TAX LIEN/APPLICATION FOR DEFERRAL OF PROPERTY TAXES

I. Date: ____________________________ Recorder’s Stamp

I hereby request deferral of my property taxes per

Article 3.5 of Title 39 Colorado Revised Statutes.

Name: Birth Date: ____________________

Property Address: Phone: ______________________

Mailing Address: ______________________________________________________________________________________

City and Zip: ______________________________________________________________________________________________

Legal Description: __________________________________________________________________________________________

_________________________________________________________________________________________________________

I certify that I(we) am(are) the owner(s) of, and reside in the above described residential property, and that this property is not income producing, and I (we) do not have any delinquent taxes owing. I(we) own the property (check one): Free and clear_______, OR, there is a mortgage over 5 years old _____, OR, there is a mortgage under 5 years old_____ (if applicable, attach a copy of the recorded Subordination Agreement*), OR, a purchase contract_____.

List name, address, phone number of mortgage company or holder of the purchase contract: __________________________________

___________________________________________________________________________________________________________

ALL OWNERS AS LISTED ON THE TITLE INCLUDING BUT NOT LIMITED TO JOINT TENANTS, TENANTS IN COMMON, ETC., MUST SIGN BELOW ACKNOWLEDGING THAT UPON ACCEPTANCE OF THE APPLICATION BY THE COLORADO STATE TREASURER’S OFFICE THERE WILL BE A LIEN PLACED ON THE SAID PROPERTY.

X________________________________________ X_______________________________________
X________________________________________ X_______________________________________

Guardian, Conservator, or Attorney-in-fact: ______________________________________________________

Other contact (relative, personal representative, etc.): ________________________________________________

Phone Number: ______________________________________________

II. Market Value (obtain from County Assessor)……………….…………………………………….$_____________a

Previous years’ deferred taxes and accrued interest………..$_______________b

(obtain previous years from County Treasurer)

Amount of 200_ taxes to be deferred……………………….._______________c

List individual amounts of any liens or mortgages on _______________d

the property (lines d, e, & f)…………………………………_______________e

_______________f

Add lines b through f………………………………………________________g

Subtract line g from a………………………………………________________h

Line g must be less than line a in order to qualify for deferral of property taxes.

IMPORTANT NOTICE TO PROPERTY OWNERS: YOU COULD LOSE YOUR PROPERTY IF THE CUMULATIVE AMOUNT OF THE DEFERRAL PLUS INTEREST EXCEEDS THE MARKET VALUE OF YOUR PROPERTY LESS THE VALUE OF ANY LIENS.

If you have mortgage liens on your real property: list the book, page number, reception number, date, and county in which the property is recorded:

Book:_________Page:_________Reception#______________Date:_________County______________

If you have mortgage liens on your mobile home: list the street address and county where the mortgage is recorded with the Authorized Agent of the Department of Revenue:

____________________________________________________________________________________

CERTIFICATE OF DEFERRAL - TO BE COMPLETED BY THE COUNTY TREASURER’S OFFICE

Tax Schedule #: Date: ______________________________

Ownership records agree with the above.

The above property is eligible for deferral of 200_ taxes in the amount of $________________

__________________________________________

Treasurer or Deputy

__________________________________________

County

State Treasurer, Original – Copy to the County Treasurer, County Assessor and Applicant