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Noted that the tax relief is confined to one family member only. DECLARATION (This declaration must be completed by all applicants) I wish to apply for relief from tax under the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations, 1994 (SI. 353 of 1994). I hereby declare that the information on this form and on supporting documentation is true and correct to the best of my knowledge and belief. Signature:........................................................... Date:.

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