Bureau of Taxation

Property Tax Division

Tel. 287-2011

APPLICATION FROM EXEMPTION EROM LOCAL TAXATION

VETERAN

INSTRUCTIONS: All questions must be answered. Any person seeking exemption as a veteran of the armed services must make written application, and file written proof of entitlement on or before the first day of April in the year in which the exemption is first requested, with the assessor of the place in which the applicant resides. The local assessor shall thereafter grant such exemption while you are so qualified and continue a legal resident. This application must be accompanied by satisfactory documentary evidence to support answers to questions. If you are in doubt as to the way in which to answer any questions, or as to documentary evidence needed, consult your local assessor.

1. Name _________________________________________________________________________

2. Mailing Address_________________________________________________________________

3. Legal Residence _________________________________________________________________

4. Telephone Number_______________________________________________________________

5. Date of Birth ____________________________________________________________________

6. A) Date of Entry into Armed Forces __________________________________________________

B) Legal Residence on Date of Entry into Armed Forces _________________________________

C) Date of Discharge or Separation from Armed Forces__________________________________

7. Do you receive from the U.S. Government as a Veteran:

A) Compensation for Wartime Service Connected Disability? _________ Yes _____________No

B) Pension or Compensation for other than Wartime Service

Connected Disability? _________ Yes _________ No

8. Is Pension or Compensation for Total Disability? _________ Yes _________ No

9. Do you receive retirement pay or vocational training from the U.S. Government for Wartime Service Connected Disability?

A) Did you receive a grant from the United States Government for Specially Adapted Housing as a Paraplegic?

_________ Yes _________ No

________Yes _________ No

10. Veterans Administration Claim Number C-____________________________________________

11. Military Service Serial Number _____________________________________________________

Bureau of Taxation Property Tax Division

Tel.287-2011

CERTIFICATE OF APPROVAL OF APPLICANT'S EXEMPT STATUS

Written proof of entitlement has accompanied this application which supports the statements here contained indicating that the applicant is entitled to exemption from property tax as indicated.

___ $5,ooo Post W.W.I.

_____ $7,000 W.W.I.

_____ $47,500 Paraplegic

In determining the local assessed value of the exemption, the assessor shall multiply the amount of the exemption by the ratio of current just value upon which the assessment is based.

Date Approved _______________ Approved by ___________________________

Effective Date ________________ Title___________________________________________

NOTE: Acceptable proof of entitlement is covered by,

but not limited to V.A. Form 20-5455a when Item 15

Tax Code indicates Code 2 or 3.

NOTE: When this form is used by a municipality the

ratio to be used is that which was reported to the

State Tax Assessor on the annual Municipal Valuation Return.

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