The URL can be used to link to this page

Home My Public Portal AboutApplication for Statutory Exemption -- Surviving Spouse or Minor17 41 42&43 State Tax Form 96-6 The Commonwealth of Massachusetts Assessors’ Use only Revised 7/2017 Date Received Application No. Name of City or Town Parcel No. SENIOR -- SURVIVING SPOUSE OR MINOR FISCAL YEAR _______ APPLICATION FOR STATUTORY EXEMPTION General Laws Chapter 59, § 5 THIS APPLICATION IS NOT OPEN TO PUBLIC INSPECTION (See General Laws Chapter 59, § 60) Return to: Board of Assessors Must be filed with assessors on or before April 1, or 3 months after actual (not preliminary) tax bills are mailed for fiscal year if later. INSTRUCTIONS: Complete all sections that apply. If you qualify under more than one category, you will receive the exemption that provides the greatest amount of assistance. Please print or type. A. IDENTIFICATION. Complete this section fully. Name of Applicant ________________________________________________________________________________________ Telephone Number _________________________ Marital Status ________________________________ Legal Residence (Domicile) on July 1, _______ No. Street City/Town Zip Code Location of Property: Mailing Address (If different) No. of Dwelling Units: 1 2 3 4 Other Did you own the property on July 1, ________? Yes No If yes, were you: Sole Owner Co-owner with Spouse Only Co-owner with Others Was the property subject to a trust as of July 1, ? Yes No If yes, please attach trust instrument including all schedules. Have you been granted any exemption in any other city or town (MA or other) for this year? Yes No If yes, name of city or town Amount exempted $ DISPOSITION OF APPLICATION (ASSESSORS’ USE ONLY) Ownership GRANTED Assessed Tax $ Occupancy DENIED Exempted Tax $ Status DEEMED DENIED Adjusted Tax $ Income Assets Board of Assessors Date Voted/Deemed Denied Certificate No. Date Cert./Notice Sent Exemption: Clause Date: FILING THIS FORM DOES NOT STAY THE COLLECTION OF YOUR TAXES THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE B. EXEMPTION STATUS. Check each status that applies to you and complete the questions that follow. SURVIVING SPOUSE Deceased Spouse’s Name Date of Death Have you remarried? Yes No If yes, date of remarriage ____________ MINOR WITH PARENT DECEASED Deceased Parent’s Name Date of Death If first year of application, attach a copy of death certificate. Are you a surviving spouse or a minor child of a firefighter or a police officer killed in the line of duty? Yes No IF NO, AND NO OTHER STATUS APPLIES TO YOU, GO ON TO SECTION D If yes, and this is the first year of application, provide circumstances of death. GO ON TO SECTION E SENIOR 70 OR OLDER (65 or older by local option- See Assessors) Date of Birth If first year of application, attach copy of birth certificate. Have you owned and occupied the property as your domicile for at least 11 years? (6 years if local option under Clause 41C½ adopted - See Assessors) Yes No If no, list the other properties you owned and/or occupied during the past 11 years (6 years if local option under Clause 41C½ adopted - See Assessors.) Address Dates Owned Occupied Continue list on attachment in same format as necessary. GO ON TO SECTION C C. GROSS RECEIPTS FROM ALL SOURCES IN PRECEDING CALENDAR YEAR . Complete this section if you are a senior. Copies of your federal and state income tax returns, and other documentation, may be requested to verify your income. Applicant & Spouse Co-owner(s) & Spouse(s) Retirement Benefits (Social Security, Railroad, Federal, MA & Political Subdivisions).….. Other Pensions and Retirement Allowances ....................................................................... .….. Wages, Salaries and other Compensation ........................................................................... .….. Net Profits from Business, Profession or Property Rental ................................................. .….. Interest and Dividends ........................................................................................................... …... Other Receipts (Capital Gains, Public Assistance, etc.) ..................................................... …... TOTALS GO ON TO SECTION D D. VALUE OF ALL PROPERTY OWNED ON JULY 1 THIS YEAR. Documentation may be requested to verify your assets. Real Estate Assessed Valuation Amount Due on Mortgage Value Domicile Other Personal Estate Bank Accounts: Name & Address of Bank Stocks, Bonds, Securities, etc.: Description & Amount Motor Vehicles & Trailers: Year, Make & Model Other Non-exempt Personal Property: Kind & Description TOTAL GO ON TO SECTION E E. SIGNATURE. Sign here to complete the application. This application has been prepared or examined by me. Under the pains and penalties of perjury, I declare that to the best of my knowledge and belief, this return and all accompanying documents and statements are true, correct and complete. Signature Date If signed by agent, attach copy of written authorization to sign on behalf of taxpayer. TAXPAYER INFORMATION ABOUT PERSONAL EXEMPTIONS PERSONAL EXEMPTIONS. You may be eligible to reduce all or a portion of the taxes assessed on your domicile if you meet the qualifications for one of the personal exemptions allowed under Massachusetts law. Qualifications vary, but generally relate to age, ownership, residency, disability, income or assets. You may be eligible for an exemption if you fall into any of these categories:  Legally blind person  Veteran with a service-connected disability  Surviving spouse of a servicemember, national guard member or veteran who died from combat active duty injury or illness  Surviving spouse  Minor child of a deceased parent  Senior citizen age 70 and older (65 and older by local option) More detailed information about the qualifications for each exemption may be obtained from your board of assessors. WHO MAY FILE AN APPLICATION. You may file an application if you meet all qualifications for a personal exemption as of July 1. You may also apply if you are the personal representative of the estate, or trustee under the will, of a person who qualified for a personal exemption on July 1. WHEN AND WHERE APPLICATION MUST BE FILED. Your application must be filed with the assessors on or before April 1, or 3 months after the actual bills were mailed for the fiscal year, whichever is later. An application is filed when (1) received by the assessors on or before the filing deadline, or (2) mailed by United States mail, first class postage prepaid, to the proper address of the assessors, on or before the filing deadline, as shown by a postmark made by the United States Postal Service. THIS DEADLINE CANNOT BE EXTENDED OR WAIVED BY THE ASSESSORS FOR ANY REASON. IF YOUR APPLICATION IS NOT TIMELY FILED, YOU LOSE ALL RIGHTS TO AN EXEMPTION AND THE ASSESSORS CANNOT BY LAW GRANT YOU ONE. PAYMENT OF TAX. Filing an application does not stay the collection of your taxes. In some cases, you must pay all preliminary and actual installments of the tax when due to appeal the assessors’ disposition of your application. Failure to pay the tax when due may also subject you to interest charges and collection action. To avoid any loss of rights or additional charges, you should pay the tax as assessed. If an exemption is granted and you have already paid the entire year’s tax as exempted, you will receive a refund of any overpayment. ASSESSORS DISPOSITION. Upon applying for an exemption, you may be required to provide the assessors with further information and supporting documentation to establish your eligibility. The assessors have 3 months from the date your application is filed to act on it unless you agree in writing before that period expires to extend it for a specific time. If the assessors do not act on your application within the original or extended period, it is deemed denied. You will be notified in writing whether an exemption has been granted or denied. APPEAL. You may appeal the disposition of your application to the Appellate Tax Board, or if applicable, the County Commissioners. The appeal must be filed within 3 months of the date the assessors acted on your application, or the date your application was deemed denied, whichever is applicable. The disposition notice will provide you with further information about the appeal procedure and deadline.