ࡱ> ?A>m bjbjZcZc 7*8 b8 b< < 8,.DZZZZ555IKKKKKK$o55555oZZ5RZZI5IZ`M-50\\\ 5555555oo5555555\555555555< B ~: CLASS 5 INCLUDEPICTURE "I:\\MASTERFILE\\Ctax Comino Templates\\letterhead logo.bmp" \d Date: Dear Council Tax Payer COUNCIL TAX PROPERTY EXEMPTION APPLICATION -DWELLING LAST OCCUPIEDBY PERSONS LIVING OR DETAINED ELSEWHERE DUE TO PROVIDING OR RECEIVING CARE COUNCIL TAX REFERENCE NUMBER - SUBJECT ADDRESS In terms of schedule 11 of the Local Government Finance Act 1992, and schedule 1 of the Council Tax (Exempt Dwellings) Scotland Order 1997 (as amended), a dwelling may be exempt from Council Tax. This application is for a dwelling which has become unoccupied because the resident is providing or receiving personal care, and carries an unlimited period of exemption while the qualifying conditions are met. Section 1 Exemption details All of the following questions must be completed before your application can be accepted. 1. Exempt period: From ____/____/____ to ____/____/____ (please provide your best estimate of when care will end) 2. Please indicate the reason(s) why you are providing or receiving personal care by circling one or more of the following: a. Old Age b. Disablement c. Illness d. Past or present alcohol dependence e. Past or present drug dependence f. Past or present mental disorder How to complete the remainder of this application If you are providing care to another person go to section 2 If you are receiving care from a relative go to section 3 If you are receiving care from a hospital / residential home go to section 4 Section 2. Please complete if you are providing care COUNCIL TAX REFERENCE NUMBER - 1. Name and address of person who is being cared for ____________________________________________ ____________________________________________ ____________________________________________ 2. Expected date at which you will stop providing care ____________ / ____________ / _____________ 3. Name of person providing care ____________________________________________ Section 3 Please complete if you are receiving care from a relative Please note: Please enclose a letter from your Doctor as confirmation that a relative is providing care 1. Name of person receiving care _____________________________________________ 2. Address at which care is being provided _____________________________________________ 3. Name of relative providing care _____________________________________________ 4. Expected date you will return home ____________ / ____________ / _____________ Section 4 To be completed by a representative of a hospital or residential home, if you are receiving care in a hospital or home 1 Name of person receiving care _____________________________________________ 2. I confirm that the above named person was admitted on ____________/ ____________ / _____________ 3. Expected discharge date if known ___________ / ___________ / ______________ 4. Details of care / treatment: _____________________________________________________________________ ______________________________________________________________________________________________ Official Stamp Signature: __________________________________ Date: ____________ / ___________ / ___________ Position: __________________________________ I declare that the information in this form is true and complete. I authorise PվɫƬ & Bute Council to verify the details. If exempt status no longer applies to this property I undertake to notify PվɫƬ & Bute Council within 21 days of this occurring and understand that failure to do so may result in a fine of 50 and 200 on repeated failure to do so. SIGNATURE OF LIABLE PERSON ___________________________________ DATE _____________________ Data Protection Fair Processing Notice: PվɫƬ, or their agents, will primarily use the information you have supplied on this form for the collection and administration of tax. The information may also be used for other legitimate purposes e.g. housing benefit administration. Where permitted by law, or where your consent has been obtained, information may be shared with other Councils, governmental and quasi-governmental bodies. By completing and submitting this form you consent to the use of your personal data including, where appropriate, sensitive personal data. You have a right to apply for a copy of the information we hold about you, and to have any inaccuracies corrected. The set fee (where applicable) will be charged. 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