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Disability Exemption Claim Affidavit

Disability Exemption Claim Affidavit

Revenue Commission

Blount County, Alabama

220 Second Avenue East, Room 102
Oneonta, Alabama 35121

TEL: (205) 973-0589
www.blountrevenue.com
property@blountcountyal.gov

Gregg Armstrong
Revenue Commissioner

Wendy Green
Chief Clerk

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)

MM slash DD slash YYYY

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.

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.

Owner #2 (Required)

LAST NAME:(Required)

FIRST NAME:(Required)

Phone:(Required)

Email:(Required)

Date of Birth:(Required)

MM slash DD slash YYYY

Relationship to Owner #1(Required)

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?

Type here(Required)

Untitled(Required)

Existing Manufactured Home or

New Manufactured Home (If so, a title application and bill of sale are required.)

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)

Mailing Address:(Required)

Street Address City State ZIP Code

***Please note why different mailing address below…(Required)

Do you own any other homes?

Do you own any other homes?

If so, list below complete addresses of each home, and if you claim homestead , use it as a second home, or a rental.(Required)

Any other homestead must be cancelled before this claim can be processed.

This application MUST include at least two supporting documents for proof of residence, such as utilities bill, homeowner’s insurance policy, etc., stating this is your primary residence, AND a document showing date of birth, such as drivers license or birth certificate. These documents MUST show the name of the applicants. The application must also include proof of disability.

Proof of Residence(Required)

Drop files here or

Max. file size: 2 MB.

Proof of Residence(Required)

Drop files here or

Max. file size: 2 MB.

Proof of Disability(Required)

Drop files here or

Max. file size: 2 GB.

Consent(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.(Required)

Consent(Required)

I certify that I am totally and permanently disabled.(Required)

Signature(Required)

(Disabled Homeowner)

Date(Required)

MM slash DD slash YYYY

Printed Name:(Required)

Δ

Blount County Revenue Commissioner
Gregg Armstrong

Blount County Courthouse

220 2nd Ave E
Oneonta, AL 35121
205-973-0285
Monday - Friday
8:00am - 5:00pm

Hayden Satellite Office

306 2nd Ave,
Hayden, AL 35079
205-973-8332
Monday - Friday
8:00 am - 5:00 pm
*Closed for lunch each day
12:00pm - 1:00pm

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BLOUNT COUNTY COURTHOUSE

220 2nd Ave E
Oneonta, AL 35121
205-973-0285
Monday - Friday
8:00am - 5:00pm

HAYDEN SATELLITE OFFICE

306 2nd Ave,
Hayden, AL 35079
205-973-8332
Monday - Friday
8:00 am - 5:00 pm
*Closed for lunch each day
12:00pm - 1:00pm

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