from Maine Revenue Services, Property Tax Division, (207) 287-2011

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 by a licensed Doctor of Medicine, Doctor of Osteopathy or Doctor of Optometry?

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.

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FOR ASSESSOR(S) USE ONLY

_______________
Date

Assessor(s)________________________
_________________________________
_________________________________
_________________________________

PTF 315

(7/96)