Affidavit Of Blind Person Form printable pdf download

ID# ________________

AFFIDAVIT OF BLIND PERSON

RCVD BY: __________

FOR PROPERTY TAX EXEMPTION

FY: ________________

PURSUANT TO NEVADA REVISED STATUTE 361.085

I, the undersigned, hereby affirm that I am a bona fide resident of the State of Nevada (possess a valid

Nevada Driver’s License or Identification Card), and I meet all requirements for the exemption for blindness,

and that I have not claimed this exemption in any other county in the State of Nevada.

A certificate is required from a licensed physician stating that they have examined the claimant and

have found him to be a blind person. To be considered legally blind, the claimant’s visual acuity with

correcting lenses cannot exceed 20/200 in the better eye, or whose vision in the better eye is

restricted to a field which subtends an angle of not greater than 20 degrees.

I wish to apply my exemption to:

(Check Box Below)

(If choosing more than one, please split the amount for each, not to exceed the total of the Exemption.)

To apply your exemption to your real property tax bill for July 1st, you must return the affidavit by June 15

, or for

real property acquired between June 15

and July 1

, you must return the affidavit by July 5th.

Exempt Amount

Real Property at the following location address or parcel number:

DMV/Governmental Services Tax (When registering vehicle you own)

Manufactured Home or Personal Property at the following location address or ID#:_______________ __________

Please enclose a copy of your Nevada Driver’s License or ID card and a copy of the certificate from a licensed

physician. (The certificate must state the claimant meets the qualifications to be considered legally blind under

NRS 361.085.)

Note: This document must be signed before a Notary Public or a Deputy Assessor.

A person who files a false affidavit or proof and obtains an exemption is guilty of a gross misdemeanor.

Signature:

Date:

Print full name:

Name of spouse:

Mailing Address:

Phone:

STATE OF NEVADA

COUNTY OF _______________

On this ___day of ________________, ________ personally appeared before me, a Notary

Public ___________________________________personally known or proven to me the person

whose name is subscribed to the above instrument who acknowledged that ___he executed the

instrument. WITNESS my hand and official seal.

______________________________________________, Notary Public

Return this affidavit with required documentation to:

Michele W. Shafe, County Assessor, Customer Service Division, 500 S. Grand Central Parkway 2

Floor, Las Vegas, NV 89155-1403

Affidavit Of Blind Person Form

Related Articles

Related forms

Related Categories