Blind Application

(Step 1 / 3)

First Name

Last Name

Mailing Address

City

State

Zip Code

Phone Number

Year of Birth

Social Security #

If your home is a mobile home, check this box.

Serial Number

Can't find or don't have your account Number? To locate your Account Number you will need to call 801-851-8295 , or 801-851-8255 and we will help you retreive that number.

Can't find or don't have your Serial Number? To locate your Serial Number on your most recent Valuation or Tax Notice CLICK HERE

Check this box if someone other than the applicant is preparing and/or signing the form.

Name of Person Preparing This Form

Full Address

Telephone Number

(Step 2 / 3)

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If you are not the owner of address above as of January 1, 2021, please provide herewith a complete explanation of ownership together with copies of supporting documents such as SALES CONTRACT OR CLOSING STATEMENTS showing you are liable for taxes from January 1, 2021 on the property. Real property held by tenants in common may receive tax relief only on the proportional share owned by the qualifying applicant.

NOTE: If the property is held in a trust and the current trust agreement is NOT on file with the Auditor's Office, you must provide a copy of the trust agreement for review and approval before relief can be granted.

(Step 3 / 3)

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AFFIDAVIT

I/We hereby certify the following (mark all that apply):

I am a United States Citizen (required for all applications filed after June 30, 2009).

I am a qualified alien as defined in 8 U.S.C., Sec. 1641 and lawfully present in the United States.

My Alien Registration Number is:

My I-94 Number is:

MUST APPLY IN PERSON

I am a:

Blind person

An unmarried surviving spouse or minor orphan or a deceased blind person.

This condition is:

Permanent

Temporary

The property identified above was owned and occupied by the applicant(s) on January 1, 2021.

I have not applied for 2021 tax relief in any other county in Utah.

First time applicants, or applicants for whom this condition is temporary, must provide a statement signed by a licensed ophthalmologist verifying that the qualifying person:

(a)has no more than 20/200 visual acuity in the better eye when corrected; or (b) has, in the case of better than 20/200 central vision, a restriction of the field of vision in the better eye which subtends an angle of vision no greater than 20/20 degrees. 59-2-1106

2021 TAX RELIEF ONLINE APPLICATION

APPLICATION FOR EXEMPTION FOR THE BLIND