Application*for*Reduction*in*Council*Tax*-Reduction*for*a*
Disabled*person.*
This%form%should%be%completed%where%your%home%has%been%adapted%to%cater%for%a%disabled%
member%of%your%household.%The%adaption%must%be%essential%or%of%great%importance%in%coping%with%
the%disability.%%If%your%application%is%successful,%we%will%reduce%the%valuation%band%of%your%property%
by%one%band.%
Please*save*the*document*to*your*device*before*completion.*You*can*then*return*the*form*as*an*
attachment.%
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Council%Tax%Account%number%
%
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Address%of%Property%
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Name%of%Disabled%Person%
living%in%your%home%
%
%
Is%there%a%room%mainly%used%to%
meet%the%needs%of%the%
disabled%person?%%
Yes% %
%
No%
If%Yes,%how%is%the%room%used?%
%
%
%
Is%there%a%second%bathroom%or%
kitchen%used%to%meet%the%
needs%of%the%disabled%person?%%
Yes% %
%
No%
Does%the%disabled%person%use%
the%wheelchair%indoors?%
%
Yes%
%
No%
Declaration*
%
I%confirm%that%the%information%
is%correct%to%the%best%of%my%
knowledge.%%
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Name%
Date%
Phone%number%
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Email%address%
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%