County of Russell

Commissioner of the Revenue

LEBANON, VIRGINIA 24266                                                                                   PHONE : 889-8018

APPLICATION FOR REAL ESTATE TAX EXEMPTION

FOR ELDERLY & DISABLED HOMEOWNER

Read Requirements for Exemption on Page 4

The information required on this application must be filled out in its entirety and returned to the Commissioner of Revenue, Lebanon, Virginia.  Applications must be filed by March 1 of the taxable year for which the exemption is applied.  Complete all spaces on application that are applicable. Questions that cannot be answered within the spaces provided may be answered by attaching additional sheets to this application.  This exemption is granted on an annual basis and a new application must be filed each year.

All information on the application is confidential and not open to the pubic inspection.

Applicant : _______________________________________________________________________________

Mailing Address : __________________________________________________________________________

Birthdate : __________________________________ Social Security No. : _____________________________

Spouse : _________________________________________________________________________________

Birthdate :__________________________________ Social Security No. : ______________________________

Name under which property is listed and appears on the tax bill, if different from the applicant or spouse's name.

_________________________________________________________________________________________

Location and description of property:

(a.)  Acreage ________________________________and/or _________________________________________

(b.) Subdivision ____________________Lot _____________Block______________Section________________

(c.) District _______________________________Description________________________________________

(d.) Map No. _____________________________

Date Received _________________________

I. OCCUPANCY AND OWNERSHIP

1.  Is this dwelling occupied by the applicant as the sole dwelling?   Yes ڤ           No ڤ

2.  Is the applicant ( Owner) ڤ                 (Partial Owner ) ڤ

    If partial ownership, explain how the ownership is legally held and the proportion owned by the applicant.

___________________________________________________________________________________________

___________________________________________________________________________________________

____________________________________________________________________________________________

3. List the names, relationship and Social Security Number of all persons related to the applicant who occupy the above dwelling :

                                        Name                                                     Relationship              Social Security No.

(1.) _____________________________________________________________________________________

(2.)______________________________________________________________________________________

(3.)______________________________________________________________________________________

II. GROSS INCOME

Please complete this gross income statement for the immediately preceding calendar year.  Included in this statement should be the total gross income from all sources of the applicant and spouse and each relative living in the dwelling.

Total combined income of the Applicant, Spouse, and Relatives.................................................$___________

III. NET WORTH

Please complete this statement of net financial worth as of December 31st of the immediately preceding calendar year.

CERTIFICATE

I certify, under the penalties provided by law, that this application for Real Estate Tax Relief for the Elderly & Disabled Homeowner, including any accompanying schedules or statements, to the best of my knowledge and belief is true, correct and complete.

_________________________________________                ______________________________________

Applicant's Signature                                                                   Date

__________________________________________              _______________________________________

Signature of Spouse                                                                    Date   

Telephone __________________________________

County of Russell

Commissioner of the Revenue

REQUIREMENTS FOR REAL ESTATE TAX EXEMPTION FOR ELDERLY AND DISABLED HOMEOWNER AS AUTHORIZED BY THE COUNTY OF RUSSELL ORDINANCE.

1. The title of the property for which exemption is claimed must be held, or partially held, on January 1 of the taxable year, by the person or persons claiming exemption.

2. The head of the household occupying the dwelling and owning title, or partial title thereto, must be sixty-five years or older or permanently disabled on December 31 of the year immediately preceding the taxable year. Such dwelling must be occupied as the sole dwelling of the persons not less than sixty-five years of age or permanently disabled.

3. The Gross Combined Income of the owner(s) during the year immediately preceding the taxable year shall be determined by the Commissioner of Revenue in an amount not to exceed $27,000.00

4. The total combined net financial worth of the owner as of December 31 of the year immediately preceding the taxable year shall be determined by the Commissioner of Revenue to be an amount not to exceed $75,000.00 Total net financial worth shall include all assets, including equitable interest, of the owner in the dwelling for which exemption is claimed, and shall exclude the fair market value of the dwelling and the land, not exceeding one acre, upon which the dwelling is situated.

5. Annually, and not later than March 1 of the taxable year, the person or persons claiming an exemption must file a real estate tax exemption application with the Commissioner of the Revenue.

6. Sec. 00-6 Amount of Exemption

For qualified persons, the amount of exemption of, the real estate tax shall be $150.00 of the tax bill.  The difference between the original tax and the figure arrived at will be due the County as the assessed property tax for that year.  In no case will the tax excused exceed $150.00.

The exemption shall be administered by the Commissioner of Revenue according to the provisions of this Ordinance.  The Commissioner of Revenue is hereby authorized and empowered to prescribe, adopt, promulgate and enforce rules and regulations in conformance with the provisions of this ordinance, including the requirement of answers under oath, as may be reasonably necessary to determine qualifications for exemption as specified by this Ordinance.  The Commissioner of Revenue may require the production of certified  tax returns and appraisal reports to establish income and/or financial worth.

RETURN TO :

Randy N. Williams

Russell County Commissioner of Revenue

Lebanon,   VA   24266