FOR COUNTY AUDITOR’S USE ONLY:
Taxing district and parcel or registration number Auditor’s application number
First year for homestead exemption
Date led
Name on tax duplicate
Taxable value of homestead: Taxable land Taxable bldg. Taxable total
Method of Veri cation (must complete one):
Tax commissioner portal: Year Total OAGI No information returned
Ohio tax return (line 3): Year Total OAGI
Federal tax return (line 4, 1040EZ): Year Total FAGI
(line 21, 1040A): Year Total FAGI
(line 37, 1040): Year Total FAGI
Worksheet (attached): Estimated OAGI
Granted Denied
County auditor (or representative) Date
DTE 105A
Rev. 9/16
Homestead Exemption Application for Senior Citizens,
Disabled Persons and Surviving Spouses
Real property: File with the county auditor on or before Dec. 31.
Manufactured or mobile homes: File with the county auditor on or before the rst Monday in June.
Please read the instructions on the back of this form before you complete it. Disabled applicants must complete form DTE 105E,
Certi cate of Disability for the Homestead Exemption, and attach it or a separate certi cation of disability status from an eligible state or
federal agency to this application. See Late Application in the instructions on page 3 of this form.
Current application
Late application for prior year
Application of person who received homestead reduction for 2013 or for 2014 for manufactured or mobile homes. Form DTE 105G
must accompany this application.
Application of person who received the homestead reduction for 2006 that is greater than the reduction calculated under the current law.
Form DTE 105G must accompany this application.
Type of application:
Senior citizen (must be at least age 65 by Dec. 31st of the year for which the exemption is sought)
Disabled person (must be permanently and totally disabled on Jan. 1 of the year for which exemption is sought)
Surviving spouse (must have been at least 59 years old on the date of the spouse’s death and must meet all other homestead exemp-
tion requirements)
Type of home:
Single family dwelling Unit in a multi-unit dwelling Condominium Unit in a housing cooperative
Manufactured or mobile home Land under a manufactured or mobile home
Applicant’s name Applicant’s date of birth SSN
Name of spouse Spouse’s date of birth SSN
Home address
County in which home is located
Taxing district and parcel or registration number
from tax bill or available from county auditor
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In order to be eligible for the homestead exemption, the form of ownership must be identi ed. Property that is owned by a corporation,
partnership, limited liability company or other legal entity does not qualify for the exemption. Check the box that applies to this property.
The applicant is:
an individual named on the deed
a purchaser under a land installment contract
a life tenant under a life estate
a mortgagor (borrower) for an outstanding mortgage
trustee of a trust with the right to live in the property
the settlor, under a revocable or irrevocable inter vivos trust, holding title to a homestead occupied by the settlor as a right under the
trust
a stockholder in a quali ed housing cooperative. See form DTE 105A – Supplement for additional information.
other
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
Have you or do you intend to le an Ohio income tax return for last year? Yes No
Total income for the year preceding year of application, if known (see instructions):
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, (4) my total income
for myself and my spouse for the preceding year is as indicated above and (5) I have examined this application, and to the best of my
knowledge and belief, this application is true, correct and complete.
I (we) acknowledge that by signing this application, I (we) delegate to both the Ohio tax commissioner and to the auditor of the county in which the
property for which I am seeking exemption is located, and to their designated agents, the authority to release my tax and/or nancial records and
to examine and consult regarding such records for the purpose of determining my eligibility for the homestead exemption or a possible violation of
the homestead laws. Such records shall not contain any federal tax information as de ned in I.R.C. 6103 and received from the Internal Revenue
Service. I expressly waive the con dentiality provisions of the Ohio Revised Code, including O.R.C. 5703.21 and 5747.18, which may otherwise
prohibit disclosure, and agree to hold the Ohio tax commissioner and county auditor harmless with respect to the limited disclosures herein. Except
as authorized by law, the parties to which this authority is delegated shall maintain the con dentiality of the information received and the information
shall not otherwise be re-disclosed.
