HEX Application - McCracken County PVA

Requirements to complete this form:

Properly complete this application. All fields with a red * are required,
Photo of driver's license. The address on your driver's license must match the address of the home. Birthday and address must be readable.

Date

Email Address *

Property Owner Name(s) *

Name of Applicant #1 *

Applicant #1 Date of Birth *

Name of Applicant #2

Applicant #2 Date of Birth

Street Address of Personal Residence

City

State

Zip Code

Description

Mailing Address (if different from above)

Phone Number

Date of Ownership

Have you applied for, or are you receiving, the homestead exemption in a different location, county, or state? *

No

YesYes

Type of residential unit: (select one) *

Type of Ownership (select one) *

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

Note: 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 and that I (we) do not or will not claim an exemption for any other property in this Commonwealth or another state. I further swear (affirm) that I (we) maintain this residential unit as my (our) primary 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.
If qualifying under the disability provision under KRS 132.810(2), I do further swear (affirm) under penalty of perjury that my disability is continuing and that if my disability status changes and benefits are no longer received I shall report such changes to the property valuation administrator’s office as required by KRS 132.810(4)(b). Failure to do so could result in supplemental bills being issued for the amount of the exemption received for up to a period of five years.

Applicant #1 Electronic Signature *

Clear

This form can be signed on your tablet, phone or desktop computer using your finger or mouse. Or, you can click the blue Keyboard icon above and type your name.

Applicant #2 Electronic Signature

Clear

This form can be signed on your tablet, phone or desktop computer using your finger or mouse. Or, you can click the blue Keyboard icon above and type your name.

Applicant #1 Driver's License *

Maximum file size: 20MB

Drivers license must match address of home.

Applicant #2 Driver's License

Maximum file size: 20MB

Drivers license must match address of home.