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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 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 General Provisions Article, §4-501. Consequently, you havethe statutory right to inspectyourfile 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.
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 to apply for a refund of any property tax paid for which you may be eligible under Tax Property Article 7-208.
• Attach a copy of the Veteran’s Honorable Discharge or a copy of DD-Form 214 as required by law. (Maryland
Annotated Code, Tax-Property Article, § 7-208)
• Attach a copy of the veteran’s most recent ratingnotification packet by the U.S. Department o f Veterans Affairs
(V.A.). Document from the V.A. must indicate that the 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 of the V.A. rating’s decision.
• Applicant must be a Maryland resident. Attach copy of a current Maryland driver’s license, voter’s registration or
redacted previous year Maryland income taxes as proof of residency. (If pending 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 the above-named veteran has been declared by the V.A. to
have a service-connected disability, which was not incurred through misconduct; that the said disability is __ % disabling. 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 allowed for reasons
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 2023 http://dat.maryland.gov