Signature of applicant Signature of spouse
Mailing address Date
Phone number E-mail address
DTE 105A
Rev. 9/16
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Mike Kovack, Medina County Auditor
144 North Broadway Street
Medina, OH 44256
(330) 725-9754 (844) 722-3800
www.medinacountyauditor.org
Individuals who received the homestead exemption for tax year 2013 (2014 for manufactured and mobile homes) on any
residence may continue to receive the homestead exemption on another residence within the state without meeting the
income test currently required for the exemption, if a different residence otherwise meets the quali cation of a homestead.
In order to assure that an applicant has previously received the homestead exemption for the aged or disabled, certain
information must be made available to the county auditor.
Applicant’s name
Applicant’s current home address
Taxing district and parcel or registration number of current home
County in which prior homestead was granted
Address for which prior homestead was granted
Taxing district and parcel or registration number of prior home
I declare under penalty of perjury that I was receiving the homestead exemption for tax year 2013 (2014 for manufactured
and mobile homes) on the property described in this addendum, and have examined this document and, to the best of my
knowledge and belief, it is true, correct and complete.
Signature of applicant Date
Mailing address
Phone number E-mail address
DTE 105G
Rev. 11/13
Addendum to the Homestead Exemption Application for
Senior Citizens, Disabled Persons and Surviving Spouses
For applicants who have previously received the homestead exemption under R.C. 323.152(A)(2)(b).
Mike Kovack, Medina County Auditor
144 North Broadway Street
Medina, OH 44256
(330) 725-9754 (844) 722-3800
www.medinacountyauditor.org
DTE 105A
Rev. 9/16
Please read before you complete the application.
What is the Homestead Exemption? The homestead exemp-
tion provides a reduction in property taxes to quali ed senior or
disabled citizens, or a surviving spouse, 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.
What Your Signature Means: By signing the front of this form,
you af rm under penalty of perjury that your statements on the
form are true, accurate and complete to the best of your knowl-
edge and belief and that you are authorizing the tax commissioner
and the county auditor to review nancial and tax information led
with the state. A conviction of willfully falsifying information on this
application will result in the loss of the homestead exemption for a
period of three years.
Quali cations for the Homestead Exemption for Real Property
and Manufactured or Mobile Homes: To receive the homestead
exemption you must be (1) at least 65 years of age during the
year you rst le, or be determined to have been permanently and
totally disabled (see de nition at right), or be a surviving spouse
(see de nition at right), and (2) own and have occupied your home
as your principal place of residence on Jan. 1 of the year in which
you le the application. For manufactured or mobile home owners,
the dates apply to the year following the year in which you le the
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 mort-
gagor of the property, you may be required to provide copies of
any contracts, trust agreements, mortgages or other documents
that identify the applicant’s eligible ownership interest in the home.
If you are applying for homestead and did not qualify for the ex-
emption for 2013 (2014 for manufactured homes), your total in-
come cannot exceed the amount set by law. “Total income” is de-
ned as the adjusted gross income for Ohio income tax purposes
(line 3 of Ohio income tax return) of the owner and the owner’s
spouse for the year preceding the year for which you are applying.
If you do not le an Ohio income tax return, you will be asked to
produce a federal income tax return for you and your spouse. If
you do not le a federal income tax return, you will be asked to pro-
duced evidence of income and deductions allowable under Ohio
law so that the auditor may estimate Ohio adjusted gross income.
Current Application: If you qualify for the homestead exemption
for the rst time this year (for real property) or for the rst time next
year (for manufactured or mobile homes), check the box for Current
Application on the front of this form.
Late Application: If you also quali ed for the homestead exemption
for last year (for real property) or for this year (for manufactured or
mobile homes) on the same property for which you are ling a cur-
rent application, but you did not le a current application for that year,
you may le a late application for the missed year by checking the
late application box on the front of this form. You may only le a late
application for the same property for which you are ling a current
application.
De nition of a Surviving Spouse: An eligible surviving spouse
must (1) be the surviving spouse of a person who was receiving
the homestead exemption by reason of age or disability for the
year in which the death occurred, and (2) must have been at least
59 years old on the date of the decedent’s death.
