Form Sdat Ex 4a - Application For Exemption For 100% Disabled Veterans

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RETURN TO
STATE OF MARYLAND
DEPARTMENT OF ASSESSMENTS AND TAXATION
Your local Assessment office; a list of
APPLICATION FOR EXEMPTION FOR 100% DISABLED VETERANS
offices is attached.
To be filed with the Supervisor of Assessments in the appropriate local office.
This form seeks information for the purpose of a disabled veterans exemption on the indicated property. Failure to provide this information will result in denial of your application.
However, some of this information would be considered a "personal record" as defined in State Government Article, §10-624. Consequently, you have the statutory right to inspect
your file and to file a written request to correct or amend any information you believe to be inaccurate or incomplete. Additionally, personal information provided to the State
Department of Assessments and Taxation is not generally available for public review. However, this information is available to officers of the State, county or municipality in their
official capacity and to taxing officials of any State or the federal government, as provided by statute. Additionally, if your property would be used by the State Department of
Assessments and Taxation as a comparable for purposes of 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 other property.
Full Name of Titled Owner:
Address of property:
Location and description of property:
Account Number:
Baltimore City
Ward
Section
Block
Lot
Counties
District
Map
Block
Parcel
Subdivision
Description
Date Acquired
Deed Reference
I declare under the penalties of perjury, pursuant to Section 1-201, Tax Property Article, of the 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 VETERAN
PHONE
DATE
ADDRESS
CITY
STATE
ZIP CODE
___ ___ — ___ ___
___ ___ ___ ___
SOCIAL SECURITY NUMBER
CLAIM NUMBER
Attach a Copy of a Veteran's Honorable Discharge or a Copy of DD-Form No. 214 as Required by Law. (Tax-
!
property Article, §7-208)
TO BE COMPLETED BY THE VETERANS ADMINISTRATION
The United States Veterans Administration hereby certifies that the above named veteran, has been declared by the Veterans Administration to
have a service-connected disability, which was not incurred through misconduct; that the said disability is
% disabling,
permanent in character, and reasonably certain to continue throughout the life of said veteran; and that the said veteran is receiving
disability payments as allowed for reasons of
% disability, or
% unemployability.
The character of the disability is as follows:
Effective Date of Disability
Adjudication/Service Officer
Address
City
State
Zip Code
Phone
Date
(FOR OFFICE USE ONLY)
COMMENTS:
New Application G
Re-Application G
Code No.
Approved
Disapproved
Effective
G
G
Land
Imp
Total
Supervisor's Signature
Date
THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION
SDAT EX 4A

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