[Medina County Auditors Office] Homestead Certificate of Disability (DTE 105E)

Thank you for visiting the Certificate of Disability for the Homestead Exemption form. This form requires the signature of a physician, psychologist, or agency; or documentation from an approved source. You can download or print this form for submission to your respective provider.

To download the form (as for sending in an e-mail), please click the "Download Original" button and save it for future access.

If you would like to print the form immediately, please click the "Print Document Without Submitting" button.

In lieu of a signature, the applicant portion of this form can be completed, and relevant documentation uploaded upon submission. In this case, the applicant will need to choose, "I am an agency", sign and print their name.

After you click Finalize and Submit:

A pop-up window for uploading your documentation will appear.

Thank you,

Medina County Auditor's Office

Please check that you agree before continuing.

By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

Full Legal Name

Your Initials

Signature Type

Type Draw Upload Custom

Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

	Signer Details	Me?
Physician, Psychologist or Agency
I'm not a signer listed above

Medina County Auditors Office

Print Document

Create Your Signature

Upload Attachment(s)

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers