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Corrie Forsling Summit County Treasurer 60 N. Main St., PO Box 128 Coalville, UT 84017 (435) 336-3267 Fax: (435) 608-4378 [EMAIL REDACTED] www.summitcounty.org/treasurer Tax Relief Program: You Must Complete: Beneficiary: ☐Circuit Breaker Sections 1, 2, 4, 9 Low-income age 66 & older, or surviving spouses ☐County Hardship Sections 1, 3, 4, 9 Low-income, in extreme hardship, or disabled ☐Disabled Veteran Sections 1, 5, 6, 9 Veterans with 10% or greater disability ☐Active Duty Military Sections 1, 7, 9 Military with 200+ days active duty service ☐Blind Exemption Sections 1, 5, 8, 9 Legally blind with vision no more than 20/200 ☐I am a homeowner age 66 or older by December 31, 2019, OR ☐ I am an unmarried surviving spouse (widow/widower). (New applicants must provide a copy of spouse’s death certificate.) ☐I OWNED and OCCUPIED my residence on January 1, 2019 ☐I will be a resident of Utah for all of 2019. ☐My household income in 2018 was less than $33,530. ☐I supplied at least 50% of my own financial support in 2018 and no one may claim me as a dependent in 2018. Provide documentation of disability or hardship. First-time applicants living with a disability must provide a physician’s medical statement verifying the disability. Those applying for a hardship abatement must provide a letter explaining the situation, as well as any bank/investment/asset statements as of December 31, 2018. ☐I am age 65 or older by December 31, 2019, OR ☐ I am under age 65 and disabled. OR ☐ I am under age 65 and not disabled, but I am experiencing extreme hardship and will be unable to pay the property taxes when they’re due without tax relief. ☐I will be living in the residence for at least ten (10) months in 2019. ☐My household income in 2018 was less than $33,530. If applying for hardship abatement: ☐I do not own income-producing assets that could be sold to pay the tax when due. ☐I have not transferred assets or made gifts of property to any relative or trust fund within the past 3 years. Continue on reverse side. 2019 Property Tax Relief Application (Office Use Only) APPLICATION ID: Date Received: Entered: Audited: Instructions Application Deadline: The early deadline for this application is September 1, 2019. (ALL supporting documentation must be received by December 31, 2019.) A new application must be filed each year. Where to Submit: Submit this application to the Summit County Treasurer. You may submit by mail, email, fax, or in person to the address listed above. SECTION 1: APPLICANT INFORMATION (All applicants must complete.) Property Parcel ID: Account Number: If the property is held in a trust and the current trust agreement is not on file with the Treasurer’s Office, you must provide a copy of the trust agreement before relief may be granted. SECTION 2: CIRCUIT BREAKER REQUIREMENTS (Also complete sections 4 and SECTION 3: COUNTY HARDSHIP REQUIREMENTS (Also complete sections 4 and Last Name First Name Initial Birth Date Social Security Number Spouse Last Name First Name Initial Birth Date Death Date Social Security Number Property Address City, State, Zip Mailing Address, if different Phone Number Email Address Please choose the tax relief program(s) for which you are applying, and complete the appropriate sections: Print Form Save Form ---PAGE BREAK--- Include ALL 2018 income of ALL persons living in the home. Attach copies of all 2018 year-end income statements. Attach copies of federal tax returns including all schedules and attachments. ☐CHECK HERE if you did not file a 2018 Federal Tax Return. (If non-filer, please supply copies of all 1099’s: social security, pensions, interest, dividends, IRA, 401(k) withdrawals for EACH household member. OR submit an IRS wage and income transcript AND a verification of non-filing letter.) 1. Wages, Salaries, other Employee Compensation 2. Business, Farm, Rent, Partnership, Sale of Property or Miscellaneous Income 3. Social Security, Railroad Retirement, or Military Retirement: 4. Pensions, Annuities, IRA, 401(k), other Retirement 5. Dividends, Interest, or Trust Income Received 6. Capital Gains not listed above 7. TANF, Worker’s Compensation, Alimony, Child Support, and Strike Benefits 8. Other Income not listed above from all household members TOTAL 2018 HOUSEHOLD INCOME (Add lines 1 through Provide vehicle information ONLY if you are applying for disabled veteran tax relief or a blind exemption. Year Make/Model License Plate # Year Make/Model License Plate # Note: New applicants and those with a percentage change of disability must provide a letter dated within the last 8 months showing the % of disability and an effective date of January 1, 2019 or earlier. ☐I have a combined percentage of disability certified by the Veterans Administration as OR ☐ I am the unmarried surviving spouse of a qualifying veteran and will provide a surviving spouse letter from the VA that shows the veteran’s disability rating. OR ☐ I am the unmarried surviving spouse of a veteran who was killed in action or died in the line of duty. (New applicants please submit a copy of DD Form 1300, Report of Casualty, or other evidence of service-connected death.) ☐I OWNED and OCCUPIED my residence on January 1, 2019 and this property is my primary residence. Note: Must provide military orders, DD214, or letter from commanding officer confirming dates of service. ☐I completed at least 200 days of active duty service outside the state of Utah in 2018. OR ☐I completed at least 200 consecutive days of active duty service outside the state of Utah across 2017-2018, provided those days were not counted as qualifying days for tax relief in a prior year. Note: New applicants must provide a letter from a licensed ophthalmologist verifying visual acuity as listed below. Letter must be updated every ten years. ☐I am visually impaired with no more than 20/200 visual acuity in my better eye when corrected; or in the case of better than 20/200 central vision, have a restriction of the field of vision in the better eye which subtends an angle of vision no greater than 20 degrees. OR ☐ I am the unmarried surviving spouse or minor orphan of a deceased blind person. ☐I OWNED and OCCUPIED my residence on January 1, 2019 and this property is my primary residence. ☐I hereby certify that I have not applied for property tax relief in any other county in Utah. I/we declare that the information provided herein is complete, true, and correct. I/we understand that the information provided is subject to verification by Summit County, and I/we authorize Summit County to receive and/or inspect confidential tax, banking, and investment information from any government office or financial institution. Applicant Date Spouse (if home is owned in joint tenancy) Date SECTION 4: HOUSEHOLD INCOME SECTION 5: MOTOR VEHICLE INFORMATION (For disabled veteran and blind applicants only.) SECTION 6: DISABLED VETERAN EXEMPTION REQUIREMENTS SECTION 8: BLIND EXEMPTION REQUIREMENTS SECTION 9: CERTIFICATION & SIGNATURE SECTION 7: ACTIVE DUTY MILITARY EXEMPTION REQUIREMENTS Save Form Print Form