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Senior Citizen Exemption Application Form for the 2015-2016 Tax Year
Quality Teacher & Education Act (QTEA) of 2008 and School Facilities Special Tax of 2010
DUE: JUNE 30, 2015
I am applying for exemptions from the following (choose one or both and please indicate whether this
is a new application or a renewal for each one):
 Quality Teacher & Education Act (QTEA)
of 2008
 New Application
 Renewal Application
 School Facilities Special Tax of 2010
 New Application
 Renewal Application
First time applicants for either exemption must complete all sections below. Applicants who are just applying for
previously received exemptions only need to complete Section A, Section E, and Section F.
A. PROPERTY OWNER INFORMATION
All applicants must complete the following information:
1. Parcel Block #: _____________________________
Parcel Lot #: ___________________________
2. Property Owner's Name: ________________________________________________________________
3. Property Address: ___________________________________________
Apt. #: ______________
4. Daytime Telephone: ______________________
Evening Telephone: ______________________
 Single-Family Dwelling/Condominium
 Apartment/Flat/Mixed-Use Dwelling
(For owners with tenants)
B. PROOF OF AGE (Submit document for the senior occupant)
Please attach a copy of one of the following legal documents indicating that a senior occupant (homeowner or tenant) will be at least
65 years of age by June 30, 2016.
 Driver's License
 Passport
 Medi-Cal Card (Not Medicare)
 California ID Card
 Birth Certificate
 Other Government-issued Document:
(MUST SHOW BIRTH DATE)
C. PROOF OF RESIDENCY (Senior document for the senior occupant)
Please attach a copy of one of the following legal documents indicating that a senior occupant (homeowner or tenant) resides at the
above stated property. Documents should include both the occupant’s name and address of the parcel.
 Utility Bill (Garbage/Telephone/PG&E)
 Mortgage Bill
 Lease or Rental Agreement
 Bank Statement
 Other Proof of Occupancy:
D. PROOF OF OWNERSHIP (Homeowner/Property Owner must complete this section)
Please attach a copy of one of the following legal documents indicating proof of ownership.
 Title Deed/Grant
 Property Tax Bill
 Other Proof of Ownership:
_______________________
E. IDENTIFICATION OF SENIOR OCCUPANT(S)
(Complete this section for parcels occupied by senior owner/tenants)
Total number units occupied with at least one senior citizen resident:
___________
Please list the senior’s name, birthday and unit number for all applicable units. Proof of age and residency must also be
provided for each new senior occupant.
Name:
Name:
________________________________________
________________________________________
Birthday: ____________
Birthday: ____________
Unit:
Unit:
_______
_______
Note: If you need to list additional senior tenants, please attach a separate page and include the above information.
F. SIGNATURE REQUIRED
Under penalty of perjury, I declare that these claims are, to the best of my knowledge, correct and complete.
_______________________________________________________
Signature of Property Owner
_____________________________
Date
If you would like to be included in our email database, please send an email to the [email protected] and we will provide
you with updates and news regarding this exemption.
FOR OFFICE USE ONLY:
Yes
NO (All Proof Verified)
CLERK: ____________ DATE: ________
Dear Property Owner:
The Quality Teacher Education Act (QTEA) of 2008 and the School Facilities Special Tax of 2010 were passed by the voters of San Francisco to
provide critically needed funds to the San Francisco Unified School District.

For the 2015-2016 tax year, the Quality Teacher Education Act (QTEA) will levy a fee of $230.94 for each eligible parcel.

For the 2015-2016 tax year, the School Facilities Special Tax will levy a fee of $35.34 for single-family dwellings, condominiums and
commercial properties and $17.68 per unit for apartments, flats and mixed-use dwellings.
In accordance with the language of the ballot measures, certain parcels are exempt from one or both of these levies, provided they meet specific
criteria:

In order for a parcel to be exempt from the QTEA, the owner of the parcel must occupy it as their primary residence and be 65 years or
older as of June 30, 2016.

