City of MAP __________ LOT___________
1 City Hall Plaza, Ellsworth Maine 04605 Assessor's Signature _____________________
Effective date of approval: April 1, ______________
Note: Forms filed after April 1st of any year will apply to the subsequent year tax assessment.
Name: ____________________________________________________________________
(first) (middle) (last)
Homestead Street Location: # ___________ Street Name: _________________________
Mailing: ______________________________ City: _______________________________
(If different from above)
State: _____________________ Zip _______________ Phone: ______________________
1. I am a legal resident of the State of Maine Yes or No
2. I declare this house is my permanent place of residence and the ONLY property
I claim as a HOMESTEAD. Yes or No
(Summer camps, vacation homes and or second residences
do not
3. I have owned this property since: (date on deed) Month ______ Day ______ Year ________
3a. 12 months added to the date above would be Month _____ Day______ Year _______
4. The next April 1st date coming after the date above in 3a would be: April 1, ___________.
5. I understand that to qualify I must have owned a home in Maine for the
12 preceding months and it must be my permanent residence. Yes or No
6. If you own, or have owned, a permanent residence prior to this home, please list:
a. Town: _____________________________________.
b. Did you claim a Homestead Exemption there? Yes or No
c. Do you continue to claim a Homestead Exemption there? Yes or No
d. Timeframe of the prior ownership:
1. Date Purchased: Month ______ Day ______ Year _______
2. Date Sold: Month ______ Day ______ Year _______
7. I file a Maine Resident Income Tax Return? Yes or No
8. Do you register your vehicle(s) in Ellsworth? Yes or No
9. The primary residence on my Driver's License is Ellsworth? Yes or No
10. Are you a registered voter in Ellsworth? Yes or No
(if you circled NO to questions 7,8,9, or 10, please explain on back of this form)
I do hereby declare, that the answers to the above are true, correct and complete and I understand that providing false information
is a criminal offense. I do hereby also declare that when and or if I cease or discontinue my permanent residency at this home, I will
contact the Assessor to discontinue this exemption.
Signature: _________________________________________ Date: _______________
(only one signature required)
This form can be submitted in person, by mail, email or fax 207-669-6618
Complete your Name, Street location (of Homestead Property), Mailing Address and phone.
Question 1 & 2
-must be answered
Yes to qualify for the Maine Homestead Exemption program.
Question 3 & 3a-require a date for ownership and permanent re
Question 4
-requires that you add 12 months to the date of permanent residency. The 12 months must
be continuous prior to April 1st of a qualifying tax year. If your permanent residency has not
fulfilled the 12 month period prior to April 1st, we will process any eligible applications for
the following tax year.
Question 5-please circle either
Yes or
Question 6
-requires you to complete this section if you have previously owned a primary residence.
Questions 7, 8, 9 & 10
-please answer
by circling either Yes or No and explain below if you have
answered any of the questions No.
7. _____________________________________________________________.
8. _____________________________________________________________.
9. _____________________________________________________________.
10. ____________________________________________________________.
Signature: Please sign and date your application before submitting it to the Assessor's Office.
(36 MSRA Section 681. Definitions)
As used in this subchapter, unless the context otherwise indicates, the following terms have
the following meanings.
Name/Applicant: "Applicant" means an individual who has applied for a Homestead
property tax exemption.
Homestead: "Homestead" means any residential property in the State of Maine
assessed as real property owned by the applicant or held in a
revocable living trust for the benefit of the applicant and occupied
by the applicant as the applicant's permanent residence. A
"homestead" does n
ot include any real property used solely for
commercial purposes.
Permanent resident: "Permanent resident" means an individual who has established a
permanent residence.
Permanent residence: "Permanent residence" means that place where an individual has a
true fixed and permanent home and a principal establishment to
which the individual, whenever absent, has the intention of
returning. An individual may have only one permanent residence at
a time and, once a permanent residence is established, that residence
is presumed to continue until circumstances indicate otherwise.
City of Ellsworth
Please do not hesitate to call if you should have any questions regarding this form.
Assessors Office: 667-8674