Permanent Disability: Permanent and totally disabled means a
person who has, on the rst day of January of the year for which
the homestead exemption is requested, some impairment of body
or mind that makes him/her un t to work at any substantially remu-
nerative employment which he/she is reasonably able to perform
and which will, with reasonable probability, continue for an inde -
nite period of at least 12 months without any present indication
of recovery, or who has been certi ed as totally and permanently
disabled by an eligible state or federal agency.
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Attach this form to the homestead exemption application (form DTE 105A)
if the applicant is requesting the homestead exemption based on disability status.
Ohio Revised Code section 323.151: “ ‘Permanently and totally disabled’ means a person who has, on the rst day of Janu-
ary of the year of application for reduction in real estate taxes, some impairment in body or mind that makes the person un-
able to work at any substantially remunerative employment that the person is reasonably able to perform and that will, with
reasonable probability, continue for an inde nite period of at least twelve months without any present indication of recovery
therefrom or has been certi ed as permanently and totally disabled by a state or federal agency having the function of so
classifying persons.”
To be completed by the applicant
Applicant’s name
Home address
To be completed by the physician, psychologist or state or federal agency representative.
In accordance with the above, I (we) hereby certify that was, as of Jan. 1, ,
and is now permanently and totally disabled according to the above de nition by virtue of physical disability or
mental disability.
License number and state issuing (Note: If reason for reduction is
mental disability, the physician or psychologist must hold an Ohio license.)
Physician (signature) Print name of person signing form
Psychologist (signature) Address (please print)
Agency (please print) City State ZIP code
If agency, signature and title of person completing the form Date
In lieu of having a physician or psychologist sign this form, the applicant may submit a statement from an eligible state or
federal agency that the applicant is permanently and totally disabled as de ned above. See the back page of this form for
more information on what constitutes acceptable proof of permanent disability.
DTE 105E
Rev. 2/16
Certi cate of Disability for the Homestead Exemption
Name of applicant
Mike Kovack, Medina County Auditor
144 North Broadway Street
Medina, OH 44256
(330) 725-9754 (844) 722-3800
www.medinacountyauditor.org
Acceptable and Unacceptable Proofs of Permanent and Total Disability
Physician’s Certi cate: Acceptable. An application based
on physical disability must include a certi cate signed by a
physician. An application based on mental disability must
include a certi cate signed by a physician or a psychologist
licensed to practice in Ohio. Note: A chiropractor is not a
“physician” for purposes of the Homestead Law.
Federal Agencies:
Social Security Administration (SSA): An SSA (or SSI)
form indicating that an applicant is “disabled” is acceptable.
The SSA only gives disability bene ts to those who are per-
manently and totally disabled.
Department of Veterans Affairs (VA): Veterans with a total
service-connected disability or veterans who are receiving
100% compensation for service-connected disabilities follow-
ing a determination of individual unemployability should le
DTE form 105I and submit the documentation indicated by
that application. If a veteran does not qualify as an eligible
disabled veteran, but meets the de nition found in R.C.
323.151(D) (provided at the top of this form), the veteran
must have a doctor or qualifying psychologist complete this
form. No VA documentation re ects the statutory de nition
of permanent and total disability in R.C. 323.151(D).
Railroad Retirement Board (RRB): The RRB has two types
of disability pensions: (1) total and permanent disability and
(2) occupational disability. Only the “permanent and total
disability” pension is acceptable.
State Agencies:
Bureau of Workers Compensation: A determination of
“permanent and total disability” is acceptable. Other de-
terminations, such as “permanent and partial disability”
“temporary and total disability,” and “temporary and partial
disability” are not.
State Retirement Systems: Not acceptable. The Public
Employees Retirement System (PERS), the State Teachers
Retirement System and the School Employees Retirement
System (SERS), do not certify permanent and total disability.
While the State Highway Patrol Retirement System (HPRS)
and the Police and Firemen’s Disability and Pension Fund
(PFDPF) do certify individuals to be “permanently and totally
disabled” these determinations are job-speci c and do not
rule out the possibility of other substantially remunerative
employment using a different set of skills.
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