Georgia Application for Property Tax Homestead Exemption

Application for Property Tax Homestead Exemption
LGS-Homestead - Application for Homestead Exemption
APPLICATION FOR HOMESTEAD EXEMPTION
The homestead exemptions provided for in this Application form are those authorized by Georgia law. Counties are authorized to provide for local homestead
exemptions that may vary from the ones shown on this application. Applicants seeking a local homestead exemption should contact the local Tax
Commissioner or Tax Receiver for additional information. If this application is denied an appeal may be filed in accordance with O.C.G.A. § 48-5-311.

LGS-Homestead Rev 10-08

APPLICANT INFORMATION
SECTION A:
List below the address of any other property where you or your spouse have applied for and been granted a homestead exemption for the current year:
___________________________________________________________________________________________________________________________________________
Are you and your spouse a Georgia resident, US citizen or non-citizen with legal authorization from the US Immigration and Naturalization Service? [ ] YES [ ] NO
If you are a non-citizen with legal authorization from the US Immigration and Naturalization Service, please provide your Legal Alien Registration # ______________________________

Applicant: Name:
Spouse: Name:
Street Address:
Street Address:
City, State, Zip:
City, State, Zip:
Social Security No.:
Social Security No.:
Phone Number:
Year of Birth:
Year of Birth:
Phone Number:
County where you are registered to vote:
County where you are registered to vote:
County where car is registered:
If you and/or your spouse are in the military service, list the state shown as your home of record:
If you answer Yes to Question #1, please follow the instructions to determine if you qualify for an increased homestead amount. Please see the Tax Commissioner or
Receiver for additional information and qualification requirements.
[ ] YES 1. Were you or your spouse age 62 or older as of Jan 1 of the year of this application? Go to Sections C1 and/or C2 on the back of this application to determine
whether you meet certain gross and/or net income requirements.
[ ] YES 2. Is the applicant or spouse a 100% disabled veteran or is the applicant the unremarried surviving spouse of a 100% disabled veteran?
[ ] YES 3. Are you the unremarried surviving spouse of a US service member killed in action?
[ ] YES 4. Are you the unremarried surviving spouse of a firefighter or peace officer killed in the line of duty?
PROPERTY INFORMATION
SECTION B:
Location of Property (Street Address):
Lot Size or Number of Acres:
Date Property Purchased:
From Whom Purchased:
Map/Parcel Number:
Amount of Lien:
Purchase Price:
Land Lot Number:
Land District Number:
Kind of Title Held:
To Whom is Lien due:
Deed Recorded: Book:_____________ Page: ____________
Is any part of the property used for business purposes? [ ] YES [ ] NO
Is any part of the property rented? [ ] YES [ ] NO
If yes, what part is rented?
If yes, what kind of business & how much of the property is used?
AFFIDAVIT OF APPLICANT
I, the undersigned, do solemnly swear that the statements made in support of this application are true and correct, that I am the bona fide owner of the property described
in this application, that I shall occupy or actually occupied same on Jan 1 of the year for which application is made, that I am an eligible applicant for the homestead exemption applied
for, qualifying or meeting the definition of the word "applicant" as defined in O.C.G.A. § 48-5-40 and that no transaction has been made in collusion with another for the purpose
of obtaining a homestead exemption contrary to law.

Sworn to and subscribed to before me this ____ day of __________, 20______
___________________________________
Tax Commissioner or Tax Receiver
[ ] APPROVED
THIS SECTION FOR TAX ASSESSORS USE ONLY:
STATE TAX >>
COUNTY TAX >>
SCHOOL TAX >>

Applicant's Signature: ___________________________________
____________________________ _________
[ ] DENIED
Board of Tax Assessors
Date

CODE

AMOUNT

SECTION C1:
COMPLETE THIS SECTION TO DETERMINE ELIGIBILITY FOR NET INCOME REQUIREMENT
If filing Joint Income Tax Return, Applicant must complete Column 1A only. If filing separately, both Columns 1A and 1B must be completed
INCOME FOR TAX YEAR ENDING DECEMBER 31, 20______

Line
Line
Line
Line
Line
Line
Line
Line
Line
Line

1
2
3
4
5
6
7
8
9
10

Total Income from Public or Private retirement, disability or pension system
Total Income from Social Security
Total Income from both retirement and Social Security (Line 1 plus Line 2)
Maximum Social Security amount (from Tax Receiver)
Retirement Income over maximum Social Security (Line 3 less Line 4) - If less than 0, use 0
Other income from all sources
Adjusted Income (Line 5 plus Line 6)
Standard or Itemized Deductions from Georgia Income Tax Return
Personal Exemption amount from Georgia Income Tax Return
Net Income (Line 7 less Lines 8 and 9)

COLUMN 1A
APPLICANT

COLUMN 1B
SPOUSE

If filing Joint Income Tax Return, Line 10, Column 1A must be less than $10,000. If filing Separately, Total of Line 10, Column 1A plus 1B must be less than $10,000
COMPLETE THIS SECTION TO DETERMINE ELIGIBILITY
FOR FEDERAL ADJUSTED GROSS INCOME REQUIREMENT
For each member residing in the household, complete the social security number & federal adjusted gross income in the spaces below
INCOME FOR TAX YEAR ENDING DECEMBER 31, 20______
FEDERAL
SOCIAL

SECTION C2:

Line
Line
Line
Line
Line
Line
Line

1
2
3
4
5
6
7

Name of Household Member
Name of Household Member
Name of Household Member
Name of Household Member
Name of Household Member
Name of Household Member
Name of Household Member

SECURITY
NUMBER

ADJUSTED GROSS INCOME-TOTAL OF LINES 1 THRU 7 MUST BE LESS THAN $30,000>>>>>>>>>>>>>

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ADJUSTED
GROSS INCOME