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Disabled Homeowners’ Exemption (DHE) RENEWAL APPLICATION — 2017/18

3. TOTAL COMBINED INCOME INFORMATION

TOTAL COMBINED INCOME (TCI), SEE SECTION 3 OF THE INSTRUCTIONS TO DETERMINE WHAT INCOME TO INCLUDE FOR THE TCI.

SUBTRACT ANY UNREIMBURSED MEDICAL AND PRESCRIPTION DRUG EXPENSES.

Enter your Total Combined Income for 2016, for all owners and spouses,

regardless of where they live and whether or not their names appear on the deed.

The income of a spouse may be excluded if absent from the residence due to divorce,

legal separation or abandonment. Submit court documents.

Note: If 2016 income is not available, you can use income for 2015.

You MUST provide the following documents to renew your Disabled Homeowners’ Exemption.

Proof of Income (for all owners):

If you did not file personal tax returns for 2016 or 2015, please do not check this box.

f you or you and your spouse filed Federal and New York State personal income tax returns for the 2016 or 2015

tax year, check this box if you authorize the NYC Department of Finance to use the most recent income tax return

information DOF received from the Internal Revenue Service and the New York State Department of Taxation &

Finance to process your application, in lieu of your submitting copies of the documents. OR

✓ Submit a copy of your Federal and New York State personal income tax returns for the 2016 or 2015 tax year,

whichever is the most recent year for which you have filed, with the application for all owners and their spouses,

regardless of where they reside and whether or not their names appear on the deed. OR

✓ If you have not submitted a 2016 or 2015 Federal Income Tax return, then submit verification of income for 2016 or 2015,

whichever is the most recent year for which you have information, such as: State Income Tax Return, Social Security

1099(s), 1099s, pension, annuities, alimony, unemployment, workers’ compensation, rental income from tenants, etc.

Allowable Deductions, if applicable:

✓ Copies of paid unreimbursed medical or prescription expenses for 2016. If 2016 is not available, you can use

2015. DO NOT submit copies of unpaid bills. If you ﬁled the 1040 Federal Tax Return and completed a schedule A,

we can use the information on the schedule for paid unreimbursed medical or prescription expenses. You do not

have to send in the receipts.

✓ Proof of unreimbursed medical and prescription expenses must be for the same tax year as the income

documentation submitted.

4. ADDITIONAL PROPERTIES OWNED (IF ANY)

IF YES, HOW MANY TOTAL

Do any owners own additional properties?

Yes

PROPERTIES DO ALL

IF NO, PROCEED TO THE CERTIFICATION SECTION ON PAGE 4.

THE OWNERS HAVE?

Complete the following for each additional property. If the property is in NYC, please provide the Borough/Block/Lot Number.

Additional property 1:

BOROUGH

BLOCK

LOT

PARCEL ID

OWNER(S) NAME

STREET ADDRESS

APT

CITY

STATE

ZIP

EXEMPTIONS RECEIVED

Basic STAR/Enhanced STAR

Senior

Disabled

Veterans

Other: ______________

An owner and their spouse cannot have exemptions on more than one property, unless the spouse or former spouse is

absent due to divorce, legal separation or abandonment. In one of those cases, please submit a copy of court documents.

8/22/2017

Disabled Homeowners' Exemption (Dhe) Renewal Application For 2017/18 - New York Department Of Finance Page 5

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