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Rev 1/01/2010 COUNTY OF FRANKLIN STATE OF NORTH CAROLINA Tax Year 2010 APPLICATION FOR PROPERTY TAX RELIEF Name/Mailing Address: Tax Parcel ID: The deadline to submit an Application is June 1, 2010. Property Address: List All Owners: North Carolina offers income based property tax relief programs for homeowners who are at least 65 years of age or totally and permanently disabled. This form may be used to apply for the: Elderly or Disabled Exclusion or Circuit Breaker Tax Deferment Program Separate applications are required for each owner that is claiming property tax relief. If a husband and wife are the sole owners of the property, only one application is required. Each owner may receive benefits from only one of these programs even though they may meet the requirements for both. Homes owned by honorably discharged disabled veterans or their unmarried surviving spouses are also eligible for tax relief. To request an application for the Disabled Veteran Exclusion or for assistance in completing this application, please call the Franklin County Tax Department at (919) 497-1397. Name of Applicant: ________________________________________________________________ Last First MI Date of Birth: __________________________ Age as of January 1, 2010: ______ Name of Spouse: ________________________________________________________________ Last First MI Date of Birth: __________________________ Age as of January 1, 2010: ______ Social Security Number (SSN) disclosure is mandatory for approval of the Elderly or Disabled Exclusion and the Circuit Breaker Tax Deferment Program and will be used to establish the identification of the applicant. The SSN may be used for verification of information provided on the application. The authority to require this number is given by 42 U.S.C. Section 405(c)(2)(C)(i). The SSN and all income tax information will be kept confidential. The SSN may also be used to facilitate collection of property taxes if you do not timely and voluntarily pay the taxes. Social Security Number: ________ - _____ - ________ ________ - _____ - ________ Applicant Spouse (if applicable) 1 In addition to any requirements stated below, applicants for a tax relief program must be at least 65 years of age or be totally and permanently disabled. Elderly or Disabled Exclusion – NC General Statute 105-277.1 This program excludes from taxation the first $25,000 or 50% (whichever is greater) of assessed value for the permanent residence. Exclusion means some of the value will not be considered when your tax bill is created. If you do not qualify for the program in future years, the excluded value from prior years does not become taxable. To qualify for the exclusion, the previous year’s total income for both an applicant and spouse cannot exceed the income eligibility limit, which is currently $27,100. For unmarried joint property owners, each owner must apply separately and benefit limitations may apply based on the percent of ownership. Once approved for the Elderly or Disabled Exclusion, you do not need to reapply unless your permanent residence has changed, your income now exceeds the current annual income eligibility limit, or you are no longer totally and permanently disabled. If the person receiving the exclusion last year was deceased prior to January 1, the person required by law to list the property must notify the Franklin County Tax Department. The surviving spouse or joint property owner is required to reapply for the exclusion if qualified. Failure to make any of these notices before June 1 will result in penalties, interest and the possible loss of the exclusion. Circuit Breaker Tax Deferment – NC General Statute 105-277.1B Under this program, taxes for each year are limited to a percentage of the owner’s income. Taxes above the limitation amount are deferred, which means delayed until a future date. The last three years of deferred taxes become payable with interest if a disqualifying event occurs. Disqualifying events include death of the owner or transfer of the property where the owner’s share is not passed to another qualifying owner, and failure to use the property as the owner’s permanent residence. For an owner whose income does not exceed the income eligibility limit, which is currently $27,100, the owner’s taxes will be limited to 4% of the owner’s income. For an owner whose income exceeds the income eligibility limit but does not exceed 150% of the income eligibility limit, which is currently $40,650, the owner’s taxes will be limited to 5% of the owner’s income. Participation in this program requires all owners to apply and qualify. In addition, each owner must have owned and lived in the residence for at least the last five full years prior to January 1. You must file an application for the Circuit Breaker Tax Deferment Program each year! COMPARING THE TAX RELIEF PROGRAMS The comparison situations are for a married couple, both over 65 years old, that have owned and lived in their residence for at least five full years. The income stated is the combined total for both applicant and spouse. The home is located in the Central Fire District and the combined tax rate for Franklin County and Central Fire District is .9375 per each $100 of assessed value. The examples provide results for incomes of both $24,000 and $30,000 with home values of both $175,000 and $225,000. Taxable Value 87,500 175,000 112,500 225,000 Tax on Value 820 1,640 1055 2,109 Tax Due & Payable 820 960 * 1055 960 * Tax Deferred 0 680 0 1149 Taxable Value 175,000 225,000 Tax on Value 1,641 2,109 Tax Due & Payable 1500 ** 1500 ** Tax Deferred 141 609 * Tax limit for deferment is based on 4% of income. ** Tax limit for deferment is based on 5% of income. Income $24,000 Home Value $175,000 Income $24,000 Home Value $225,000 Exclusion Circuit Breaker Exclusion Circuit Breaker Not qualified. Income exceeds limit for program. Not qualified. Income exceeds limit for program. Income $30,000 Home Value $175,000 Income $30,000 Home Value $225,000 Exclusion Circuit Breaker Exclusion Circuit Breaker The figures shown above are for comparison purposes only. Your individual property value and jurisdictional tax rates will apply. 