Over 65 Exemption Claim Affidavit

PROPERTY OWNER/APPLICANT INFORMATION

(owner's name(s) must match names on deed)

Owner #1 (Required)

LAST NAME: (Required)

FIRST NAME: (Required)

Phone: (Required)

Email: (Required)

Date of Birth: (Required)

Owner #2 (Optional)

Add Owner #2 Yes No

You MUST have the deed for this property recorded in the Blount County Judge of Probate office prior to claiming this Over 65 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? Yes No

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?

Did you and/or your spouse file a Federal Income Tax Return this year? (Required) No Yes

Did you and/or your spouse file an Alabama Income Tax Return this year? (Required) No Yes

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 Over 65 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.

File (Required)

I hereby affirm that this statement is true and correct to the best of my knowledge and that any fraudulent statement is subject to a penalty of perjury.

Signature (Required)

(Over 65 years of age Homeowner)

Date (Required)

Printed Name: (Required)

Over 65 Exemption Claim Affidavit

Revenue Commission

Blount County, Alabama