APPLICATION FOR BLIND PERSONS EXEMPTION FROM LOCAL

PROPERTY TAXES

Under Title 36 M.R.S.A §654

1. Name of applicant ________________________________________________________________________

2. Mailing Address of Applicant ________________________________________________________________

3. Legal Residence _________________________________________________________________________

4. Telephone Number _______________________________________________________________________

5. Eligibility _______________________________________________________________________________

a. Has the applicant been determined to be blind ______________ Yes ________________No b. Is the applicant receiving aid under Title 22, __________Yes___________No

NOTE: No property conveyed to any person for the purpose of obtaining exemption from taxation under this provision Shall be so exempt, and the obtaining of such exemption by means of fraudulent conveyance shall be punished by a fine of not less than $100 and not more than 2 times the amount of taxes evaded by such fraudulent conveyance, whichever amount is greater. In case any person entitled to such exemption has property taxable in more than one place in the State, such proportion of such total exemption shall be made in each place as the value of the property taxable in such place bears to the value of the whole of the property of such person taxable in the State.

___________________________________ ____________________________________________

Date Signature of Applicant

___________________________________ ____________________________________________

Date Signature of Guardian or Authorized

Agent if Applicant is unable to sign

FOR ASSESSOR USE ONLY

_____APPROVED for ______ $4000 at 100%

_____DENIED. Grounds for denial. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date: ______________________________ Assessor ___________________________________