the information you provide in this section.
Net worth doesn’t include the value of the property for which deferral is claimed, the cash value of life insurance
policies on the life of an applicant, or tangible personal property owned by an applicant (such as, furniture, vehicles).
Net worth asset worksheet ($500,000 limit, not including your home)
00
1. Cash, savings, and checking account balances as of Dec. 31, 2018 .......... 1
2. Amount of investments in qualified retirement plans and
00
individual retirement accounts as of Dec. 31, 2018. ..................................... 2
00
3. Net worth of other investments as of Dec. 31, 2018 .................................... 3
(Net worth means current value minus debt. Investments include real estate,
trust funds, stocks, stock options, bonds, other securities, commodities, etc.)
00
4. Your total assets. Add lines 1–3 .............................................................................................
4
Stop here.
If your total assets on line 4 exceed $500,000,
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).
Applicant’s signature
Date
Joint applicant’s signature
Date
X
X
150-490-014 (Rev. 08-18)
County section
(Don’t complete. This section will be completed by the county assessor’s office.)
Platted
LOT ________________
BLK ________________
________________________________________________ Legal description
Unplatted
For all unplatted properties attach a copy of the recorded deed or contract.
Property
description
T ______________________
R ___________________________
SEC_____________________________
Parcel in:
As described in _____________________________________________ County
Containing ________________________ acres
Current deed
Deed recorded (date)
__________________________
Contract recorded (date) ____________________________
information
Deed
Document/instrument number
Microfilm number
Reel
Book/volume
Page
information
Recorded (date)
Document/instrument number
Earliest deed showing
ownership by the taxpayer(s)
Levy code
Assessor’s account number
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
of value allocated to the taxpayer’s unit (percent to be deferred)?
___________ %
A
single unit
Multi-units
County number
Assessor’s (or Assessor’s designee’s) signature verifying applicant is the owner of record
Date
X
150-490-014 (Rev. 08-18)
Tax Information Authorization
and
For office use only
Power of Attorney for Representation
Date received
• Please print. • Use only blue or black ink. • See additional information on the back.
Taxpayer name
Identifying number (SSN, BIN, FEIN, etc.)
Spouse’s identifying number (SSN, etc.)
Spouse’s name, if joint return
Address
City
State
ZIP code
Check only one:
Tax Information Authorization: Checking this box allows the department to disclose your confidential tax information to your
des ig nee. You may designate a person, agency, firm, or or ga ni za tion.
Power of Attorney for Representation: Check this box if you want a person to “rep re sent” you. This means the person may
receive confidential information and may make decisions on your behalf. The per son you des ig nate must meet the qual i fi ca tions
listed on the back of this form.
For
All tax years, or
Specific tax years: __________________________________________________________________ ,
I hereby appoint the following person as designee or authorized representative:
Name
Phone
Fax
(
)
(
)
Mailing address
City
State
ZIP code
Representative’s title and Oregon license number or relationship to taxpayer
If out-of-state CPA, sign here attesting you meet the requirements to practice in Oregon (see instructions)
The above named is authorized to receive my confidential tax information and/or represent me before the Oregon Department of Rev e nue for:
All tax matters, or
Specific tax matters.
Enter tax program name(s): ________________________________________________________________________
Signature of taxpayer(s)
• I acknowledge the following provision: Actions taken by an authorized representative are binding, even if the representative is
not an attorney. Proceedings cannot later be declared legally defective because the representative was not an attorney.
• Corporate officers, partners, fiduciaries, or other qualified persons signing on behalf of the taxpayer(s): By signing, I also certify
that I have the authority to execute this form.
• If a tax matter concerns a joint return, both spouses must sign if joint representation is requested. Taxpayers filing jointly may
authorize separate representatives.
Signature
Print name
Date
X
Title (if applicable)
Daytime phone
(
)
Spouse (if joint rep re sen ta tion)
Print name
Date
X
Note: This authorization form automatically revokes and replaces all earlier tax authorizations and/or all earlier powers of attorney
on file with the Oregon De part ment of Rev e nue for the same tax mat ters and years or periods covered by this form. If you do not
want to revoke a prior authorization, initial here ______.
Attach a copy of any other tax information authorization or power of attorney you want to remain in effect.
Complete the following, if known (for routing purposes only):
Send to: Oregon Department of Rev e nue
Revenue employee: __________________________________________________
955 Center St NE
Division/Section: ____________________________________________________
Salem OR 97301-2555
Phone/Fax: _________________________________________________________
Visit www.oregon.gov/dor to complete this form using Revenue Online.
If this tax in for ma tion au tho ri za tion or pow er of at tor ney form is not signed, it will be returned.
