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CONFIDENTIAL Elbert County Assessor 221 Comanche St, PO Box 26 Kiowa, CO 80117 [PHONE REDACTED] [EMAIL REDACTED] 15-DPT-AR SE-003-01/20 1. Identification of Applicant and Property Applicant's First Name, Middle Initial, and Last Name Social Security Number Date of Birth Property Address (number & street name) Schedule or Parcel Number City or Town State Zip Code Telephone Number CO Mailing Address (if different from property address) Check box if ownership is held in a life estate. 2. Age, Occupancy, and Ownership Requirements Each question must be answered "True" to qualify using this form. As of January 1 of this year, I am at least 65 years old. True False The owner of record for the property described above is either a) me, b) my spouse, or c) both of us. The property has been owned by one or both of us for at least 10 consecutive years prior to January 1 of this year. During periods when the property was owned by my spouse and not by me, my spouse and I were married, and my spouse occupied the property as his or her primary residence. True False I occupy the property described above as my primary residence, and I have done so for at least 10 consecutive years prior to January 1 of this year. True False 3. Each additional person who occupies the property as his or her primary residence must be listed here. (Attach an additional sheet if necessary.) Person who also occupies property as primary residence Spouse Social Security Number Yes No Person who also occupies property as primary residence Social Security Number Person who also occupies property as primary residence Social Security Number 4. Affidavit and Signature I declare, under penalty of perjury in the second degree 18-8-503, that the information I provided on this form and on any attachments is correct. Signer is: Applicant Spouse Guardian* Conservator* Attorney-in-fact* * Authorization in the form of a court order or power of attorney is required. Other (relative, personal representative, etc.) The assessor must be informed of any change in ownership or occupancy of the property within 60 days of when the change occurs. Mail or deliver this form to your county assessor by July 15. We recommend you obtain a receipt when delivering the form in person, or mail the form by certified mail. You may also call the assessor prior to July 15 to ensure that it was received. SHORT FORM: PROPERTY TAX EXEMPTION FOR SENIORS