"Residential Property Declaration
This form must be submitted to the County Assessor's office where your new residential property is located within 90 days of receipt. Failure to do so will result in the county assessor taking action that could result in the withdrawal of the primary residential exemption from your residential property.
Residential Property Owner Information
Name(s):__________________________________________________
Home Phone:_______________________________________________
Work Phone:_______________________________________________
Mailing Address:____________________________________________
Residential Property Information
Physical Address:___________________________________________
Certification
"Part-year residential property" means owned property that is not residential property on January 1 of a calendar year but becomes residential property after January 1 of the calendar year.
Yes No
A part-year residential property occupied for 183 or more consecutive calendar days in a calendar year by the owner(s) or a tenant is eligible for the exemption.
Yes No
If a property owner or a property owner's spouse claims a residential exemption under Utah Code Ann. §59-2-103 for property in this state that is the primary residence of the property owner or the property owner's spouse, that claim of a residential exemption creates a rebuttable presumption that the property owner and the property owner's spouse have domicile in Utah for income tax purposes. The rebuttable presumption of domicile does not apply if the residential property is the primary residence of a tenant of the property owner or the property owner's spouse.
Signature
Under penalties of perjury, I declare to the best of my knowledge and belief, this declaration and accompanying pages are true, correct, and complete.
__________________(Owner signature) _____________________Date (mm/dd/yyyy)
__________________(Owner printed name)
Utah Code § 59-2-103.5