Non-Resident Affidavit For Property Tax Exemption Form - The State Of Connecticut

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Non-Resident Affidavit For Property Tax Exemption In
Revised March 2012
The State of Connecticut
SERVICEMEMBERS CIVIL RELIEF ACT (SCRA)
I, ________________________________________________
_____________________________________________________________,
(Last name/First name/Middle initial)
(Rank)
(Branch)
(Date of Birth)
hereby claim an exemption from personal property taxation in accordance with the provisions of §571 of the Servicemembers Civil
Relief Act (SCRA) as amended. Having been duly sworn, I depose the following in support of my claim:
1.
On or after October 1, __________ (hereinafter referred to as the assessment date), I was an active duty member of the United States
Armed Forces, attached to the following duty station in Connecticut: __________________________________________________.
2.
I reported to my present duty station in Connecticut on or about ____/____/______ (mth/day/yr), and anticipate that my 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 official military orders.
If ‘No’, explain______________________________________________________________________________.
4.
My home of record or permanent address as shown in my military records is in the State of ________________________________.
Yes  No 
5.
I have retained my domicile in said State without interruption throughout my service in the Armed Forces.
If ‘No’, explain_______________________________________________________________________________
Yes  No 
6.
It is now, and was on the assessment date, my intention to return to the State of my domicile upon my separation
or retirement from the United States Armed Forces. If ‘No’, explain ___________________________________.
7.
On 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 
8.
If ‘No’, current address: _____________________________________________________________________________________.
Yes  No 
Spouse’s name _____________________________
9.
I am (and was) married on the assessment date.
If yes,
10.
On the assessment date, I (and/or my spouse) owned the personal property described below, which was located in the
City/Town of ____________________________________, Connecticut.
Note: With respect to ‘Ownership’, please
S -
for property owned solely by serviceman;
for property owned solely by serviceman’s spouse; or
enter the following code(s), as applicable:
SP -
J -
for property jointly owned by serviceman and his/her
spouse.
MOTOR VEHICLE (including unregistered snowmobiles)
Year, Make and Model
State & Plate #
Ownership
_________________________________________________
__________________________________________________
Signature of Affiant
Signature of Notary Public
_____________________________________________
Phone
Email
PLEASE ATTACH A CURRENT LEAVE & EARNINGS
Subscribed and sworn to me this _____ day of ______, year______.
.
STATEMENT TO THIS AFFIDAVIT
My Commission expires: _______________________

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