Disability Exemption Claim Affidavit

DISABLED HOMEOWNER/APPLICANT INFORMATION

(owner's name must match name on deed)

Owner #1 (Required)

LAST NAME: (Required)

FIRST NAME: (Required)

Phone: (Required)

Email: (Required)

Date of Birth: (Required)

Please check only if additional owners occupy this residence. If so, list below name(s), phone, date of birth, email, and their relationship with you.

You MUST have the deed for this property recorded in the Blount County Judge of Probate office prior to claiming this Disability Exemption.

Recorded Deed Book (Required)

Page (Required)

(If unknown, go to www.blountcountyalprobate.com to search recorded deeds.)

PROPERTY INFORMATION

Is this home your primary residence? (Required) Yes No (If no, please explain below)

Is this a Manufactured Home?

Physical Address: (Required)

Street Address

City

State

ZIP Code

Mailing Address for Property Tax Notice same as physical address? (Required) Yes No (If no, please complete below)

Do you own any other homes?

This application MUST include your driver's license showing the new address, AND two (2) supporting documents proving this is your primary residence for which you are applying for Disability Exemption.

Examples of documentation should include proof of payment of utilities, homeowner's insurance policy, etc. These documents must show the name and address of the owners.

Applicants also must include proof of disability.

Proof of Residence (Required)

Max. file size: 2 MB.

Proof of Residence (Required)

Max. file size: 2 MB.

Proof of Disability (Required)

Max. file size on original form: 2 GB.

Signature (Required)

(Disabled Homeowner)

Date (Required)

Printed Name: (Required)

Disability Exemption Claim Affidavit

Revenue Commission

Blount County, Alabama