Form Cr-1b - Special Homestead Classification: Class 1b Property

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For Office Use Only
Approved
CR-1B
Name of applicant ________________________________Assessment year ____________
Denied
Assessor’s signature ______________________________Date _______________________
Special Homestead Classification: Class 1b Property
For homesteads of persons who are blind or permanently and totally disabled
Applications are due by October 1. Read instructions before completing.
Check if:
This is my first application
This is a change of address
Last Name
First Name
M.I.
Social Security Number
Spouse’s First Name
Spouse’s Last Name
M.I.
Social Security Number
Address (Cannot be a P.O. Box Number)
Date of Birth
City
State
Zip Code
County
Property ID Number or Plate and Parcel Number (from property tax statement)
Do you own this property?
I have owned this property since:
Yes
No
Month
Year
Does a relative own the property?
I have lived in this property since:
Yes
No
Month
Year
Check all boxes that apply. If you are applying for the first time, you must attach the appropriate documentation
certifying that you are blind or permanently and totally disabled. (See instructions to determine what information to
provide.)
Check if:
I am legally blind
I am permanently and totally disabled
The onset of your disability or blindness must have occurred on or before June 30 of the year you are filing for the special homestead
classification.
Check one box only
I own this property with:
No one else
My spouse only
My spouse and others
One other person (who is not my spouse)
Others (not including my spouse)
Home is owned by a relative
What is your relationship to the owner? ____________________________________
I have attached the appropriate documentation certifying that I am legally blind or permanently and totally disabled, and this
documentation shows that the onset of my disability or blindness occurred on or before June 30 of the filing year.
Yes
No
I certify that I am not receiving the Disabled Veterans Homestead (Market Value Exclusion program).
Yes
No
I declare all information on this form is true, correct, and complete to the best of my knowledge and belief.
Signature of Applicant
Signature of Spouse
Date
Daytime Phone
(Rev. 11/13)

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