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                                                                                                              DTE 105E 
                                                                                                              Rev. 2/16 

                 Certifi cate 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 indefi nite period of at least twelve months without any present indication of recovery 
therefrom or has been certifi 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,     , 
                                                         Name of applicant 

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



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       Acceptable and Unacceptable Proofs of Permanent and Total Disability 
Physician’s Certifi cate: Acceptable. An application based      Railroad Retirement Board (RRB): The RRB has two types 
on physical disability must include a certifi cate 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 certifi cate signed by a physician or a psychologist  disability” pension is acceptable. 
licensed to practice in Ohio. Note:  A chiropractor is not a 
“physician” for purposes of the Homestead Law.                 State Agencies: 
Federal Agencies:                                              Bureau of Workers Compensation:       A determination of  
                                                               “permanent and total disability” is acceptable. Other de-
Social Security Administration (SSA): An SSA (or SSI)          terminations, such as “permanent and partial disability”  
form indicating that an applicant is “disabled” is acceptable. “temporary and total disability,” and “temporary and partial 
The SSA only gives disability benefi ts to those who are per-   disability” are not. 
manently and totally disabled. 
                                                               State Retirement Systems:     Not acceptable. The Public  
Department of Veterans Affairs (VA): Veterans with a total     Employees Retirement System (PERS), the State Teachers 
service-connected disability or veterans who are receiving     Retirement System and the School Employees Retirement 
100% compensation for service-connected disabilities follow-   System (SERS), do not certify permanent and total disability. 
ing a determination of individual unemployability should file   While the State Highway Patrol Retirement System (HPRS) 
DTE form 105I and submit the documentation indicated by        and the Police and Firemen’s Disability and Pension Fund 
that application. If a veteran does not qualify as an eligible (PFDPF) do certify individuals to be “permanently and totally 
disabled veteran, but meets the defi  nition found in R.C.      disabled” these determinations are job-specifi c and do not 
323.151(D) (provided at the top of this form), the veteran     rule out the possibility of other substantially remunerative 
must have a doctor or qualifying psychologist complete this    employment using a different set of skills. 
form. No VA documentation refl ects the statutory definition 
of permanent and total disability in R.C. 323.151(D). 






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