File with the county auditor no later than the fi rst Monday in June
only if changes in your eligibility status have occurred.
To be completed by the county auditor prior to mailing:
County Tax year Real property Manufactured or mobile home
Taxing district and parcel or registration number
Owner(s) as shown on the tax list
Homestead address
Instructions to Homestead Recipient
You must report any changes each year that would affect your homestead exemption on this form. If any have occurred,
complete this form and return it to the county auditor by the fi rst Monday in June. If no changes have occurred, you do
not have to return this form.
Check any of the following changes in your eligibility status that apply:
The property described above is no longer the owner’s principal place of residence.
There has been a change in the ownership of the property.
New owner(s)
The owner’s disability status has changed.
The owner qualifi es as a veteran with a service-connected disability with a total disability rating for compensation follow-
ing a determination of individual unemployability and either the rating or the determination has changed.
The owner qualifi es as a veteran with a service-connected disability, and the veteran’s service-connected disability or
combination of service-connected disabilities rating has changed.
The owner has died.
Name of decedent Date of death
Name of surviving spouse Spouse’s age on date of death
The property is in a revocable inter vivos trust and there has been a change thereto or a revocation thereof.
The owner qualifi ed under R.C. 323.152(A)(2)(c) (Income Verifi cation) and total income has changed.
Total income
Owner’s Social Security # Spouse’s Social Security #
I declare under penalty of perjury that I have examined this application, and to the best of my knowledge and belief,
it is true, correct and complete.
Signature of owner Date
Mailing address
Applicant’s daytime phone number Applicant’s e-mail address
DTE 105B
Rev. 2/16
Continuing Application for Homestead Exemption
