MARYLAND STATE DEPARTMENT OF ASSESSMENTS AND TAXATION 
              APPLICATION FOR EXEMPTION FOR SURVIVING SPOUSES OF BLIND PERSONS 

TO BE FILED with the Supervisor of Assessments in the appropriate local office; a list of offices is attached. 
This form seeks information for the purpose of a blind exemption for a surviving spouse of blind person on the indicated property. Failure to 
provide this information will resultin denial of your application. However, some ofthis information would be considered a"personal 
record"asdefinedinStateGovernmentArticle§10-624.Consequently,youhavethestatutoryrighttoinspectyourfileandtofileawritten 
requesttocorrectoramendanyinformationyoubelievetobeinaccurateorincomplete.Additionally,personalinformationprovidedtothe 
State Departmentof Assessmentsand Taxation is not generally available forpublic review. However, this information is available to 
officersof the State,county ormunicipality in theirofficial capacity and to taxingofficials ofany State orthe federal government, as 
provided by statute. Additionally, if your property would be used by the State Department ofAssessments and Taxation asa comparable 
for purposesof 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 otherproperty. 

Title to property is in the name(s): 
Address of property: 
Location and Description of Property:          Account Number:  
Baltimore City                Ward                   Section                 Block                             Lot 
County:                       District               Map                     Block                             Parcel 
Subdivision:                                   Description: 
                                                      
Date Acquired                                  Deed Reference 
Date of Blind Person's Death 
Name of Property Owner 

        I hereby certify that the above described property is my place of residence, that is was the legal residence of my blind and 
deceased spouse, and that he/she met the requirements of the Maryland Law granting the exemption from property taxation as the 
attached doctor's certification will indicate and, that I have not remarried.
        I declare under the penalties of perjury, pursuant to Section 1-201, Tax Property Article, 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 Surviving Spouse                                                               Date 
Print Name _______________________________________   Telephone number __________________________ 
The following certification must be completed by a licensed medical doctor or optometrist. 

This is to certify that the herein  named applicant                                                                , a blind 
person hasbeen       examined by me, and is found to have permanent impairment of both eyes of the following status: 
central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 
20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter 
of visual field subtends an angular distance no greater than twenty degrees on the better eye. 

Signature                                                                    Date 

Full Address 

Phone_______________________________________  Effective Date of Blindness________________________ 

                                     THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION 
                                                       (FOR OFFICE USE ONLY) 
Comments: 

New Application [  ]                   Re-Application [  ]                   Code No__________________________________ 

Approved [  ]                          Disapproved [  ]                      Effective___________________________________ 

Land                                   Imp                                   Total 

Supervisor's Signature                                                             Date 

                     SDATRP_EX-5B       January 2019                               http://dat.maryland.gov

                                                                            MARYLAND STATE DEPARTMENT OF ASSESSMENTS & TAXATION 
                                                                                       REAL PROPERTY DIVISION 
                                                                       Listed below are the mailing addresses for local assessment offices 

