Ppb-8a - Disabled American Veteran Application Form Montana
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1MONTANA
PPB-8A
Rev. 11-07
Disabled American Veteran Application
(15-6-211, MCA)
County
This form, including all supporting documentation, must be returned to your local DOR office before
April 15th or no exemption or reduction can be allowed. The exemption or reduction applies to the land
up to five acres in size, the veteran’s residence, and one attached or detached garage. Additional
buildings do not receive the reduction or exemption. You will receive a follow up letter that will indicate if your
application has been approved or denied.
Geocode:
Name:
School District:
Mailing Address:
Assessment Code:
City, State Zip:
Affidavit of DAV
I affirm that I have been honorably discharged from active service in the armed forces, currently rated 100% disabled or
compensated at the 100% disabled rate due to a service-connected disability. I own and occupy the property on which I am
applying and my adjusted gross income is not more than $44,266 if single or $51,076 if married. If your disability rating is
permanent, a letter of eligibility need only be submitted once.
Single – Adjusted Gross Income $_________________
Married – Adjusted Gross Income $________________
A copy of your 2007 federal or state income tax return must be included with this application. If you are not required to file a
federal income tax return, please state the reason:___________________________________________________.
Under penalty of law, I affirm that the information provided in this form is true and correct.
Signature
SSN__________
Phone ________________
Date_________________________________
Affidavit of Surviving Spouse of DAV
I affirm that I am the surviving spouse of a veteran who was 100% service-connected disabled or compensated at the 100%
disabled rate at the time of death, died while on active duty, or died as a result of a service connected disability.
I have remained unmarried, own and occupy this property and have an adjusted gross income, as reported on the latest federal
income tax return, of not more than $38,591.
Adjusted Gross Income $
A copy of your 2007 federal or state income tax return must be included with this application. If you are not required to file a
federal income tax return, please state the reason:___________________________________________________.
Under penalty of law, I affirm that the information provided in this form is true and correct.
Signature
SSN
______
Phone __________________________
Date_____________________________________
Department Use Only
Current Letter of Disability
Verification of Income
Granted
Yes
No
Yes
No
Yes
No
Single
Married
Surviving Spouse
%
Class Codes
$
0 - $
34,051
$
0 - $
40,861
$
0 - $
28,376
00
2140
3145
6245
$ 34,052 - $
37,456
$ 40,862 - $
44,266
$ 28,377 - $
31,781
20
2141
3146
6246
$ 37,457 - $
40,861
$ 44,267 - $
47,671
$ 31,782 - $
35,186
30
2142
3147
6247
$ 40,862 - $
44,266
$ 47,672 - $
51,076
$ 35,187 - $
38,591
50
2143
3148
6248
460
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