Low Income, Owner-Occupied Exemption Refund Forms
Process Overview
- Within 10 days of execution of the Purchase Contract, Homebuyer must contact Impact Fee Administrator to make application for Exemption Refund of the Impact Fees.
- Homebuyer will provide, at time of application, a copy of the signed Purchase Contract, Form A, C, (if applicable) D, and proof of income to the Impact Fee Administrator. Impact Fee Administrator: Michaela Dugan @ City of Lincoln, 555 S. 10th Street, Lincoln, NE. Phone 441-7559
- Once eligibility has been determined, Impact Fee Administrator provides, via fax, an "Exemption Certificate Letter" to the Lender.
- Builder makes application for Building Permit, pays the applicable impact fees and provides signed Form B to the Impact Fee Administrator through Building & Safety.
- Form B must be in Impact Fee file before reimbursement can take place.
- Escrow closing company will receive notification of exemption from lender. Escrow closing company will contact Impact Fee Administrator seven days in advance of anticipated closing to allow adequate time to have check cut from City of Lincoln, payable to Homebuyer(s) and Title Company.
Acrobat (PDF) Version of Process Overview (85 K) ![]()
Filling Out Forms
Forms A, B, C and D are in Adobe Acrobat (PDF)
format. To fill out forms, please tab to each field, type contents and print form when complete.
Mail Completed Form To:
Public Works and Utilities Department
c/o Impact Fees Administrator
555 South 10th Street, Suite 203
Lincoln, Ne 68508-3994
| Form | What Do I Need? | Who Completes This Form? |
|---|---|---|
| Copy of Purchase Contract on House | Builder | |
| Copy of the Previous tax year 1040 tax returns, signed and dated, from household members OR Self-Employment Documentation. | Your Records (Homebuyer) | |
| Form A | Completed Family Income Worksheet Signed Purchaser Statement. | Homebuyer |
| Form B | Signed Builder/Developer Statement. | Builder |
| Form C | Documentation Checklist with Supporting Document(s) attached. | Homebuyer |
| Form D | Impact Fee Refund Household Income Worksheet (If you are not required to file federal income taxes, recent statements of income will be required from all income recipients, over the age of 19, living in the household to determine gross income using this worksheet.) | Homebuyer |
| If Self Employed: | ||
| 1099 for commissions for past 2 years | Your Records | |
| 1065 & K-1 tax returns | Your Records | |
| 1120 tax forms | Your Records |