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PTAX343-R Annual Verification of Eligibility for the Homestead Exemption for Persons with Disabilities (HEPD)

  1. PIN, Tax ID, Property Identification Number

  2. Please upload your proof of disability.

  3. Is this the only property for which you have applied for this exemption?*

  4. On January 1, were you the owner of record, or have a legal or equitable interest, or have a life care contract with a facility under the Life Care Facilities Act?*

  5. Are you liable for the payment of real estate taxes?*

  6. On January 1, did you occupy this property as your primary residence?*

  7. On January 1, were you a resident of a facility licensed under the ID/DD (intellectually disabled/developmentally disabled) Community Care Act, Nursing Home Care Act, Specialized Mental Health Rehabilitation Act of 2013, or MC/DD (Medically Complex for the Developmentally Disabled) Act?*

  8. enter the name and address of the facility

  9. was this property occupied by your spouse or did it remain unoccupied?

  10. 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.

  11. I state under penalties of perjury that to the best of my knowledge, the information contained in this application is true, correct, and complete.

  12. Leave This Blank:

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