                                               ASSESSMENT OFFICE MAILING ADDRESSES                                                         PHONE           FAX  EMAIL
Allegany County Assessments 112 Baltimore Street, 3rd Floor, Cumberland, MD 2150  2                                                 (301)777-2108 (301)777-2052 sdat.alle@maryland.gov
Anne Arundel County Assessments 45 Calvert St., 3rd Floor, Annapolis, MD 21401                                                      (410)974-5709 (410)974-5738 sdat.aa@maryland.gov
Baltimore City Assessments Wm. Donald Schaefer Tower, 6 Saint Paul Street, 11th Floor, Baltimore, MD 21202                          (410)767-8250 (410)333-4626 sdat.baltcity@maryland.gov
Baltimore County Assessments Hampton Plaza, 300 E Joppa Road Suite,    602, Towson, MD 21286                                        (410)512-4900 (410)321-4148 sdat.blco@maryland.gov
Calvert County Assessments State Office Bldg. 200 Duke Street, Room 1200, Prince Frederick, MD 20678                                (443)550-6840 (443)550-6850 sdat.calv@maryland.gov
Caroline County Assessments Denton Multi-Service Center,  207 South 3rd St, Denton, MD 21629                                        (410)819-4450 (410)819-4441 sdat.crln@maryland.gov
Carroll County Assessments  15 E Main Street, Suite 229, Westminster, MD 21157                                                      (410)857-0600 (410)857-0128 sdat.carl@maryland.gov
Cecil County Assessments District Court Multi-Service Center, 170 East Main Street, Elkton, MD 21921                                (410)996-2760 (410)996-2770 sdat.cec@maryland.gov
Charles County Assessments Southern Maryland Trade Center, 101 Catalpa Drive Suite 101A, LaPlata, MD 20646                          (301)932-2440 (301)932-2189 sdat.char@maryland.gov
Dorchester County Assessments 501 Court Lane, PO Box 488, Cambridge, MD 21613                                                       (410)228-3380 (410)228-3704 sdat.dor@maryland.gov
Frederick County Assessments 5310 Spectrum Dr, Suite E, Frederick, MD 21703                                                         (301)815-5350 (301)663-8941 sdat.fred@maryland.gov
Garret County Assessments County Courthouse 317 East Alder St., Room 106 PO, BOX 388, Oakland, MD 21550                             (301)334-1950 (301)334-5018 sdat.gar@maryland.gov
Harford County Assessments Mary E.W. Risteau District Court Multi- Service Center, 2 South Bond Street Suite, 400, Belair, MD 21014 (410)836-4800 (410)838-5914 sdat.harf@maryland.gov
Howard County Assessments District Court Multi- Service Center, 3451 Court House Dr, Ellicott City, MD 21043                        (410)480-7940 (410)480-7960 sdat.how@maryland.gov
Kent County Assessments 114-A Lynchburg Street, Chestertown, MD 21620                                                               (410)778-1410 (410)778-1525 sdat.kentco@maryland.gov
Montgomery County Assessments 30 W. Gude Drive, Suite 400,  Rockville MD 20850                                                      (240)314-4510 (301)424-3864 sdat.mont@maryland.gov
Prince George's County Assessments 14735 Main Street, Suite 354B, Upper Marlboro, MD 20772                                          (301)952-2500 (301)952-2955 sdat.princeg@maryland.gov
Queen Anne's County Assessments Carter M. Hickman District Court Multi- Service Center, 120 Broadway Suite 7, Centreville, MD 21617 (410)819-4160 (410)819-4170 sdat.qaco@maryland.gov
St Mary's County Assessments Carter Building, 23110 Leonard Hall Drive, Room 2059, PO Box 1509 Leonardtown, MD 20650                (301)880-2900 (301)475-4856 sdat.stm@maryland.gov
Somerset County Assessments 11545 Somerset Avenue, Princess Anne, MD 21853                                                          (410)651-0868 (410)651-1995 sdat.som@maryland.gov
Talbot County Assessments 29466 Pintail Drive,  ui S te 12, Easton, MD 21601                                                        (410)819-5920 (410)822-0048 sdat.talb@maryland.gov
Washington County Assessments 3 Public Square, Hagerstown, MD 21740                                                                 (301)791-3050 (301)791-2925 sdat.wash@maryland.gov
Wicomico County Assessments Salisbury District Court Multi-Service Center, 201 Baptist Street, Box 8 Salisbury, MD 21801            (410)713-3560 (410)713-3570 sdat.wic@maryland.gov
Worcester County Assessments One West Market Street, Rm. 1202, Snow Hill, MD 21863                                                  (410)632-1196 (410)632-1366 sdat.wor@maryland.gov

                                                            ALL ASSESSMENT OFFICES ARE OPEN MONDAY - FRIDAY 8:00 AM – 4:30 PM, 
                                                                       EXCEPT BALTIMORE CITY WHICH IS OPEN 8:00 AM – 5:00 PM 
                                 For a complete list of office locations visit http://dat.maryland.gov/realproperty/Pages/Maryland-Assessment-Offices.aspx 

        Revised: 8/20/18