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2. Parcel Number*
   PIN, Tax ID, Property Identification Number
3. Assessment year *
   -- Select One --20212022

   Year for which you are applying for

5. First Name*
6. Last Name*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Email Address
17. Is this the only property for which you have applied for a homestead exemption? *

    1. Yes
    2. No
18. Are you liable for the payment of real estate taxes?*

    1. Yes
    2. No
20. Did you receive the SHEVD for the prior assessment year on this property?*

    1. Yes
    2. No
21. Select the amount of the SHEVD received
    -- Select One --$2,500 EAV Reduction$5,000 EAV ReductionProperty tax exempt residence
23. Check the statement that applies*

    1. Veteran with a disability who currently has a service- connected disability of 30% or more but less than 50%.
    2. Veteran with a disability who currently has a service- connected disability of 50% or more but less than 70%.
    3. Veteran with a disability who currently has a service- connected disability of 70% or more. If this is an increase from the prior year, you must submit documentation verifying the increase.
    4. Un-remarried, surviving spouse who previously received the SHEVD.
25. Awards letter (if percentage of disability has changed)
    If your disability percentage has changed, please submit a new awards letter.
27. On January 1, were you the owner of the property?*

    1. Yes
    2. No
29. On January 1, did you occupy this property as your principal residence?*

    1. Yes
    2. No
30. If “No,” complete

    1. Were you a resident of a facility licensed under the Nursing Home Care Act?
    2. Was this property occupied by your spouse or did it remain unoccupied?

    Select all that apply
32. On January 1, were you a resident of a facility licensed under the Nursing Home Care Act or operated by the U.S. Department of Veterans’ Affairs?

    1. Yes
    2. No
33. If “Yes,” complete
    Enter the name and address of the facility.
34. If “Yes,” please select
    -- Select One --The property occupied by your spouse?The property remain unoccupied?
36. 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.

    1. I agree.
38. Electronic Signature*
    I state that to the best of my knowledge, the information contained on this application is true, correct, and complete
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

* indicates a required field