Notice Of Residential Property Tax Relief Confirmation Form
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1NOTICE OF RESIDENTIAL PROPERTY TAX RELIEF CONFIRMATION
Government of the
District of Columbia
Office of the Deputy Chief Financial Officer
Office of Tax and Revenue
P.O. Box 176
Washington, DC 20004
Dear Property Owner:
The records of the Office of Tax and Revenue indicate that you are currently receiving a Homestead Deduction, and/or Senior Citizen Tax
Relief for the property noted below. To confirm the accuracy of the information in our records, you must verify the address of the property,
answer the fourteen questions in this letter, and provide your Social Security number and signature. Your Social Security number will be
used for verification of tax law compliance by the Office of Tax and Revenue.
If you have any questions, please contact our Customer Service Telephone Information Center at (202) 727-4TAX (4829) during the hours
of 8:15 a.m. and 4:30 p.m., Monday through Friday.
Thank you for your cooperation.
Property Information Questionnaire
Square
Suffix
Lot
Property Address
Questions
1. Do you own this residential property?
Yes
No
Yes
No
2. Do you occupy this residential property?
3. Do you own a condominium parking space in the condominium?
Yes
No
Parking Lot #
4. Do you own an additional lot abutting this property?
Yes
No
Abutting Lot #
5. Does the abutting lot continue to share the same ownership?
Yes
No
6. Please provide the date you moved into the property. (mmddyyyy)
Yes
No
7. Is the property your principle place of residence (domicile)?
8. Do you have a District of Columbia driver’s license?
Yes
No
Yes
No
9. Do you have a motor vehicle registered in the District of Columbia?
10. Are you registered to vote in the District of Columbia?
Yes
No
Yes
No
11. Do you file District of Columbia individual income tax?
12. Are you 65 years old or older?
Yes
No
(If YES, please answer questions 13 and 14)
13. Do you own 50% or more of the residential property?
Yes
No
14. Is your total adjusted gross household income less than $100,000?
Yes
No
Owner(s) of record must sign this document. Anyone convicted of making false statements on this document will be fined up to $1000 or imprisoned
up to 180 days, or both, under D.C. Official Code § 22-2405. Under penalties of law, I declare that all the information I have provided in this
document is true and correct to the best of my knowledge and belief.
Owner
Social Security Number
Signature
Co-Owner
Social Security Number
Signature
Daytime Phone No.
Date
Evening Phone No.
SOCIAL SECURITY INFORMATION:
Pursuant to 42 U.S.C. §405(c)(2)(C), the Office of Tax and Revenue may request the social security number for
tax administration purposes. Inclusion of the social security number is mandatory. The social security number will be used to determine the property owner’s
eligibility for the homestead deduction and/or senior citizen tax relief.
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