Cancellation Of Homestead Deduction - Senior Citizen Tax Relief Form

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CANCELLATION OF HOMESTEAD DEDUCTION — SENIOR CITIZEN T AX RELIEF
Government of the
District of Columbia
Office of Tax and Revenue
Customer Service Administration
1101 4th Street, S.W., Second Floor
Washington, DC 20024
homestead@dc.gov
Square
Suffix
Lot
Please cancel my Homestead Deduction
Senior Citizen Tax Relief
1. This is no longer my principal place of residence
(domicile) as of this date (mmddyyyy):
2. Owner(s) no longer meet age requirement
3. Total adjusted household income is no longerless than $100,000
4. Owner(s) deceased (please attach a copy of the death certificate)
Owner’s Social Security Number
Spouse’s Social Security Number
Signature
date (mmddyyyy)
Print Full Name
Current Mailing Address
RETURN TO:
Government of the District of Columbia
Office of the Chief Financial Officer
Office of Tax and Revenue
1101 4th Street, S.W., Second Floor
Day Time Phone No.
Washington, DC 20024
E:mail Address
If you have further questions, please call the Customer Service Telephone Information Center at (202)727-4T AX (4829) or FAX (20 2)442-6691.
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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