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PTAX-340 - 2022 Senior Citizens Assessment Freeze Homestead Exemption Application and Affidavit

  1. Last date to apply:


  2. Have you or your spouse received this exemption for this property previously?*
  3. If your spouse maintains a separate residence, has he or she applied for this exemption?*
  4. Income Information

  5. 2021 Federal Income Tax Return
    End of the year Social Security statement

  6. Part 4: Affidavit

  7. 1. On January 1, 2021, the property identified in Part 2, Line 1, was improved with a permanent structure
  8. 2. On January 1, 2021, I
  9. 3. I am liable for paying real property taxes on the property identified in Part 2, Line 1.

    Note: If I have not received this exemption for this property previously, I also met the eligibility requirements listed in Part 4, Lines 1, 2, and 3 for this property on January 1, 2020

  10. 4. (Mark the statement that applies.)
  11. 5. The property identified in Part 2, Line 1, is the only property for which I am applying for a senior citizens assessment freeze homestead exemption for 2021
  12. 6. The amount reported in Part 3, Line 13, of this form includes the income of my spouse and all persons living in my household and the total household income for 2020 is $65,000 or less
  13. 8. On January 1, 2021, I was
  14. My spouse’s name and address (if different)is:
  15. Under penalties of perjury, I state that, to the best of my knowledge, the information contained in this affidavit is true, correct, and complete
  16. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  17. Note: The CCAO may conduct an audit to verify that the taxpayer is eligible to receive this exemption.
  18. Leave This Blank:

  19. This field is not part of the form submission.