State Tax Form 96-1 - Senior Application For Statutory Exemption - 2007
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The Commonwealth of Massachusetts
Assessors’ Use only
State Tax Form 96-1
Date Received
Revised 2/2007
Application No.
Parcel Id.
Name of City or Town
SENIOR
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 December 15
or 3 months after actual (not preliminary) tax bills are
mailed for fiscal year if later.
Exception: Seniors must file by the earlier abatement
application deadline if local option Clause 41C½
accepted. See Assessors.
INSTRUCTIONS: Complete the following. Please print or type.
A. IDENTIFICATION. Complete this section fully.
Name of Applicant:
Marital Status: ____________________________
________________________________________
Social Security No
Phone Number: (
)
.
(optional)
Legal Residence (Domicile) on July 1, _________
Mailing Address
(If different)
No.
Street
City/Town
Zip Code
Location of Property:
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
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