Form D.v.s.s.e. - Claim For Property Tax Exemption On Dwelling House Of Disabled Veteran Or Surviving Spouse/civil Union Or Domestic Partner Of Disabled Veteran Or Serviceperson

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CLAIM FOR PROPERTY TAX EXEMPTION ON DWELLING HOUSE OF DISABLED VETERAN OR SURVIVING
SPOUSE/CIVIL UNION OR DOMESTIC PARTNER OF DISABLED VETERAN OR SERVICEPERSON
(N.J.S.A. 54:4-3.30 et seq.; P.L.1948, c.259 as amended; N.J.A.C. 18:28-1.1 et seq.)
IMPORTANT File this completed claim with your municipal tax assessor. (See instructions on reverse.)
1. CLAIMANT NAME
______________________________________________________________________________________________________________
Name(s) of veteran claimant owner (& spouse, as tenants by entirety, or civil union or domestic partner) or of surviving spouse/civil
union or domestic partner permanently residing in dwelling
**************************************************************************************************************
2. DWELLING LOCATION
______________________________________________________________________________________________________________
Street Address of claimant owner's principal residence
Phone #
______________________________________________________________________________________________________________
County
Municipality
______________________________________________________________________________________________________________
Block
Lot
Qualifier
**************************************************************************************************************
3. DISABLED VETERAN/SURVIVING SPOUSE/CIVIL UNION OR DOMESTIC PARTNER OF DISABLED VET OR
SERVICEPERSON (Check A, B, or C)
A.
Honorably discharged disabled veteran with active wartime service in United States Armed Forces. ATTACH copy DD214.
B.
Surviving spouse/civil union or domestic partner of honorably discharged disabled veteran with active wartime service in
United States Armed Forces; and
I have not remarried/formed a new registered civil union or domestic partnership. ATTACH copy DD214.
C.
Surviving spouse/civil union or domestic partner of serviceperson who died on wartime active duty in the United States Armed
Forces; and
I have not remarried/formed a new registered civil union or domestic partnership. ATTACH copy Military Notification of
Death.
**************************************************************************************************************
4. ACTIVE WAR TIME SERVICE PERIOD (Check All Applicable Service Periods)
**A.
Operation Northern/Southern Watch
August 27, 1992 - March 17, 2003
**B.
Operation Iraqi Freedom
March 19, 2003 - Ongoing
**C.
Operation Enduring Freedom
September 11, 2001 - Ongoing
**D.
"Joint Endeavor/Joint Guard" - Bosnia & Herzegovina
November 20, 1995 - June 20, 1998
**E.
"Restore Hope" Mission - Somalia
December 5, 1992 - March 31, 1994
**F.
Operation Desert Shield/Desert Storm Mission
August 2, 1990 - February 28, 1991
**G.
Panama Peacekeeping Mission
December 20, 1989 - January 31, 1990
**H.
Grenada Peacekeeping Mission
October 23, 1983 - November 21, 1983
**I.
Lebanon Peacekeeping Mission
September 26, 1982 - December 1, 1987
J.
Vietnam Conflict
December 31, 1960 - May 7, 1975
**K.
Lebanon Crisis of 1958
July 1, 1958 - November 1, 1958
L.
Korean Conflict
June 23, 1950 - January 31, 1955
M.
World War II
September 16, 1940 - December 31, 1946
N.
World War I
April 6, 1917 - November 11, 1918
**NOTE - Peacekeeping Missions require a minimum of 14 days service in the actual combat zone except where service-incurred injury
or disability occurs in the combat zone, then actual time served though less than 14 days, is sufficient for purposes of property tax
exemption or deduction. The 14 day requirement for Bosnia and Herzegovina may be met by services in one or both operations for 14
days continuously or in aggregate. For Bosnia and Herzegovina combat zone also includes the airspace above those nations.
**************************************************************************************************************
5. DISABILITY (Check A or B & complete C)
A.
Wartime service-connected disability from paraplegia, sarcoidosis, osteochondritis resulting in permanent loss of use of
both legs, or permanent paralysis of both legs and lower parts of the body, or from hemiplegia and having permanent
paralysis of one leg and one arm or either side of the body, resulting from injury to spinal cord, skeletal structure, or
brain or from disease of spinal cord not resulting from any form of syphilis; or from total blindness; or from amputation
of both arms or both legs, or both hands or both feet, or the combination of a hand and a foot; or
B.
Other wartime service-connected disability declared to be a total or 100% permanent disability, and not so evaluated
solely because of hospitalization or surgery and recuperation, sustained through enemy action, or accident,
or resulting from disease contracted while in such service.
C.
Date V.A. determined 100% permanently and totally disabled______________________
**************************************************************************************************************
6. OWNERSHIP & OCCUPANCY (Complete A, B, and C)
A.
I (my spouse/civil union partner & I, as tenants by entirety), solely own or hold legal title to the above dwelling house.
Partial owners: I (as joint tenant or tenant in common) own _____%.
Grantee (buyer)____________________ name per deed. Deed Date__________________________
B.
The dwelling house is One-Family and I occupy all of it as my principal residence. OR
C.
The dwelling house is Multi-Unit and I occupy ________________% as my principal residence.
**************************************************************************************************************
7. CITIZEN & RESIDENT (Complete A or B)
A.
As of _____________________(insert date - month/day/year), I, the above named veteran claimant was a
citizen and legal or domiciliary resident of New Jersey.
B.
As of _____________________(insert date - month/day/year), I, the above named surviving spouse/civil union or
domestic partner claimant was a citizen and legal or domiciliary resident of New Jersey; and
My deceased veteran or serviceperson spouse/civil union or domestic partner was a citizen and resident of New Jersey
at death.
**************************************************************************************************************
I certify the above declarations are true to the best of my knowledge and belief and understand they will be considered as if made under
oath and subject to penalties for perjury if falsified.
____________________________________________________________________________________________________
Signature of claimant
Date
**************************************************************************************************************
OFFICIAL USE ONLY - Block_____________________ Lot________________
Approved
Disallowed
Assessor_______________________________________________Date__________________________________________
Form D.V.S.S.E. rev. February 2013

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