Homestead Qualification Survey

Homestead Qualification Survey
Please complete this survey to determine your eligibility for the homestead program.
Applicant Full Name*
First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Property Address for Homestead Application*
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
YesNo
YesNo
How long have you continuously lived at this property?*
How many people live in your household (including yourself)?*
YesNo
Please indicate your total household income bracket for the last year.*

Please rate your agreement with the following statements regarding your homestead application:*

Rows	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I occupy this property as my main home.
I have not claimed a homestead exemption elsewhere.
All information provided is accurate to the best of my knowledge.

Please provide any additional information or comments regarding your application (optional):
Should be Empty: