Enlarge image | 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. |
Enlarge image | 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). |