Commonwealth of Kentucky
REVENUE CABINET		 APPLICATION FOR EXEMPTION
UNDER THE HOMESTEAD / DISABILITY AMENDMENT   		 
County                
Date Submitted:                  
Application is hereby made for the homestead exemption provided by Section 170 of the Kentucky Constitution.
1.Name(s) of owner-applicant(s) in whose name(s) title is vested:
      
2.Name of Applicant(s)Applicant's Date of BirthCo-Applicant Date of Birth
 
  
 
 
3.Address of residence
 		   
  Location
 		   
  Description
 		   
4.Type of residential unit: single family duplex apartment building mobile home condominium
  other (describe)
 
5.Type of ownership: fee simple equitable title jointly with survivorship jointly in common by stock ownership or membership representing the owner's or member's proprietary interest in a multi-family structure
6.Amount of Exemption: If ownership is fee simple, equitable title, jointly with survivorship or jointly in common, applicant receives full exemption or up to the assessed value of his interest in the property, whichever is less.
If ownership is by stock ownership or membership, the amount of exemption is full exemption or the percentage that the applicant's ownership bears to the total value of the property. (Example: Total value of the structure = $50,000; applicant's stock ownership = 10%; exemption limit = $5,000.)
AFFIDAVIT AND OATH
I, ______________________ , hereby swear(affirm) under penalty of perjury that I(we) am(are) the owner(s) of the property for which this assessment exemption is sought; that I(we) occupy and maintain this residential unit as my(our) personal residence; that I(we) am(are) 65 years of age or over, or totally disabled; and that all information contained in this application is true and correct.
 
Signature of Applicant
Date
 
Signature of Spouse
Date
RESERVED FOR OFFICIAL USE
This application is Approved Disapproved.
Property Valuation Administrator
Date