APPLICATION FOR EXEMPTION
UNDER THE HOMESTEAD/DISABILITY AMENDMENT
(Explanation on Reverse Side)
County JEFFERSON Date Submitted
Application is hereby made for the homestead exemption provided by Section 170 of the Kentucky Constitution.
1. Name(s) of owner-applicant(s) in whose name(s) title is vested:
2. Name of applicant(s) Date of birth Age Sex Relationship to other occupants
3. Address of residence
Phone number_______________________________________________________________________________________
E-mail address ___________________________________________________________________________________________
Parcel ID (if known)
4.
Have you applied for, or are you receiving, the homestead exemption in a different location, county, or state?
yes no If “yes”, where?
5. Type of residential unit: single-family residence duplex apartment building mobile home condominium
other (describe) _________________________________________________________________________________________
6. Type of ownership: fee simple equitable title jointly with survivorship jointly in common by stock ownership or membership
representing the owner’s or member’s proprietary interest in a multi-family structure
Note: Amount of exemption: If ownership is fee simple, equitable title, jointly with survivorship, jointly in common, applicant receives full
exemption, or up to the assessed value of his interest in the property, whichever is less. If ownership is by stock ownership or membership, the
amount of exemption is full exemption or the percentage that the applicant’s ownership bears to the total value of the property. (Example: Total
value of the structure = $50,000; applicant’s stock ownership = 10%; exemption limit = $5,000.)
AFFIDAVIT AND OATH
I (we), _____________________________________________ / ________________________________________________,
(Applicant) (Spouse)
hereby swear (affirm) under penalty of perjury that I (we) am (are) the owner(s) of the property for which this assessment exemption is sought; that I
(we) occupy and maintain this residential unit as my (our) primary residence; that I, the applicant, am 65 years of age or over, or totally disabled; and
further that I (we) have not applied for nor receive a homestead exemption on any other property I (we) may own in Kentucky or any other state and
that all information contained in this application is true and correct.
___________________________________________ ______________________________________________
Signature of Applicant Date
____________________________________________ ______________________________________________
Signature of Spouse Date
RESERVED FOR OFFICIAL USE
This application is approved disapproved ________________________________________________
Property Valuation Administrator Date
Mail Completed Application to:
Colleen Younger
Property Valuation Administrator
Glassworks Building
815 W. Market Street, Suite 400
Louisville, KY 40202-2654
Husband Wife Other
62A350 (092019 JC)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Husband
Wife
Other
Phone: (502) 574-6380
Website: www.jeffersonpva.ky.gov
Office Hours: Monday-Friday 8am-4pm
Husband
Wife
Other
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EXPLANATION
1. To apply for the homestead exemption, this application-affidavit must be submitted during the year in which exemption is sought
for residential property located in Jefferson County to the Jefferson County Property Valuation Administrator’s Office (JCPVA).
Once approved, annual reapplication is not required.
Applicants seeking the homestead exemption under the disability provision must file this application-affidavit by December 31
st
of the year in which exemption is sought. Under KRS 132.810(4)(b) applicants are required to report any change in their
disability classification to the JCPVA. Failure to do so could result in delinquent tax liabilities for any years an applicant
did not legally qualify for the exemption.
2. What does homestead exemption mean?
Under the provisions of the Homestead Amendment, a person or persons must be 65 years of age or older or totally disabled
during the year for which application is made, and must own, occupy and maintain a residential unit for such exemption. Only
1 exemption per residence is allowed. Applicants must not have applied for nor received a homestead exemption on any other
property they may own in Kentucky or any other state other than their primary legal residence for which application is made.
3. Age Requirement
A person or persons owning, living in and maintaining a residential unit must meet the 65 years of age requirement. If only one
spouse is 65, the age requirement is met.
4. Verification of Age & Jefferson County Residence
A person must own and occupy the property for which exemption is sought as his or her Primary Residence. A Primary
Residence is a person’s fixed permanent or principal home for legal, voting and tax purposes. Date of birth of the applicant(s)
and proof of Jefferson County residence can be verified by submitting a copy of one of the following forms of identification:
1. Valid Jefferson County Driver’s License issued by the Jefferson County Circuit Court Clerk’s Office.
2. Valid Personal ID Card issued by the Jefferson County Circuit Court Clerk’s Office.
The address shown on the Driver’s License or Personal ID Card must match the address of residence for which
application is made.
If obtaining one of the above forms of identification presents an undue hardship due to disability and/or advanced age, an
applicant may provide a copy of their birth certificate along with a copy of their voter registration card to verify the age and
primary residence requirements.
5. Disability Requirements
A person must be classified as totally disabled under a program authorized or administered by an agency of the United States
government or by any retirement system either within or without the Commonwealth of Kentucky. Applicants must document
their disability with a copy of their award letter from their retirement system that declares the date they became eligible for
disability benefits. Applicants must also document their date of birth and primary residence for which application is made. To be
eligible, applicants must have maintained their disability classification and received disability payments under such classification
for the entire year.
6. KRS 132.810(2) (h) provides, “When title to property which is exempted, either in whole or in part, under the homestead
exemption is transferred, the owner, administrator, executor, trustee, guardian, conservator, curator or agent shall report such
transfer to the property valuation administrator.”
6. Fraudulent Misrepresentations
Under the provisions of KRS 132.990(1), “Any person who willfully fails to supply the property valuation administrator or the
Department of Revenue with a complete list of his property and such facts with regard thereto as may be required or who violates
any of the provisions of KRS 132.570 shall be fined not more that five hundred dollars ($500).”