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PTAX-343-R Annual Verification of Eligibility for Disabled Persons’ Homestead Exemption Step 2: Complete your affidavit Part 1: Check either “yes” or “no” as it applies to the property and assessment year you identified in Step 1. 5 Is this the only property for which you have applied for this exemption? Yes No 6 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? Yes No 7 Are you liable for the payment of real estate taxes? Yes No 8 On January 1, did you occupy this property as your primary residence? Yes No 9 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 or Specialized Mental Health Rehabilitation Act? Yes No If Yes, a write the name and address of the facility. b was this property occupied by your spouse or did it remain unoccupied? Yes No Part 2: Mark the statement to identify the proof of disability that qualifies you for the DPHE If your proof of disability benefits has expired, terminated or switched to retirement from the prior assessment year, your CCAO may require additional documentation. If you check below, you must attach your completed Form PTAX-343-A. See instructions. 10 a Valid Class 2 or 2A Illinois Disabled Person Identification Card issued from the Illinois Secretary of State. ID card number: Issue date: Class: Expiration date: b Social Security Administration (SSA) disability benefits — Claim no.: c Veterans Administration (VA) pension for a non-service connected disability — Claim/file no.: d Railroad or Civil Service disability benefits for total (100%) disability — Claim/file no.: e Form PTAX-343-A, Physician’s Statement for Disabled Persons’ Homestead Exemption. Read this first To continue to receive the Disabled Persons’ Homestead Exemption (DPHE), you must file Form PTAX-343-R each year with your Chief County Assessment Officer (CCAO) by your county’s due date. Failure to do so may result in the termination of the exemption. Step 1: Complete the following information 1 Property owner’s name Street address of homestead property City State ZIP - Daytime phone 2 Your date of birth:___ 3 Assessment year for which you are requesting the Disabled Persons’ Homestead Exemption: Year 4 Write the property index number (PIN) of the property for which you receive the exemption listed on your property tax bill. You may obtain it from your CCAO. If you are unable to obtain your PIN, attach a copy of the legal description. a PIN Step 3: Sign below I state under penalties of perjury that to the best of my knowledge, the information contained in this application is true, correct, and complete. Property owner’s or authorized representative’s signature Date IL Last date to apply: PTAX-343-R (R-11/11) IL-492-4536 Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes. 07 31 ---PAGE BREAK--- Form PTAX-343-R General Information What is the Disabled Persons’ Homestead Exemption? The Disabled Persons’ Homestead Exemption (DPHE) (35 ILCS 200/15-168) provides an annual $2,000 reduction in the equal ized assessed value (EAV) of the property owned and occupied as the primary residence on January 1 of the assessment year by a disabled person who is liable for the payment of property taxes. Who is eligible? To qualify for the DPHE you must • be disabled or have become disabled during the assessment year cannot participate in any “substantial gainful activity by reason of a medically determinable physical or mental impairment” which will result in the person’s death or that will last for at least 12 continuous months), • own or have a legal or equitable interest in the property on which a single-family residence is occupied as your primary residence on January 1 of the assessment year, and • be liable for the payment of the property taxes. If you previously received the DPHE and now reside in a facility licensed under the ID/DD (intellectually disabled/developmen tally disabled) Community Care Act, Nursing Home Care Act, or Specialized Mental Health Rehabilitation Act you are still eligible to receive the DPHE provided your property • is occupied by your spouse; or • remains unoccupied during the assessment year. If you are a resident of a cooperative apartment building or life care facility as defined under Section 2 of the Life Care Facilities Act (210 ILCS 40/1 et. seq.) you are still eligible to receive the DPHE provided you occupy the property as your primary residence and you are • liable by contract with the owner(s) of record for the payment of the apportioned property taxes on the property; and • an owner of record of a legal or equitable interest in the cooperative apartment building. Leasehold interest does not qualify for this exemption. What documentation is required? Your Chief County Assessment Officer (CCAO) may request you to provide documentation as proof of your disability to continue to qualify for the DPHE. You must provide documentation if your proof of disability has changed or expired from the prior year, including Social Security Administration’s disability benefits that switched over to retirement benefits. The proof of disability must be for the same year as the assessment year shown on Line 3 of this application. If you are unable to provide any of the items listed below as proof of your disability, you must resubmit Form PTAX 343-A, Physi cian’s Statement for Disabled Persons’ Homestead Exemption, each year to your CCAO. This form must be completed by a physician. You are responsible for any physicians’ costs. 1 A Class 2 Illinois Disabled Person Identification Card from the Illinois Secretary of State’s Office. Class 2 or Class 2A qualifies for this exemption. Class 1 or 1A does not qualify. 2 Proof of Social Security Administration disability benefits which includes an award letter, verification letter or annual Cost of Living Adjustment (COLA) letter (only COLA Form SSA-4926- SM-DI). If you are under the age of 65 receiving Supplemental Security Income (SSI) disability benefits, proof includes a letter indicating SSI payments (COLA Forms SSA-L8151, SSA-L8155, or SSA-L8156). 3 Proof of Veterans Administration disability benefits which includes an award letter or verification letter indicating you are receiving a pension for a non-service connected disability. 4 Proof of Railroad or Civil Service disability benefits which includes an award letter or verification letter of total (100%) disability. When will I receive my exemption? The year you apply (renew) for this exemption is referred to as the assessment year. The County Board of Review while in ses sion for the assessment year has the final authority to grant your exemption. If your exemption is granted, it will be applied to the property tax bills that are paid the year following the assessment year. When and where must I file Form PTAX-343-R? To continue to receive this exemption, you must file Form PTAX-343-R, each year with your CCAO. Failure to do so may result in termination of the exemption. Contact your CCAO at the telephone number or address below for assistance and to verify your county’s due date. File or mail your completed Form PTAX-343-R: County, CCAO Mailing address City IL ZIP If you have any questions, call: Can I designate another person to receive a property tax delinquency notice for my property? Yes. Contact your CCAO for information on how to designate an other person to receive a duplicate of a property tax delinquency notice for your property. Are there other homestead exemptions available for disabled persons or disabled veterans? Yes. However, only one of the following disabled homestead exemp tions may be claimed on your property for a single assessment year • Disabled Veterans’ Homestead Exemption • Disabled Persons’ Homestead Exemption • Disabled Veterans’ Standard Homestead Exemption Official use. Do not write in this space. Date received:___ Verify Proof of Disability: 1 2 3 4 343-A Expiration date:___ Board of review action date: Approved Denied Reason for denial PTAX-343-R (R-11/11) McLean 115 E Washington St Rm 101 PO Box 2400 Bloomington 61701 [PHONE REDACTED] Reset Print