Massachusetts State Tax Form 96

Senior Fiscal Year Application for Statutory Exemption

State Tax Form 96-1 - The Commonwealth of Massachusetts

This application is not open to public inspection

Return to: Board of Assessors

Must be filed with assessors on or before December 15 or 3 months after actual tax bills are mailed, whichever is later.

A. Identification

Name of Applicant:

Telephone Number: Marital Status:

Legal Residence (Domicile) on July 1:

Location of Property:

No. Street: City/Town: Zip Code:

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 for this year? Yes No

If yes, name of city or town: Amount exempted:

Disposition of Application (Assessors' Use Only)

B. Exemption Status

SENIOR 70 OR OLDER (65 or older by local option) 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? Yes No

If no, list the other properties you owned and/or occupied during the past 11 years:

C. Gross Receipts From All Sources in Preceding Calendar Year

D. Value of All Property Owned on July 1 This Year

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.

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.

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 or national guard member who died in combat or from combat injury or disease
• Surviving spouse
• Minor child of a deceased parent
• Senior citizen age 70 and older (65 and older by local option)

Who May File an Application. You may file an application if you meet all qualifications for a personal exemption as of July 1.

When and Where Application Must Be Filed. Your application must be filed with the assessors by December 15 or 3 months after the actual bills were mailed for the fiscal year, whichever is later.

Payment of Tax. Filing an application does not stay the collection of your taxes.

Assessors Disposition. Upon applying for an exemption, you may be required to provide the assessors with further information and supporting documentation.

Appeal. You may appeal the disposition of your application to the Appellate Tax Board, or if applicable, the County Commissioners.