DTE 105E
                                                                                                             Rev. 10/19

                     Certificate of Disability for the Homestead Exemption
                     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 first 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 indefinite period of at least twelve months without any present indication of recovery 
therefrom or has been certified 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 January 1,           , 
                                                         Name of applicant 

and is now permanently and totally disabled according to the above definition 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 defined above. See the back page of this form for 
more information on what constitutes acceptable proof of permanent disability.

    Acceptable and Unacceptable Proofs of Permanent and Total Disability
Physician’s Certificate: Acceptable. An application based        Railroad Retirement Board (RRB): The RRB has two types 
on physical disability must include a certificate signed by a    of disability pensions: (1) total and permanent disability and 
physician. An application based on mental disability must        (2) occupational disability. Only the “permanent and total 
include a certificate signed by a physician or a psychologist    disability” pension is acceptable.  
licensed to practice in Ohio. Note: Neither a chiropractor 
nor certified nurse practitioner is considered a “physician”     State Agencies:
for purposes of the Homestead Law. 
                                                                 Bureau of Workers Compensation: A determination of 
Federal Agencies:                                                “permanent and total disability” is acceptable. Other de-
                                                                 terminations,  such  as  “permanent  and  partial  disability” 
Social Security Administration (SSA): An SSA (or SSI)            “temporary and total disability,” and “temporary and partial 
form indicating that an applicant is “disabled” is acceptable.   disability” are not. 
The SSA only gives disability benefits to those who are per-
manently and totally disabled.                                   State Retirement Systems:     Not acceptable. The Public 
                                                                 Employees Retirement System (PERS), the State Teachers 
Department of Veterans Affairs (VA): Veterans with a total       Retirement System and the School Employees Retirement 
service-connected disability or veterans who are receiving       System (SERS), do not certify permanent and total disability. 
100% compensation for service-connected disabilities follow-     While the State Highway Patrol Retirement System (HPRS) 
ing a determination of individual unemployability should file    and the Police and Firemen’s Disability and Pension Fund 
DTE form 105I and submit the documentation indicated by          (PFDPF) do certify individuals to be “permanently and totally 
that application. If a veteran does not qualify as an eligible   disabled” these determinations are job-specific and do not 
disabled  veteran,  but  meets  the  definition  found  in  R.C. rule out the possibility of other substantially remunerative 
323.151(D) (provided at the top of this form), the veteran       employment using a different set of skills.
must have a doctor or qualifying psychologist complete this 
form. No VA documentation reflects the statutory definition 
of permanent and total disability in R.C. 323.151(D).