Form Boe-261-Gnt (P1) - Disabled Veterans' Exemption Change Of Eligibility Report May 2014 Page 2
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3BOE-261-GNT (P2) REV. 23 (05-14)
SIGN HERE ONLY IF YOU NO LONGER QUALIFY FOR THE DISABLED VETERANS’ EXEMPTION AS OF JANUARY 1, 2015
I no longer qualify for the Disabled Veterans’ Exemption.
Signature ______________________________________________
Date ____________________
(
)
Daytime Telephone Number
_____
__________________
Social Security Number
______ - ____ - ________
:
REASON AND DATE OF DISQUALIFICATION (It is extremely important that you enter the date that you became ineligible.)
1.
The property is no longer my principal place of residence because:
A.
I sold the property on (date): ________________
If sale is unrecorded, enter name of purchaser: ___________________________________________________
B.
I am still the owner of the property but I no longer reside there as of (date): _________________
2.
I received the exemption as the surviving spouse of a deceased disabled veteran and I remarried on (date): _____________
3.
My disability or disability compensation was changed to less than 100 percent on (date): _________________
4.
I am no longer blind; visual acuity in both eyes was not rated at 5/200 or less, or have a concentric contraction of 5
degrees or less on (date): ________________
5.
I have no longer lost the use of two limbs; use was restored on (date): ________________
6.
Following a death, the property is no longer occupied by a qualified disabled veteran.
A. Name of deceased veteran: ______________________________________________
B. Date of death: _________________ Please attach a copy of the Death Certificate.
C. Name of person requesting change: _______________________________________
D. Relationship to disabled veteran or unmarried surviving spouse: _________________
E. Daytime telephone number: ( ____ ) ________________
F. Signature _______________________________________
If you change your principal place of residence on or after January 1, 2015, and the new resident of the property is not
eligible for the exemption, the exemption shall cease to apply to that property on the date of the sale or transfer. An
exemption will not be allowed on your new residence until you qualify and file a claim with the Assessor or within 30 days
of the date of notice of supplemental assessment. In the case where a supplemental notice was not mailed or not required,
you must file a claim the later of:
(a) 90 days of acquisition of your new residence, or 90 days after you establish residency at a property you previously
owned; or
(b) on or before the next following lien date after the year that your property was acquired, or when you established
residency in a previously owned property.
Note: If you were not eligible for the exemption on January 1, 2015, you must notify the Assessor on or before June 30, 2015, or you
will be subject to payment of the amount of taxes the exemption represents, plus a 25 percent penalty and interest.
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