ࡱ> k objbj:: -2XubXubDD8 4@,0#lqqq"""""""$(%'r"qqqqq""q"q"U!"!|`v!"#00#!P(ujP( "P("qqqqqqq""qqq0#qqqqP(qqqqqqqqqDB : CLASS 23A  Name___________________________________________ Subject Address___________________________________ ________________________________________________ ________________________________________________ Council Tax Reference Number_______________________ Contact Number___________________________________ Email Address_____________________________________ Dear Council Tax Payer COUNCIL TAX PROPERTY EXEMPTION APPLICATION - DWELLING OCCUPIED BY SEVERELY MENTALLY IMPAIRED PERSON With effect from 1 April 1995, in terms of schedule 2 and 11 of the Local Government Finance Act 1992, and the Council Tax (Exempt Dwellings) Scotland Order 1997 (as amended), a dwelling house may be exempt from Council Tax for an unlimited period if the sole resident or all of the residents are severely mentally impaired. Occupied house which is occupied by a severely mentally impaired person(s): This application is for a person who has an apparently permanent severe impairment of intelligence and social functioning, as certified by a registered medical practitioner, and who is receiving one or more of the following state benefits: Incapacity Benefit Employment Support Allowance Attendance Allowance Severe Disablement Allowance An increased rate of Disablement Pension for constant attendance The highest or middle rate care component of Disability Living Allowance (DLA) Enhanced Rate of daily living component of Personal Independence Payment (PIP) Disabled Person's Tax Credit Unemployability Allowance Constant Attendance Allowance under the Personal Injuries (Civilians) Scheme or the Naval, Military and Air Forces etc. (Disablement & Death) Service Pension Order or an Unemployability Allowance under the Personal Injuries or Service Pension Legislation. Income Support which includes a disability premium Universal Credit Limited Capability for Work and Work Related Activity OR Limited Capability for Work Adult Disability Payment (Daily Living Part) Evidence required that MUST be provided in support of your claim LETTER FROM BENEFITS AGENCY AND/OR A COPY OF YOUR AWARD CERTIFICATE DETAILING BENEFIT ENTITLEMENT AND THE DATES BENEFIT COMMENCED FAILURE TO SUPPLY SUCH EVIDENCE COULD DELAY IN THE PROCESSING OF YOUR CLAIM Data Protection Fair Processing Notice: ֱ, will primarily use the information you have supplied on this form for the collection and administration of Council Tax. You have a statutory duty to provide the information. The level of Council Tax charged must be accurate and the Council will use information from other agencies to check liability for Council Tax and minimise fraud and error where it is necessary to do so. We share information with other sections of the Council and other organisations external to the Council where it is lawful to do so. A full privacy notice is available at /privacy/council-tax.You have a right to apply for a copy of the information we hold about you, and to have any inaccuracies corrected. Should you wish to exercise this right, your request must be made in writing to the Data Protection Officer, ֱ & Bute Council, Kilmory, Lochgilphead, PA31 8RT, mail HYPERLINK "mailto:iain.jackson@argyll-bute.gov.uk"iain.jackson@argyll-bute.gov.uk or telephone 01546 604188. CLASS 23 Council Tax Account Reference__________________ To be completed by a registered medical practitioner I certify that in my opinion Mr / Mrs / Miss ______________________________ suffers from a severe mental impairment within the meaning of paragraph 2 (2) of schedule 1 to the Local Government Finance Act 1992 i.e. a person is severely mentally impaired if he/she has a severe impairment of intelligence and social functioning (however caused) which appears to be permanent. To my knowledge this condition has existed since: __________/__________/__________ Please give a description of the nature of the impairment and medical term :- Practice stamp: Doctors Name Surgery/Hospital Address Signed: __________________________________________ Position: _________________________________ Date: __________/__________/__________ I declare that the information on this form is true and complete and I authorise ֱ & Bute Council to verify the details. If exempt status no longer applied to this property I undertake to notify ֱ & Bute Council within 21 days of this occurring. I understand that failure to provide this information is an offence which may make me liable for an initial fine of 50 and 200 on repeated failure to do so. 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