Affidavit of Blind Person for Property Tax Exemption

If an affiant wishes to conform to a court that he is a legal resident of the State of Nevada and in possession of an identification document such as a driver’s license, he/she has to execute this affidavit.

Extracted Text for Proper Search

AFFIDAVIT OF BLIND PERSON 	
FOR PROPERTY TAX EXEMPTION 	
PURSUANT TO NEVADA REVISED STATUTE 361.085 
 	
I, the undersigned, hereby affirm that I am a bona fide resident of the State of Nevada (possess a valid 
Nevada Driver’s License or Identification Card), and I meet all requirements for the exemption for blindness, 
and that I have not claimed this exemption in any other county in the State of Nevada. 
                	
A certificate is required from a licensed physician stating that they have examined the claimant and 
have found him to be a blind person.  To be considered legally blind, the claimant’s visual acuity with 
correcting lenses cannot exceed 20/200 in the better eye, or whose vision in the better eye is 
restricted to a field which subtends an angle of not greater than 20 degrees. 	
 
I wish to apply my exemption to:    (Check Box Below)                        
 (If choosing more than one, please split the amount for each, not to exceed the total of the Exemption.)          
To apply your exemption to your real property tax bill for July 1st, you must return the affidavit by June 15	th,  or for 
real property acquired between June 15	th and July 1	st, you must return the affidavit by July 5th.    
             	
Exempt  Amount 	
   
 
Real Property at the following location address or parcel number:                      	
         	     
DMV/Governmental Services Tax (When registering vehicle you own)                    
 
Manufactured Home or Personal Property at the following location address or ID#:_______________   __________ 	
  
Please enclose a copy of your Nevada Driver’s License or ID card and a copy of the certificate from a licensed 
physician. (The certificate must state the claimant meets the qualifications to be considered legally blind under       
NRS 361.085.) 
 
Note:   This document must be signed before a Notary Public or a Deputy Assessor. 
 A person who files a false affidavit or proof and obtains an exemption is guilty of a gross misdemeanor. 
 
Signature:   Date:  
     	
Print full name:    Name of spouse:   
     
Mailing Address:   Phone:  
     	
     	
  
  
  
  
               
          
         
 	
 
 
    
  
 
 
 
 
 
 
 
 
  
 
 	
 ID# ________________ 
RCVD BY: __________ 
FY:  ________________ 	
STATE OF NEVADA 
COUNTY OF _______________ 
 
On this ___day of ________________, ________ personally appeared before me, a Notary  
Public ___________________________________personally known or proven to me the person 
whose name is subscribed to the above instrument who acknowledged that ___he executed the 
instrument.  WITNESS my hand and official seal. 
______________________________________________, Notary Public 	
Return this affidavit with required documentation to: 	
Michele W. Shafe, County Assessor, Customer Service Division, 500 S. Grand Central Parkway 2	nd Floor, Las Vegas, NV  89155-1403