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Type or Print Last Name First Name M.I. Social Security Number/ITIN Spouse’s Last Name Spouse’s First Name M.I. Social Security Number/ITIN Address (Cannot be a P.O. Box Number) Date of Birth City State Zip Code County Property ID Number or Plate and Parcel Number (from property tax statement) Do you own this property? I have owned this property since: Yes No Month Year Does a relative own the property? I have lived in this property since: Yes No Month Year Check all boxes that apply. If you are applying for the first time, you must attach the appropriate documentation certifying that you are blind or permanently and totally disabled. (See instructions to determine what information to provide.) Check if: I am legally blind I am permanently and totally disabled The onset of your disability or blindness must have occurred on or before June 30 of the year you are filing for the special homestead classification. Check one box only I own this property with: No one else My spouse only My spouse and others One other person (who is not my spouse) Others (not including my spouse) Home is owned by a relative What is your relationship to the I have attached the appropriate documentation certifying that I am legally blind or permanently and totally disabled, and this documentation shows that the onset of my disability or blindness occurred on or before June 30 of the filing year. Yes No I certify that I am not receiving the Disabled Veterans Homestead (Market Value Exclusion program). Yes No Special Homestead Classification: Class 1b Property (Rev. 07/23) For homesteads of persons who are blind or permanently and totally disabled Applications are due by October 1. Read instructions before completing. Sign Here CR-1B Check All That Apply Signature of Applicant Signature of Spouse Date Daytime Phone I declare all information on this form is true, correct, and complete to the best of my knowledge and belief. Check if: This is my first application This is a change of address For Office Use Only Approved Denied Name of Assessor’s ---PAGE BREAK--- Who is Eligible Penalties on this Application is