Cancellation Of Homestead Deduction - The District Of Columbia
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2PRINT
CLEAR
Government of the
FP-105 Cancellation of Homestead Deduction -
District of Columbia
Senior Citizen/Disabled Tax Relief
Print in CAPITAL letters using black ink. Leave lines blank that do not apply.
SENIOR CITIZEN/DISABLED TAX RELIEF
Please Cancel My:
HOMESTEAD DEDUCTION
PART 1 – PERSONAL INFORMATION
Your social security number (SSN) -
Email address
REQUIRED
Co-owner SSN-
REQUIRED
M.I.
Last name
Your first name
Co-owner first name
M.I.
Last name
Current mailing address (number and street)
City
State
Zip Code +4
PART 2 – PROPERTY INFORMATION
Property address (number and street)
Unit Number
Quadrant
Square
Suffix
Lot
Zip Code +4
PART 3 – HOMESTEAD or SENIOR CITIZEN/DISABLED CANCELLATION REASONS
1
1. The property is no longer owner's principal place of residence
.
2.
2. Owner(s) no longer meet(s) age, disability or domicile requirement
3. Total household federal adjusted gross income in 2013 of Senior or Disabled is
3.
not less than $127,100
4.
4. Owner(s) is /are deceased [please attach a copy of the death certificate(s)]
5.
5. No longer own home
6.
6. Other
(specify)_________________________________________________________________________
(mmddyyyy)
ENTER DATE WHEN THE ABOVE EVENT OCCURRED OR WILL OCCUR
PART 4 – AFFIDAVIT
Making a false statement on this form is punishable by criminal penalties under DC Official Code §22‐2405. Under the penalties of law,
I declare that I have examined this document and its attachments, if any, and to the best of my knowledge, it is correct.
Your signature
Date (mmddyyyy)
Daytime phone
Printed First name
M.I.
Last name
If you have further questions, you may reach us through the Customer Service Telephone Information center at (202) 727-4TAX(4829),
FAX: (202) 442-6691, EMAIL : homestead@dc.gov, WEBSITE:
MAIL TO
Office of Tax and Revenue, Attention: Homestead Unit, 1101 4th Street, SW, Suite 550W, Washington, DC 20024
:
Form FP-105 (Rev. 12/2014)
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