Claim For Property Tax Exemption In The State Of Connecticut Amendment Under The Service Members' Civil Relief Act Form
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Revised April 21, 2010
Military Spouses Residency Relief Act
Claim For Property Tax Exemption In The State of Connecticut
Amendment Under The Service Members’ Civil Relief Act
To: Assessor or Board of Assessors, Town or City of ___________________________, Connecticut:
I, _______________________________________________________________________________________________________________,
(Name: Last name/first name/middle initial)
(Date of Birth)
hereby claim an exemption from personal property taxation in accordance with the provisions of §574 of the Federal Soldiers’ And Sailor’s Civil
Relief Act of 1940, as amended. I understand that I (and/or my spouse, if applicable) am not entitled to an exemption from the personal property
tax liability arising from a business that I/we conduct in the State of Connecticut, and that I/we are required to submit an annual Personal
Property Declaration, on or before November 1st, to the assessor(s) of the town in which such a business is/was subject to taxation. Having been
duly sworn, I depose the following in support of my claim.
MILITARY DATA
1.
On or after October 1, __________ (hereinafter referred to as the assessment date), my spouse was an active duty member of the United States
Armed Forces, attached to the following duty station in Connecticut: ____________________________________________________________.
2.
My spouse reported to his/her present duty station in Connecticut on or about ____/____/______ (mth/day/yr), and anticipates that his/her present
tour of duty assignment at that station will be completed on or about ____/____/______ (mth/day/yr).
Yes No
3.
My presence in Connecticut on the assessment date was solely as a result of my spouse’s official military orders.
If ‘No’, explain______________________________________________________________________________
4.
I was married to ________________________________________ on ____/____/______ (mth/day/yr).
5.
My domicile (i.e., my permanent and legal residence) on the assessment date was in the State of ______________________.
I have retained my domicile in said State without interruption throughout my spouse’s service in the Armed Forces.
Yes No
6.
If ‘No’, explain______________________________________________________________________________
It is now, and was on the assessment date, my intention to return to the State of my domicile upon my spouse’s
Yes No
7.
separation or retirement from the United States Armed Forces.
If ‘No’, explain______________________________________________________________________________
PERSONAL DATA
8.
On or thereafter the assessment date, I lived in the State of Connecticut at _______________________________________________________.
(
Number, Street and City/Town)
My current address is the same as on the assessment date. Yes No If ‘No’, current address: ___________________________________
9.
Yes No
10.
11.
I am a registered voter.
I last voted in the State of_______________________,
in an election held in the year _________.
I have a valid motor vehicle operator’s license.
Yes No
12.
13.
The State of _____________________ issued said license.
Yes No
14.
I have executed a last will and testament.
15.
In said document, I declared the State of ______________
as my legal residence, for probate and taxation purposes.
TAX DATA
Yes No
16
My spouse has been assigned to his/her present duty station for more than one calendar year, based upon which my
spouse has received an exemption from the Commissioner of the Department of Revenue Services from the
payment of the State of Connecticut’s personal income tax. (If Yes, do not answer Questions 17 to 21.)
Yes No
17.
The State of my legal domicile levies a personal income tax on its citizens.
Yes No
18.
I file a personal income tax return in the State of my legal domicile.
If Yes, my most recent filing was for the ______ calendar year. If No, explain. ____________________________
Yes No
19.
I pay other than personal income taxes to the State of my legal domicile.
Check tax type: Property Business Other
20.
If Yes, my most recent payment was for the ______ calendar
21.
year.
If Other, please describe: _________________________________________
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