Office Phone: Tracy A. Jemison, AAS Geauga County Auditor 231 Main Street, Suite 1A Chardon OH 44024 440-279-1600 440-285-2222 440-834-1856 440-564-7131 Ext. 1600 DTE 105A Rev. 10/07 Homestead Exemption Application for Senior Citizens, Disabled Persons and Surviving Spouses File with the county auditor after the first Monday in January and on or before the first Monday in June. AUDITOR'S USE ONLY Please read the instructions on the back of this Taxing district and parcel or registration number form before you complete it. Disabled applicants must complete form DTE 105E, Certificate of Disability for the Homestead Exemption, and attach First year for homestead exemption it or a separate certification of disability status from Auditor's application number an eligible state or federal agency to this applicaGranted Denied tion. See the instructions for a Late Application on the back of this form. Current application Late application for prior year Type of application: Type of home: Senior citizen (age 65 and older) Single family dwelling Unit in a housing cooperative Disabled person Unit in a multi-unit dwelling Manufactured or mobile home Surviving spouse Condominium 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 Geauga 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 forthe exemption. Check the box that applies to this property. The applicant is: the settlor under a revocable, inter vivos trust, where the an individual named on the deed applicant has complete control of the assets in the trust. a purchaser under a land installment contract a stockholder in a qualified housing cooperative. See DTE 105A/Supplemental for additional information. a life tenant under a life estate a mortgagor (borrower) for an outstanding mortgage If the applicant or the applicant's spouse owns a second or vacation home, please provide the address and county below. Address City State ZIP code County 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 application is true, correct and complete. Signature of applicant Date Mailing address Phone number E-mail address American LegalNet, Inc. www.FormsWorkflow.com DTE 105A Rev. 10/07 Please read before you complete the application. What is the Homestead Exemption? The homestead exemption provides a reduction in property taxes to any senior or disabled citizen, regardless of income, on the dwelling that is that individual's principal place of residence and up to one acre of land of which an eligible individual is an owner. The reduction is equal to the taxes that would otherwise be charged on up to $25,000 of the market value of an eligible taxpayer's homestead. application. A person only has one principal place of residence; your principal place of residence determines, among other things, where you are registered to vote and where you declare residency for income tax purposes. You may be required to present evidence of age. If the property is being purchased under a land contract, is owned by a life estate or by a trust, or the applicant is the mortgagor of the property, you may be required to provide copies of any contracts, trust agreements, mortgages or other documents that identify the What Your Signature Means: By signing the front of this applicant's eligible ownership interest in the home. form, you affirm under penalty of perjury that your statements on the form are true, accurate, and complete to the best of Current Application: If you qualify for the homestead exyour knowledge and belief. A conviction of willfully falsifying emption for the first time this year (for real property) or for the information on this application will result in the loss of the first time next year (for manufactured or mobile homes), check the box for Current Application on the front of this form. homestead exemption for a period of three years. Qualifications for the Homestead Exemption for Real Late Application: If you also qualified for the homestead Property: To receive the homestead exemption you must be exemption for last year (for real property) or for this year (for (1) at least 65 years of age during the year you first file, or be manufactured or mobile homes) on the same property for determined to have been permanently and totally disabled which you are filing a current application, but you did not file (see definition at right), or be a surviving spouse (see defini- a current application for that year, you may file a late application at right), and (2) own and have occupied your home as tion for the missed year by checking the late application box your principal place of residence on Jan. 1 of the year in on the front of this form. You may only file a late application which you file the application. A person only has one principal for the same property for which you are filing a current appliplace of residence; your principal place of residence deter- cation. mines, among other things, where you are registered to vote and where you declare residency for income tax purposes. Definition of a Surviving Spouse: An eligible surviving You may be required to present evidence of age. If the prop- spouse must (1) be the surviving spouse of a person who was erty is being purchased under a land contract, is owned by a receiving the homestead exemption by reason of age or dislife estate or by a trust, or the applicant is the mortgagor of ability for the year in which the death occurred, and (2) must the property, you may be required to provide copies of any have been at least 59 years old on the date of the decedent's contracts, trust agreements, mortgages or other documents death. that identify the applicant's eligible ownership interest in the Permanent Disability: Permanent and totally disabled home. means a person who has, on the first day of January of the Qualifications for the Homestead Exemption for Manu- year for which the homestead exemption is requested, some factured or Mobile Homes: To receive the homestead ex- impairment of body or mind that makes him/her unfit to work emption you must be (1) at least 65 years of age during the at any substantially remunerative employment which he/she year following the year in which you first file, or be determined is reasonably able to perform and which will, with reasonable to be permanently and totally disabled (see definition at right), probability, continue for an indefinite period of at least twelve or be a surviving spouse (see definition at right), and (2) own months without any present indication of recovery, or who and occupy your home as your principal place of residence has been certified as totally and permanently disabled by an on Jan. 1 of the year following the year in which you file the eligible state or federal agency. FOR COUNTY ONLY: Date filed AUDITOR'S USE Name on tax duplicate Taxable value of homestead: Taxable land Taxable bldg. Taxable total American LegalNet, Inc. www.FormsWorkflow.com