Randolph County, IL · Randolph County
Physician’s Statement for the Homestead Exemption for Persons with Disabilities
This form documents disability for a Homestead Exemption for Persons with Disabilities request when an applicant cannot provide another accepted proof of disability.
At a glance
- Issued by
- City of Randolph County · Randolph County, Randolph County, Illinois
- Notarization
- Not required: file this form without a notary.
- Official source
- randolphcountyil.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this form when applying for the Homestead Exemption for Persons with Disabilities and you cannot provide another accepted proof of disability. The property owner completes information about the homestead, assessment year, and property index number; a physician, advanced practice nurse, or physician assistant provides patient and disability details and signs the statement. The applicant is responsible for any medical professional’s costs.
Who needs it
A property owner seeking the disability homestead exemption needs this form if they cannot provide another accepted proof of disability.
How to submit it
File or mail the completed form to the Chief County Assessment Officer at the address entered in the filing section, before the county’s due date for the exemption.
About notarization
This form is signed and dated without a notary; the applicant and medical professional sign it, and no notarized attachment is identified.
How to submit this form
- 1
Download the Form
Download the physician’s statement PDF.
- 2
Complete Applicant Information
Enter the property owner’s details, assessment year, and property index number, or attach a legal description if you cannot obtain the PIN.
- 3
Have a Medical Professional Complete the Statement
A physician, advanced practice nurse, or physician assistant completes the patient and disability information and signs and dates the form.
- 4
Submit to the County
File or mail the completed form to the Chief County Assessment Officer before the county’s exemption due date.
Frequently asked questions
- Do I need a notary for the Physician’s Statement for the Homestead Exemption for Persons with Disabilities?
- No. This form is signed and dated without a notary. The applicant and medical professional sign it, and the form does not identify a notarized attachment.
- How do I submit the physician’s statement?
- File or mail the completed form to the Chief County Assessment Officer at the address entered in the filing section, before the county’s due date for the exemption.
- When do I need to complete this form?
- Complete it if you are seeking the Homestead Exemption for Persons with Disabilities and cannot provide another accepted proof of disability.
- Who completes the physician’s statement?
- The property owner completes the applicant section. A physician, advanced practice nurse, or physician assistant completes the patient and disability information and signs the statement.