STATE OF MARYLAND DEPARTMENT OF ASSESSMENTS AND TAXATION APPLICATION FOR EXEMPTION FOR SURVIVING SPOUSES OF ACTIVE MILITARY PERSONNEL
Your local Assessment Office. Click this box to get a list of local offices.
WHO DIED IN THE LINE OF DUTY
TO BE FILED with the Supervisor of Assessments at the address shown above.
This form seeks information for the purpose of an exemption on the dwelling house of a surviving spouse of active military personnel who died in the line of duty. 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 Property Acquired Name of Deceased Military Personnel Date of Death 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 application (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 form and that I am the unremarried spouse of active duty military personnel who died in the line of duty.
SIGNATURE OF SURVIVING SPOUSE ADDRESS ___ ___ -- ___ ___ -- ___ ___ ___ ___ SOCIAL SECURITY NUMBER
PHONE CITY CLAIM NUMBER STATE
DATE ZIP CODE
TO BE COMPLETED BY THE VETERANS ADMINISTRATION Name of Active Military Personnel who Died in the Line of Duty: The United States Veterans Administration hereby certifies that the above named individual died while in Active Military Service as a result of an injury or disease incurred in the line of duty. Cause of Death: Date of Death:
Signature of Adjudication/Service Officer
(FOR OFFICE USE ONLY) COMMENTS: New Application G Approved G Land Imp Re-Application G Disapproved G Code No. Effective Total
THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION SDAT -4C