Free Surviving Spouses of Disabled Veterans - Maryland

STATE OF MARYLAND DEPARTMENT OF ASSESSMENTS AND TAXATION APPLICATION FOR EXEMPTION FOR SURVIVING SPOUSES OF DISABLED VETERANS
TO BE FILED with the Supervisor of Assessments at the address shown above.

RETURN TO:
Your local Assessment Office. Click this box to get a list of local offices.

This form seeks information for the purpose of an exemption for the surviving spouse of a disabled veteran on the indicated property. Failure to provide this information will result in denial of your application. However, some of this information would be considered a "personal record" as defined in State Government Article, §10-624. Consequently, you have the statutory right to inspect your file and to file a written request to correct or amend any information you believe to be inaccurate or incomplete. Additionally, personal information provided to the State Department of Assessments and Taxation is not generally available for public review. However, this information is available to officers of the State, county or municipality in their official capacity and to taxing officials of any State or the federal government, as provided by statute. Additionally, if your property would be used by the State Department of Assessments and Taxation as a comparable for purposes of establishing the value of another property in a hearing before the Maryland Tax Court, the requested information, or a portion thereof, may have to be provided to the owner of that other property.

Full Name of Titled Owner: Address of property:

Location and description of property: Baltimore City Counties Subdivision Description Date Acquired Date of Veteran's death Ward District

Account Number: Section Map Block Block Lot Parcel

Deed Reference

I declare under the penalties of perjury, pursuant to Section 1-201, Tax Property Article, of the Annotated Code of Maryland, that this return (including any accompanying schedules and statements) has been examined by me and to the best of my knowledge and belief is a true, correct and complete return and that I am the unremarried spouse of the veteran.

SIGNATURE OF SURVIVING SPOUSE

PHONE

DATE

ADDRESS ___ ___ -- ___ ___ -- ___ ___ ___ ___

CITY

STATE

ZIP CODE

SOCIAL SECURITY NUMBER

CLAIM NUMBER

!

Attach a Copy of a Veteran's Honorable Discharge or a Copy of DD-Form No. 214 as Required by Law. (Tax-property Article, §7-208).

TO BE COMPLETED BY THE VETERANS ADMINISTRATION The United States Veterans Administration hereby certifies that the above named veteran, prior to his/her death, was declared by the Veterans Administration to have a service-connected disability, which was not incurred through misconduct; that the said disability was % disabling, permanent in character, and reasonably certain to have continued throughout the life of said veteran; and that the said veteran had been receiving disability payments as allowed for reasons of % disability, or % unemployability. The character of the disability is as follows:

Effective Date of Disability Address Phone

Adjudication/Service Officer City Date (FOR OFFICE USE ONLY) State Zip Code

COMMENTS:

New Application Approved Land

Re-Application Disapproved Imp

Code No. Effective Total

Supervisor's Signature

Date
THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION SDAT - 4B