District of Columbia Homestead and Senior Citizen Tax Benefit Appeal Application

Homestead and Senior Citizen Tax Benefit Appeal Application
Microsoft Word - CANCELLATIONOFHOMESTEADDEDUCTION Nov 14 edits(clean) (2).docx
Government of the
District of Columbia

*001070110000 *

ASD-107 Benefit Appeal Application

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Print in CAPITAL letters using black ink. Leave lines blank that do not apply.
Benefit Appeal:

HOMESTEAD

DISABLED TAX RELIEF

SENIOR

PART 1 – PERSONAL INFORMATION
Owner Social Security Number (SSN)

Co-owner SSN

Owner First Name

M.I.

Last Name

Co-owner First Name

M.I.

Last Name

Current mailing address (number and street)

City

State

Zip Code +4

Email address

PART 2 – PROPERTY INFORMATION
Quadrant

Property address (number and street)-REQUIRED

Square

Suffix

Lot

Unit Number

Zip Code +4

PART 3 – APPEAL REASONS
PLEASE INDICATE WHAT TAX YEAR YOU ARE APPEALING:
To be eligible for the any of these benefits 1. The owner/applicant must be domiciled in the District of Columbia; 2. The property must be the
principal residence of the owner/applicant; 3. The property must be occupied by the owner/applicant and contain no more than five dwelling
units (including the unit occupied by the owner; and 4. an application must be on file with the Office of Tax and Revenue.
Note: The property cannot receive the Homestead tax benefit if it is held in an irrevocable trust or if the record owner is a corporation or
business entity (except a partnership in which all partners occupy the property as their principal residence).
For more information on the eligibility requirements for the Homestead, Senior Citizen, and Disabled property tax relief programs, you can
visit: https://otr.cfo.dc.gov/page/homesteadsenior-citizen-deduction.
Please state below clearly your reasons for appealing the decision of the Office of Tax and Revenue and enclose any
documentation that would help substantiate the property's eligibility to receive the property tax benefit(s).
(Please attach any supporting documentation with your appeal form)

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Form ASD-107 (Rev. 01/2022)

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ASD-107
Page 2

*001070120000 *

Name
SSN

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PART 3 – APPEAL REASONS CONT'D

PART 4 – SIGNATURE

The applicant who is an owner of record of the property or trust beneficiary must sign and date this application.
Making a false statement on this form is punishable by criminal penalties under DC Official Code §47-4106 and §22‐2405. Under
penalties of law, I declare that I have examined this document and its attachments, if any, and to the best of my knowledge, it is correct.
Owner signature

Printed First name

Date (mmddyyyy)

M.I.

Daytime phone

Last name

If you have further questions, you may reach us at (202) 727-4TAX(4829), FAX: (202) 442-6691, WEBSITE: MyTax.DC.gov
MAIL TO: Office of Tax and Revenue, 1101 4th Street SW, 4th Fl, Washington, DC 20024

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Form ASD-107 (Rev. 01/2022)

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