Application*for*Reduction*in*Council*Tax!Long-Term*
Patients*in*a!Hospital/Residential*Care*home/Hostel.!!
This!form!should!be!completed!for!those!in!long!term!care!who!are!unlikely!to!return!home.!
Please*save*the*document*to*your*device*before*completion.**You*can*then*return*the*Form*as*
an*attachment.**
Council!Tax!Account!Number!
!
!
*
Address!of!Property!
!
!
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Name!of!Person!receiving!care!
!!
!
!
Their!Date!of!Birth!
!
!
!
Do!they!own!the!property!!
!
Yes! No!
If!no,!what!date!does!the!tenancy!end?!
!
!
Name!and!address!of!Landlord!
!
!
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Date!of!Admission!into!Care!
!
!
!
Name!and!Address!of!
Hospital/Care!Home/Hostel!
!
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Expected!date!of!release!
!
!
Does!the!person!expect!to!
return!to!the!above!address?!
!
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Is!the!property!still!occupied?!
!!
Yes! No!
Number!of!remaining!
occupants!
!
!
Declaration*
I!confirm!that!the!information!
is!correct!to!the!best!of!my!
knowledge.!!
!
Name!!
Date!!
Phone!number!
!
!
Email!address!
!
!
!