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 fi 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, 
Certifi cate of Disability for the Homestead Exemption, and attach it or a separate certification 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 

                                                FOR COUNTY  AUDITOR’S USE ONLY: 
  Taxing district and parcel or registration number                        Auditor’s application number 
  
  First year for homestead exemption 
  
 Date filed                                                  
                                                                                                                      
  Name on tax duplicate 
                                                                                                                      
  Taxable value of homestead: Taxable land                      Taxable bldg.                       Taxable total 
                                             Method of Verification (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 
                                                                  - 1 -

                                                                                                                              DTE 105A 
                                                                                                                              Rev. 9/16 

In order to be eligible for the homestead exemption, the form of ownership must be identifi 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 qualifi 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 fi 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 fi 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 defi ned in I.R.C. 6103 and received from the Internal Revenue  
Service. I expressly waive the confi 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 confi 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 

                                                           - 2 -

                                                                                                                                          DTE 105A 
                                                                                                                                          Rev. 9/16 

                            Please read before you complete the application. 
What is the Homestead Exemption? The homestead exemp-                      fined as the adjusted gross income for Ohio income tax purposes 
tion provides a reduction in property taxes to qualifi ed senior or       (line 3 of Ohio income tax return) of the owner and the owner’s  
disabled citizens, or a surviving spouse, on the dwelling that is that   spouse for the year preceding the year for which you are applying. 
individual’s principal place of residence and up to one acre of land     If you do not fi le an Ohio income tax return, you will be asked to 
of which an eligible individual is an owner. The reduction is equal      produce a federal income tax return for you and your spouse. If 
to the taxes that would otherwise be charged on up to $25,000 of         you do not fi le a federal income tax return, you will be asked to pro-
the market value of an eligible taxpayer’s homestead.                    duced evidence of income and deductions allowable under Ohio 
                                                                         law so that the auditor may estimate Ohio adjusted gross income. 
What Your Signature Means: By signing the front of this form, 
you affi rm under penalty of perjury that your statements on the          Current Application: If you qualify for the homestead exemption  
form are true, accurate and complete to the best of your knowl-          for the fi rst time this year (for real property) or for the first time next 
edge and belief and that you are authorizing the tax commissioner        year (for manufactured or mobile homes), check the box for Current  
and the county auditor to review fi nancial and tax information filed      Application on the front of this form.   
with the state. A conviction of willfully falsifying information on this 
application will result in the loss of the homestead exemption for a     Late Application:  If you also qualifi ed for the homestead exemption  
period of three years.                                                   for last year (for real property) or for this year (for manufactured or  
                                                                         mobile homes) on the same property for which you are fi ling a cur-
Qualifi cations for the Homestead Exemption for Real Property             rent application, but you did not fi le a current application for that year,  
and Manufactured or Mobile Homes:  To receive the homestead              you may fi le a late application for the missed year by checking the  
exemption you must be (1) at least 65 years of age during the            late application box on the front of this form. You may only fi le a late  
year you first fi le, or be determined to have been permanently and        application for the same property for which you are fi ling a current  
totally disabled (see defi nition at right), or be a surviving spouse     application.  
(see defi 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      Defi nition of a Surviving Spouse:  An eligible surviving spouse 
you fi le the application. For manufactured or mobile home owners,        must (1) be the surviving spouse of a person who was receiving 
the dates apply to the year following the year in which you fi le the     the homestead exemption by reason of age or disability for the 
application. A person only has one principal place of residence;         year in which the death occurred, and (2) must have been at least 
your principal place of residence determines, among other things,        59 years old on the date of the decedent’s death. 
where you are registered to vote and where you declare residency 
for income tax purposes. You may be required to present evidence         Permanent Disability: Permanent and totally disabled means a 
of age. If the property is being purchased under a land contract,        person who has, on the fi rst day of January of the year for which 
is owned by a life estate or by a trust, or the applicant is the mort-   the homestead exemption is requested, some impairment of body 
gagor of the property, you may be required to provide copies of          or mind that makes him/her unfi t to work at any substantially remu-
any contracts, trust agreements, mortgages or other documents            nerative employment which he/she is reasonably able to perform 
that identify the applicant’s eligible ownership interest in the home.   and which will, with reasonable probability, continue for an indefi-
                                                                         nite period of at least 12 months without any present indication 
If you are applying for homestead and did not qualify for the ex-        of recovery, or who has been certifi ed as totally and permanently 
emption for 2013 (2014 for manufactured homes), your total in-           disabled by an eligible state or federal agency. 
come cannot exceed the amount set by law. “Total income” is de-

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