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COVID-19 TAX DEFERRAL PROGRAM

Instructions & Application Form

INSTRUCTIONS:

Please read the instructions before completing the application. It is the applicant’s responsibility to accurately complete this form and provide any required proof in order to be considered for the tax deferral. Taxpayers will be notified if they are approved, or if further information is needed.

This application must be filed no later than July 1, 2020

This application is for residents, businesses, non-profits, and landlords who have been financially impacted by COVID-19.

ALL APPLICANTS – Check the box after “DEFERRAL PROGRAM” on page 1 and read what this program allows before continuing.

NOTE: ESCROWED REAL ESTATE ACCOUNTS ARE NOT ELIGIBLE FOR TAX DEFERRAL PER GOVERNOR’S EXECUTIVE ORDER.

Residents:

1. Fill out all information required on lines 1 – 5.
2. Under “CHECK PROPER ELIGIBILITY” check the Resident box. 
3. Check the box that states you have suffered at least a 20% income loss due to COVID-19.
4. Check the box stating proof of ownership and provide driver’s license, utility bill or other proof.
5. Sign and date page 2 of the application.
6. Email the form and proof of residency to [email protected]

OR mail the form and proof to: 
Tax Collector - TDP
253 Main Street
Ansonia, CT 06401

You must provide proof of residency with this form. This can be a driver’s license, utility bill, or other proof.

Businesses/Non-Profits

1. Fill out all information required on lines 1 – 5.
2. Under “CHECK PROPER ELIGIBILITY” check the Business/Non-Profit box.
3. Check the box that says Proof of Ownership and provide a Business License, Utility Bill, or Secretary of State listing
4. Email the form and proof of ownership to [email protected]

OR mail the form and proof to: 
Tax Collector – TDP 
253 Main Street
Ansonia, CT 06401

Landlords:

1. In the Landlords section check the Deferral Program box.
2. Check the applicable box for the type of proof you are providing.
3. Email the form and proof to [email protected]

OR mail the form and proof to: 
253 Main Street
Ansonia, CT 06401

Please click here for fillable PDF form.

HAVE QUESTIONS?

SEND AN EMAIL TO: [email protected]