DTE 105A
                                                                                                                                      Rev. 10/19

                    Homestead Exemption Application for Senior Citizens, 
                         Disabled Persons and Surviving Spouses
 Real property and manufactured or mobile homes: File with the county auditor on or before December 31.

Please read the instructions on the back of this form before you complete it. Disabled applicants must complete form DTE 105E, 
CertificateofDisabilityfortheHomesteadExemption,andattachitoraseparatecertificationofdisabilitystatusfromaneligiblestateor
federal agency to this application. See 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 December 31st of the year for which the exemption is sought)            
 Disabled person (must be permanently and totally disabled on January 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 
Homeaddress
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
 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 MAGI                             No information returned
 Ohio tax return (line 3 plus line 11 of Ohio Schedule A): Year                 Total MAGI
 Federal tax return (line 4, 1040EZ): Year                                      Total FAGI
                    (line 21, 1040A): Year                                      Total FAGI
                    (line 37, 1040): Year                                       Total FAGI
 Worksheet (attached): Estimated MAGI
  Granted Denied
 County auditor (or representative)                                                       Date
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                                                                                                                        DTE 105A
                                                                                                                        Rev. 10/19

In order to be eligible for the homestead exemption, the form of ownership must be identified. 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
 astockholderinaqualifiedhousingcooperative.SeeformDTE105A                 –Supplementforadditionalinformation.
 other
 
If the applicant or the applicant’s spouse owns a second or vacation home, please provide the address and county below. 

                                                                                     ZIP                       County

HaveyouordoyouintendtofileanOhioincometaxreturnforlastyear?                YesNo
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 January 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 
propertyforwhichIamseekingexemptionislocated,andtotheirdesignatedagents,theauthoritytoreleasemytaxand/orfinancialrecordsand
to examine and consult regarding such records for the purpose of determining my eligibility for the homestead exemption or a possible violation of 
thehomesteadlaws.SuchrecordsshallnotcontainanyfederaltaxinformationasdefinedinI.R.C.6103andreceivedfromtheInternalRevenue
Service.IexpresslywaivetheconfidentialityprovisionsoftheOhioRevisedCode,includingO.R.C.5703.21and5747.18,whichmayotherwise
prohibit disclosure, and agree to hold the Ohio tax commissioner and county auditor harmless with respect to the limited disclosures herein.  Except 
asauthorizedbylaw,thepartiestowhichthisauthorityisdelegatedshallmaintaintheconfidentialityoftheinformationreceivedandtheinformation
shall not otherwise be re-disclosed.   

Signature of applicant                                      Signature of spouse

Mailing address                                             Date

Phone                                                       E-mailaddress

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                                                                                                                           DTE 105A
                                                                                                                           Rev. 10/19

                          Please read before you complete the application.
What is the Homestead Exemption? The homestead exemp-                    “total income” is defined as “modified adjusted gross income,”
tion provides a reduction in property taxes to qualified senior or       which is comprised of Ohio adjusted gross income plus any busi-
disabled citizens, or a surviving spouse, on the dwelling that is that   ness income deducted on Schedule A, line 11 of your Ohio IT 
individual’s principal place of residence and up to one acre of land     1040. “Total Income” is that of the owner and the owner’s spouse 
of which an eligible individual is an owner. The reduction is equal      for the year preceding the year for which you are applying. If you 
to the taxes that would otherwise be charged on up to $25,000 of         donotfileanOhioincometaxreturn,youwillbeaskedtoproduce
the market value of an eligible taxpayer’s homestead.                    a federal income tax return for you and your spouse. If you do not 
                                                                         file a federal income tax return, you will be asked to produce evi-
What Your Signature Means: By signing the front of this form,            dence of income and deductions allowable under Ohio law so that 
you affirm under penalty of perjury that your statements on the          theauditormayestimateOhiomodifiedadjustedgrossincome.
form are true, accurate and complete to the best of your knowl-
edge and belief and that you are authorizing the tax commissioner        Current Application: If you qualify for the homestead exemption 
andthecountyauditortoreviewfinancialandtaxinformationfiled               forthefirsttimethisyear(forrealproperty)orforthefirsttimenext
with the state. A conviction of willfully falsifying information on this year (for manufactured or mobile homes), check the box for Current 
application will result in the loss of the homestead exemption for a     Application on the front of this form.  
period of three years.  
                                                                         Late Application: Ifyoualsoqualifiedforthehomesteadexemption
Qualifications for the Homestead Exemption for Real Property             for last year (for real property) or for this year (for manufactured or 
and Manufactured or Mobile Homes: To receive the homestead               mobile homes) on the same property for which you are filing a cur-
exemption you must be (1) at least 65 years of age during the            rentapplication,butyoudidnotfileacurrentapplicationforthatyear,
yearyoufirstfile,orbedeterminedtohavebeenpermanentlyand                  you may file a late application for the missed year by checking the
totally disabled (see definition at right), or be a surviving spouse     lateapplicationboxonthefrontofthisform.Youmayonlyfilealate
(seedefinitionatright),and(2)ownandhaveoccupiedyourhome                  application for the same property for which you are filing a current
as your principal place of residence on Jan. 1 of the year in which      application. 
youfiletheapplication.Formanufacturedormobilehomeowners,
thedatesapplytotheyearfollowingtheyearinwhichyoufilethe                  Definition of a Surviving Spouse: An eligible surviving spouse 
application. A person only has one principal place of residence;         must (1) be the surviving spouse of a person who was receiving 
your principal place of residence determines, among other things,        the homestead exemption by reason of age or disability for the 
where you are registered to vote and where you declare residency         year in which the death occurred, and (2) must have been at least 
for income tax purposes. You may be required to present evidence         59 years old on the date of the decedent’s death. 
of age. If the property is being purchased under a land contract, 
is owned by a life estate or by a trust, or the applicant is the mort-   Permanent Disability: Permanent and totally disabled means a
gagor of the property, you may be required to provide copies of          person who has, on the first day of January of the year for which
any contracts, trust agreements, mortgages or other documents            the homestead exemption is requested, some impairment of body 
that identify the applicant’s eligible ownership interest in the home.   ormindthatmakeshim/herunfittoworkatanysubstantiallyremu            -
                                                                         nerative employment which he/she is reasonably able to perform 
If you are applying for homestead and did not qualify for the ex-        and which will, with reasonable probability, continue for an indefi-
emption for 2013 (2014 for manufactured homes), your total in-           nite period of at least 12 months without any present indication 
come cannot exceed the amount set by law. Beginning tax year             of recovery, or who has been certified as totally and permanently
2020 for real property and tax year 2021 for manufactured homes,         disabled by an eligible state or federal agency.

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