STATE OF MARYLAND
DEPARTMENT OF ASSESSMENTS AND TAXATION
APPLICATION FOR EXEMPTION FOR 100% DISABLED VETERANS
Your local Assessment Office. Click this box to get a list of local offices.
TO BE FILED with the Supervisor of Assessments at the address shown above.
This form seeks information for the purpose of a disabled veterans exemption 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 Ward District
Account Number: Section Map Block Block Lot Parcel
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.
SIGNATURE OF VETERAN ADDRESS ___ ___ -- ___ ___ -- ___ ___ ___ ___ CLAIM NUMBER PHONE CITY STATE DATE ZIP CODE
SOCIAL SECURITY NUMBER
Attach a Copy of a Veteran's Honorable Discharge or a Copy of DD-Form No. 214 as Required by Law. (Taxproperty Article, §7-208) TO BE COMPLETED BY THE VETERANS ADMINISTRATION
The United States Veterans Administration hereby certifies that the above named veteran, has been declared by the Veterans Administration to % disabling, have a service-connected disability, which was not incurred through misconduct; that the said disability is permanent in character, and reasonably certain to continue throughout the life of said veteran; and that the said veteran is receiving % disability, or % unemployability. disability payments as allowed for reasons of The character of the disability is as follows:
Effective Date of Disability Address Phone City Date (FOR OFFICE USE ONLY) COMMENTS:
Adjudication/Service Officer State Zip Code
New Application G Approved G Land
Re-Application G Disapproved G Imp
Code No. Effective Total
Date THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION SDAT EX 4A