In order for a unit to be exempt from the School Facilities Special Tax, the unit must be the primary residence of an occupant (either an
owner or a tenant) who will be 65 years or older as of June 30, 2016.
To apply for this exemption, complete the appropriate sections on the reverse side of this form. Please enclose this entire form in a stamped
envelope with copies of the required documents and mail it to the SFUSD Senior Exemption Office at the address shown above. Documents must
be received by our office by 5 PM on June 30, 2015. If you have any questions regarding this tax or the exemptions, please call the SFUSD
Exemption Office at (415) 355-2203 or send an email to [email protected].
Estimado propietario:
La Ley para Maestros de Calidad (QTEA) del año 2008 y el Impuesto Especial para el Mejoramiento de las Instalaciones Escolares del año 2010, se
aprobaron por los votantes de San Francisco para proveer fondos indispensables para las Escuelas Públicas del Distrito Escolar Unificado de San Francisco.

Para el año fiscal 2015-2016 la Ley para Maestros de Calidad (QTEA) impondra un impuesto de $230.94 por cada propiedad elegible.

Para el año fiscal 2015-2016 el Impuesto Especial para el Mejoramiento de las Instalaciones Escolares impondra un impuesto de $35.34 por cada
casa- habitación, condominio y propiedad comercial, y $17.68 por cada unidad de apartamentos, pisos y casa habitación de usos múltiples.
Conforme al lenguaje de las medidas que se sometieron a votación, algunas parcelas están exentas de la imposición de uno o ambos de estos impuestos,
siempre y cuando cumplan con los criterios específicos siguientes:

Para que a una propiedad se le exima del QTEA, el dueño de dicha propiedad debe habitarla como su residencia principal, y debe tener 65 o mas
años de edad, a partir del 30 de junio del 2016.

Para que a una propiedad se le exima del Impuesto Especial para el Mejoramiento de las Instalaciones Escolares, dicha unidad debe habitarse
como residencia principal, ya sea por el dueño o un inquilino, quien deberá tener 65 o más años de edad, a partir del 30 de junio del 2016.
Si usted desea presentar una solicitud de exención para este impuesto, por favor rellene las secciones correspondientes que se encuentran al reverso de este
formulario y enviela en un sobre por correo, incluyendo copias de todos los documentos requeridos al SFUSD Senior Exemption Office (Oficina de Exención
de Impuestos para Ciudadanos de la Tercera Edad) a la dirección que se muestra en la parte superior. Nuestra oficina debe recibir dicha documentación
antes de las 5 de la tarde del 30 de junio de 2015. Si tiene alguna pregunta al respecto, por favor llame al teléfono de nuestra oficina (415) 355-2203 o
envie un correo electrónico a [email protected].
各位物業持有人：
三藩市聯合校區蒙三藩市選民支持，投票通過2008年度優質教師教育法案及2010年度學校設施特別稅提案，獲得急需的
資金。
 在 2015–2016課稅年度，優質教師教育法案將向每塊應課稅土地徵收 $230.94。
 在 2015–2016課稅年度，學校設施特別稅提案將向獨立屋、共渡公寓及商業物業徵收$35.34，以及向柏文、分層
住宅及混合用途住宅每單位徵收$17.68。
根據有關投票提案規定，凡符合條件的地皮，可獲豁免繳交上述一項或兩項的稅務：
 如欲申請豁免優質教師教育法案的地稅，申請人必須是地皮上住宅的業主，而且該住宅也必須是申請人的主要住所
及申請人須於2016年6月30日前年滿65歲。
 業主如欲申請免繳學校設施特別稅，業主或租客居住的單位必須是其主要住宅，並且(業主或租客)必須於2016年6
月30日前年滿65歲。
如欲申請豁免，請填妥本表格背面適當部份，連同所需文件，用郵資已付的信封寄回三藩市聯合校區長者豁免辦事處
（地址如上）。所需文件必須於2015年6月30日下午5時前寄達該辦事處。如你對此稅或長者豁免事宜有任何疑問，需要
查詢，請致電三藩市聯合校區長者豁免辦事處，電話：(415)355-2203，或發電郵到
[email protected]。
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IMPORTANT INFORMATION
Note that the Quality Teacher Education Act Tax and the School Facilities Special Tax are distinct and separate charges on the property tax bill.
Please read all instructions on this form to ensure that you have completed all necessary sections.
Direct all questions to the SFUSD Senior Exemption office at (415) 355-2203 or [email protected].
Please submit this application with copies of the correct legal documents as needed.
Applicants are encouraged to retain a copy of the application.
All applications and supporting copies or documents must be received by the SFUSD Senior Exemption Office by:
June 30, 2015 at 5 P.M.
No late application forms will be accepted after deadline.