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MARYLAND STATE DEPARTMENT OF ASSESSMENTS & TAXATION
APPLICATION FOR EXEMPTION FOR DISABLED VETERANS
Application be filed with the Supervisor of Assessments at the appropriate office; a list of offices is attached.
This form seeks information for the purpose of a disabled veteran’s exemption onthe 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 General Provisions Article, §4-501. Consequently,youhavethe statutory right to inspectyourfile and to file a written request to
correct or amend any information believeyou to be inaccurate incomplete.or Additionally, personal information provided State to the
Department of Assessments and Taxation notis generally available for public review. However, this information is available toofficers of the
State, county or municipality in their official capacity and to taxing officials of any State or government,the federalas provided by statute.
Full Name of Titled Property Owner(s): _________________________________________________________________________
Address of Property: _______________________________________________________________________________________
County Account Number: (Baltimore City)Ward____ Section ____ Block ____ Lot ______
Description of Property: ___________
I declare under the penalties of perjury, pursuant to Section 1-201, Tax Property Article, of the Annotated Code Maryland,of 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: Date: ___________________________
Printed Name: ____ Social Security Number: ____________________________
Mailing Address: ____
Daytime Phone: Email Address: _________
Check if transferring an exemption & provide an address: ___________________________________________
Check to apply for a refund of propertyany tax paid for which you may be eligible under Tax Property Article 7-208.
Please list all properties owned by veteran, use additional paper if needed:______________________
• Attach a copy of the Veteran’s Honorable Discharge or a copyof DD-Form 214 as required (Marylandby law. Annotated Code, Tax-
Property Article, § 7-208)
• Attach a copytheofveteran’s most recent rating notification packet by the U.S. Department of Veterans Affairs (V.A.). Document from
the V.A. must indicate thatthe veteran’s final service-connected disability rating is 100%permanent and total or 100% permanently
unemployable. This document must include the disability rating’s effective date and date the of V.A. rating’s decision.
• Applicant
must be a Maryland resident. Attach copy ofa current Maryland driver’s license, voter’s registration or redacted previous
year Maryland income taxes as proofresidency.of pending (If purchase, provide a contract of sale)
IF V.A RATING DOCUMENT IS NOT AVAILABLE, THIS SECTION MUST BE COMPLETED BY THE V.A.
The United States Veterans Administration (V.A.) hereby certifies that above-namedthe veteran has been declared theby V.A. to
have a service-connected disability, which was not incurred through misconduct; that the said __disability %isdisabling. Is
the disability permanent in character? . Is the disability reasonably certain to continue for the life of the veteran? _____
Is the veteran 100% permanently unemployable?. Is the said veteran receiving disability payments as forallowedreasons
of _________% disability, or __% unemployability.
The character of the disability is as follows: ______________________________________________________________________
________________________________________________________________________________________________________
Effective Date of Disability Rating: Date of V.A. Rating Decision: ____________________________
Adjudication/Service Officer Name: ____ Date: ________________
Mailing Address: _________
Daytime Phone: Email: _____________________________________
THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION
FOR ASSESSMENT OFFICE USE ONLY
Comments ____________________________________________________________
Approved Re-Application [ ]Disapproved [ ] [ ] Effective Date: ________________
Supervisor’ s Signature: ______ Date:
SDATRP_EX4B Rev July 204 http://dat.maryland.gov
