Disabled Exemption

Application Form

Income/Asset Worksheet

*Please print and complete both applications above

Disabled Exemption Qualifications

Criteria

1. The applicant must have been a New Hampshire resident for five years prior to April 1st.
2. The applicant must have owned the residence by April 1st individually or jointly, or if a spouse owns the resuidence, they must have been married for at least five years.
3. The applicant must have a net income of less then $35,000.  If married, a combined net income of less than $50,000.
4. Net income is to be determined by deducting from all monies received from any source whatsoever, the amount of any of the following, or the sum thereof:
   1. Life insurance paid on the death of the insured
   2. Expenses and costs incurred when conducting a business enterprise
   3. Proceeds from the sale of assets
5. The applicant cannot have assets in excess of $150,000, excluding the value of the dwelling.  Any units of a multi-family home not occupied by the exemption recipient are considered to be an asset.
6. If your income or asset level changes and you no longer qualify for the exemption, you are obligated by law to advise the Assessing Department.
7. If your property is held in a trust, you must supply a copy of the trust instrument and a State of Qualification (PA-33) must be completed and submitted with the appropriate documents (see below).

Disabled homeowners, regardless of age, may apply for the disabled exemption.

Also, proof of 100% disability must be provided through Social Security Administration/

IF APPROVED: Exemption = $70,000

Documents required for NEW Applicants

1. SSA – 1099 Statement (Social Security Benefit Statement)
2. Previous year’s income tax form – If not filing a federal income tax form, the following forms will be required if applicable:
   1. 1099R – Distribution of pensions, annuities
   2. W-2 Wage Statements
   3. 1099 Interest Statement
3. Bank statements and verification of assets listed