REVENUE SERVICES,
HOLT ROAD, CROMER, NORFOLK, NR27 9EN
For guidance or advice on completing this form
EMAIL ctax@north-norfolk.gov.uk
To receive this form in a different format or language,
please phone 01263 513811
Application for EXEMPTION E
PROPERTY LEFT EMPTY BY SOMEONE IN RESIDENTIAL CARE
Qualifying Criteria
An unoccupied property where the owner or tenant has their sole or main residence in a
hospital, care home, nursing home where they are receiving care or treatment.
The unoccupied property must previously have been the sole or main residence of the absent
person.
Council Tax Reference No
1.
Name and Address of property owner
2.
Name and address of Hospital/Care/Nursing Home
3.
Date admitted
Declaration:
I declare that the information given is correct to the best of my knowledge and belief and I
understand that if I have knowingly given false information I may be liable for prosecution for
attempting to obtain pecuniary advantage by deception
Full name: ………………………………………….
Signature: ………………………………… Date: …………………………………..
Telephone number: ………………………………………………………………….