Form DTE 105E is a one-page document used to provide information about a company's trademark. The form can be filled out and filed with the United States Patent and Trademark Office (USPTO) to request protection for a trademark. The form must be completed in full, and all fields must be accurate and legible. The instructions provided on the form must be followed closely in order to ensure that the application is processed correctly. A company's trademarks are an important part of its business, so it is crucial to file for protection as soon as possible. Filing for trademark protection with the USPTO is a simple process, and Form DTE 105E makes it easy to get started.
| Question | Answer |
|---|---|
| Form Name | Form Dte 105E |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | remunerative, form dte 105e, Jan, 105A |
DTE 105E
Rev. 10/07
Certifi cate of Disability for the Homestead Exemption
Attach this form to the homestead exemption application (form DTE 105A)
if the applicant is requesting the homestead exemption based on disability status.
Ohio Revised Code section 323.151: “ ‘Permanently and totally disabled’ means a person who has, on the first day of Janu- ary of the year of application for reduction in real estate taxes, some impairment in body or mind that makes the person un- able to work at any substantially remunerative employment that the person is reasonably able to perform and that will, with reasonable probability, continue for an indefinite period of at least twelve months without any present indication of recovery therefrom or has been certified as permanently and totally disabled by a state or federal agency having the function of so classifying persons.”
To be completed by the applicant
Applicant’s name
Home address
To be completed by the physician, psychologist or state or federal agency representative.
In accordance with the above, I (we) hereby certify that |
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was, as of Jan. 1, |
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Name of applicant |
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and is now permanently and totally disabled according to the above defi nition by virtue of physical disability or
mental disability.
Ohio license number |
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Physician (signature) |
Print name of person signing form |
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Psychologist (signature) |
Address (please print) |
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Agency (please print) |
City |
State |
ZIP code |
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If agency, signature and title of person completing the form |
Date |
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In lieu of having a physician or psychologist licensed to practice in Ohio sign this form, the applicant may submit a statement from an eligible state or federal agency that the applicant is permanently and totally disabled as defined above. See the back page of this form for more information on what constitutes acceptable proof of permanent disability.
Acceptable and Unacceptable Proofs of Permanent and Total Disability
Physician’s Certificate: Acceptable. An application based on physical disability must include a certificate signed by a physician licensed to practice in Ohio. An application based on mental disability must include a certificate signed by a phy- sician, which includes a psychiatrist or psychologist licensed to practice in Ohio. Note: A chiropractor is not a “physician” for purposes of the Homestead Law.
Federal Agencies:
Social Security Administration (SSA): An SSA (or SSI) form indicating that an applicant is “disabled” is acceptable. The SSA only gives disability benefits to those who are per- manently and totally disabled.
Department of Veterans Affairs (VA): Not acceptable, un- less the individual is also determined to have “individual un- employability.” The VA certifies all members as “permanently and totally disabled,” whether or not they are employable.
Railroad Retirement Board (RRB): The RRB has two types
of disability pensions: (1) total and permanent disability and
(2)occupational disability. Only the “permanent and total disability” pension is acceptable.
State Agencies:
Bureau of Workers Compensation: A determination of “permanent and total disability” is acceptable. Other de- terminations, such as “permanent and partial disability” “temporary and total disability,” and “temporary and partial disability” are not.
State Retirement Systems: Not acceptable. The Public Employees Retirement System (PERS), the State Teachers Retirement System and the School Employees Retirement System (SERS), do not certify permanent and total disability. While the State Highway Patrol Retirement System (HPRS) and the Police and Firemen’s Disability and Pension Fund (PFDPF) do certify individuals to be “permanently and totally disabled” these determinations are