Form Dte 105a - Homestead Exemption Application For Senior Citizens, Disabled Persons And Surviving Spouses

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DTE 105A
Homestead Exemption Application for Senior Citizens,
Rev. 7/13
Disabled Persons and Surviving Spouses
Includes changes to law affecting 2014 applications or 2015 for manufactured or mobile homes
File with the county auditor after the fi rst Monday in January and on or before the fi rst Monday in June.
Please read the instructions on the back of
this form before you complete it. Disabled
applicants must complete form DTE 105E,
Taxing district and parcel or registration number
Certifi cate of Disability for the Homestead Ex-
First year for homestead exemption
emption, and attach it or a separate certifi ca-
Auditor’s application number
tion of disability status from an eligible state
or federal agency to this application. See the
Tax commissioner income verifi cation
instructions for a Late Application on the back
of this form.
Current application
Late application for prior year
Application of person who received homestead reduction
in 2014 or 2015 (manufactured or mobile homes)
Type of application:
Senior citizen (age 65 and older)
Disabled person
Surviving spouse
Type of home:
Single family dwelling
Unit in a multi-unit dwelling
Unit in a housing cooperative
Manufactured or mobile home
Land under a manufactured or mobile home
Applicant’s name
Applicant’s date of birth
Name of spouse
Spouse’s date of birth
Home address
County in which home is located
Taxing district and parcel or registration number
from tax bill or available from county auditor
In order to be eligible for the homestead exemption, one of the following statements must apply to the applicant’s interest
in the property. Property that is owned by a corporation, partnership, limited liability company or other legal entity does not
qualify for the exemption. Check the box that applies to this property. The applicant is:
an individual named on the deed
the settlor, under a revocable or irrevocable inter vivos
trust, holding title to a homestead occupied by the set-
a purchaser under a land installment contract
tlor as a right under the trust
a life tenant under a life estate
a stockholder in a qualifi ed housing cooperative. See
a mortgagor (borrower) for an outstanding mortgage
DTE 105A/Supplemental for additional information.
trustee of a trust with the right to live in the property
If the applicant or the applicant’s spouse owns a second or vacation home, please provide the address and county below.
ZIP code
If the applicant is fi ling a current or late application for the fi rst time for tax year 2014 (2015 for manufactured and mobile
homes) or any years after those dates, total income
I declare under penalty of perjury that (1) I occupied this property as my principal place of residence on Jan. 1 of the year(s)
for which I am requesting the homestead exemption, (2) I currently occupy this property as my principal place of residence,
(3) I did not acquire this homestead from a relative or in-law, other than my spouse, for the purpose of qualifying for the
homestead exemption, and (4) I have examined this application, and to the best of my knowledge and belief, this applica-
tion is true, correct and complete.
I acknowledge that by signing this application, I delegate to both the Ohio tax commissioner and to the auditor of the county in which
the property for which I am seeking exemption is located, the authority to examine and consult regarding my tax and/or fi nancial re-
cords for the purpose of determining eligibility for the homestead exemption or a possible violation of the laws regarding homestead.
Signature of applicant
Signature of spouse (if total income must be verifi ed
Mailing address
Phone number
E-mail address


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