Power of attorney forms submitted with Revenue Online will be signed electronically.
150-800-005 (Rev. 12-15)
Additional information
3. For ad valorem property tax issues:
a. All those listed in (1); plus
This form is used for two purposes:
b. An Oregon licensed real estate broker or a principal real
• Tax information disclosure authorization. You authorize
estate broker; or
the department to disclose your confidential tax infor-
c. An Oregon certified, licensed, or registered appraiser; or
mation to another person. This person will not receive
d. An authorized agent for designated utilities and com-
original notices we send to you.
• Power of attorney for representation. You authorize
panies assessed by the department under ORS 308.505
another person to represent you and act on your behalf.
through 308.665 and ORS 308.805 through 308.820.
The person must meet the qualifications below. Unless
4. For forestland and timber tax issues:
you specify differently, this person will have full power to
a. All those listed in (1), (2), and (3)(b) and (c); plus
do all things you might do, with as much binding effect,
including, but not limited to: providing information; pre-
b. A consulting forester.
paring, signing, executing, filing, and inspecting returns
An individual who prepares and either signs your tax return
and reports; and executing statute of limitation extensions
or who is not required to sign your tax return (by the instruc-
and closing agreements.
tions or by rule), may represent you during an audit of that
This form is effective on the date signed. Authorization termi-
return. That individual may not represent you for any
nates when the department receives written revocation notice
other purpose unless they meet one of the qualifications
or a new form is executed (unless the space provided on the
listed above.
front is initialed indicating that prior forms are still valid).
Generally, declarations for representation in cases appealed
Unless the appointed representative has a fiduciary relation-
beyond the Department of Revenue must be in writing to the
ship to the taxpayer (such as personal representative, trustee,
Tax Court Magistrate. A person recognized by a Tax Court
guardian, conservator), original Notices of Deficiency or
Magistrate will be recognized as your representative by the
Assessment will be mailed to the taxpayer as required by
department.
law. A copy will be provided to the appointed representative
when requested.
Tax matters partners and S corporation shareholders. See
For corporations, “taxpayer” as used on this form, must be
OARs 150-305.242(2) and (5) and 150-305.230 for additional
the corporation that is subject to Oregon tax. List fiscal years
information. Include the partnership or S corporation name
by year end date.
in the taxpayer name area.
Qualifications to represent taxpayer(s) before
Out-of-state attorneys and CPAs
Department of Revenue
Attorneys may contact the Oregon State Bar for information
Under Oregon Revised Statute (ORS) 305.230 and Oregon
on practicing in Oregon. If your out-of-state representative
Administrative Rule (OAR) 150-305.230, a person must meet
receives authorization to practice in Oregon, attach proof to
one of the following qualifications in order to represent you
this form.
before the Department of Revenue.
CPAs may practice in Oregon if they meet the following
1. For all tax programs:
substantial equivalency requirements of ORS 673.010:
a. An adult immediate family member (spouse, parent,
1. Licensed in another state;
child, or sibling).
b. An attorney qualified to practice law in Oregon.
2. Have an accredited baccalaureate degree with at least 150
c. A certified public accountant (CPA) or public accoun-
semester hours of college education;
tant (PA) qualified to practice public accountancy in
3. Passed the Uniform CPA exam; and
Oregon, and their employees.
4. Have a minimum of one year experience.
d. An IRS enrolled agent (EA) qualified to prepare tax
Have questions? Need help?
returns in Oregon.
e. A designated employee of the taxpayer.
General tax information ...................... www.oregon.gov/dor
f. An officer or full-time employee of a corporation (includ-
Salem ............................................................... (503) 378-4988
ing a parent, subsidiary, or other affiliated corporation),
Toll-free from an Oregon prefix ................ 1 (800) 356-4222
association, or organized group for that entity.
g. A full-time employee of a trust, receivership, guardian-
Asistencia en español:
ship, or estate for that entity.
En Salem o fuera de Oregon ........................ (503) 378-4988
h. An individual outside the United States if representa-
Gratis de prefijo de Oregon ...................... 1 (800) 356-4222
tion takes place outside the United States.
TTY (hearing or speech impaired; machine only):
2. For income tax issues:
Salem area or outside Oregon ..................... (503) 945-8617
a. All those listed in (1); plus
Toll-free from an Oregon prefix ................ 1 (800) 886-7204
b. A licensed tax consultant (LTC) or licensed tax pre-
Americans with Disabilities Act (ADA): Call one of the help
parer (LTP) licensed by the Oregon State Board of Tax
Practitioners.
numbers above for information in alternative formats.
150-800-005 (Rev. 12-15)