2 SECTION A Do you and your spouse (if applicable) own 100% interest in the property? Yes No If you answered No, list all owners and their ownership percentage: (Attach an additional sheet if necessary) Owner ____________________________ _____ % Owner ____________________________ _____ % Owner ____________________________ _____ % Owner ____________________________ _____ % Owner ____________________________ _____ % Owner ____________________________ _____ % SECTION B 1. Yes No Is this property the permanent legal residence of both the applicant and spouse (if applicable)? 2. Yes No Does your spouse (if applicable) live with you in the residence? If you answer No, provide your spouse’s address: _____________________________________________________________ 3. Yes No Are you or your spouse (if applicable) currently residing in a health care facility? If you answer Yes, circle one (applicant / spouse) and indicate length of stay: ________________________ 4. Yes No Were either you or your spouse (if applicable) at least 65 years of age as of January 1? If you answer Yes, you may elect to skip question 5. 5. Yes No Are you or your spouse (if applicable) totally and permanently disabled? If you answer Yes, you must file a Certification of Disability form with this application. The form is available by calling our office at (919) 496-1397. 6. Yes No Was your income for the prior year $27,100 or less? Your spouse’s income (if applicable) must also be included. (Income means all moneys received from every source other than gifts or inheritances received from a spouse, lineal ancestor or lineal descendant.) 7. Yes No If your income for the prior year was greater than $27,100, was it $40,650 or less? Your spouse’s income (if applicable) must also be included. 8. Yes No Have you and your spouse (if applicable) owned and lived in this residence for at least the last five full years prior to January 1? SECTION C To apply for either tax relief program, you must answer Yes to either question 4 or 5 above. To apply for the Elderly or Disabled Exclusion, you must answer Yes to question 6 above. To apply for the Circuit Breaker Tax Deferment Program, you must answer Yes to either question 6 or 7 and to question 8 above. Please select the program for which you are applying. Only one program may be selected. ___ Elderly or Disabled Exclusion ___ Circuit Breaker Tax Deferment 3 SECTION D You must provide a copy of the first page of your individual Federal Income Tax Return for the preceding calendar year. If you do not file a Federal Income Tax Return, you must attach documentation of the income that you report below (W-2, SSA-1099, 1099-R, 1099-INT, 1099-DIV, financial institution statements, etc.) Married applicants filing separate returns should submit both returns. Your application will not be processed until the income tax information is received. All applicants must complete the following: Applicant Spouse a. Wages, Salaries, Tips, etc. $ __________________ $ __________________ b. Interest (Taxable and Tax Exempt) $ __________________ $___________________ c. Dividends $ __________________ $___________________ d. Capital Gains $ __________________ $ __________________ e. IRA Distributions $ __________________ $ __________________ f. Pensions and Annuities $ __________________ $ __________________ g. Disability Payments $ __________________ $ __________________ (not included in Pensions and Annuities) h. Social Security Benefits (Taxable and Tax Exempt) $ __________________ $ __________________ i. All other moneys received (example: alimony, $ __________________ $ __________________ rents, gifts, income from Schedule C, E, F) Total $ __________________ $ __________________ INFORMATION IS SUBJECT TO VERIFICATION WITH THE NC DEPARTMENT OF REVENUE SECTION E AFFIRMATION OF APPLICANT – Under penalties prescribed by law, I hereby affirm that, to the best of my knowledge and belief, all information furnished by me in connection with this application is true and complete. Furthermore, I understand that if I participate in the Circuit Breaker Property Tax Deferment Program, liens for the deferred taxes will exist on my property, and that when a disqualifying event occurs, the taxes for the year of the disqualifying event will be fully taxed and the last three years of deferred taxes prior to the disqualifying event will become due and payable, with all applicable interest. ______________________________ __________________________________ _____________ Applicant’s Name (please print) Applicant’s Signature Date ______________________________ __________________________________ _____________ Spouse’s Name (please print) Spouse’s Signature Date Daytime Telephone: _____________________________ The deadline to submit an application is June 1, 2010. Did you remember to: Complete all sections? Select a tax relief program in Section C: Sign the application? Include tax returns or income documentation? For Office Use Only: ____Approved ____Denied because______________________________________________ 4 Return completed application to: Franklin County Tax 215 E Nash St Louisburg, NC 27549
