COOPERATIVE HOUSING SHAREHOLDER APPLICATION FOR EXEMPTION FOR WIDOW,
WIDOWER, MINOR CHILD OR WIDOWED PARENT OF A VETERAN
Title 36 MRSA Section 653
Please refer to Bulletin #7 for additional information
PLEASE FILE THIS FORM WITH YOUR LOCAL COOPERATIVE HOUSING CORPORATION
DO NOT FILE THIS RETURN WITH THE MUNICIPAL ASSESSOR
INSTRUCTIONS: Completed forms must be filed with your local cooperative housing corporation along with
satisfactory documentary evidence in order to show exemption eligibility. Your cooperative housing corporation
st
must file for the Veteran Exemption with the municipal assessor no later than April 1
. This form will be included with the
st
cooperative housing corporation’s Veteran Exemption application which must be filed by April 1
. Forms filed after April
st
1
of any year will be applied to the subsequent year tax assessment.
1. Name:________________________________________________________________________
If the property is in a Revocable Living Trust, are you the beneficiary of that trust?
Yes
No
2. Mailing Address:___________________________________Telephone #___________________
3. Legal Residence:____________________________
4. Property Description (map, lot, location, unit #, etc) ____________________________________
5. Do you Receive a Pension from the United State Government as the:
a) Unremarried Widow, Widower or the Minor Child of a Veteran?
Yes
No
b) Unremarried Widowed Parent of a Veteran?
Yes
No
6. If Minor Child or Parent of a deceased veteran, Date of Birth:______________________
7. Information Relating to Deceased Veteran who was the Husband, Wife, Child or Parent of Applicant:
a) Name of Veteran: ________________________________________________________
b) Date of Birth of Veteran: ___________________________________________________
c) Date of Decease of Veteran: ________________________________________________
d) Was Veteran’s Death Service Connected?
Yes
No
e) Date of Entry into Armed Forces:___________________________________
f) Legal Residence on Date of Entry into Armed Forces:___________________________
g) Date of Discharge or Separation from Armed Forces:____________________________
h) Was Veteran Receiving 100% Disability Pension or Compensation at Death?
Yes
No
i) Did Veteran Receive a Grant from U.S. Government for Specially Adapted Housing as a Paraplegic?
Yes
No
j) Veterans Administration Claim No: C-_______________________________________
k) Military Service Serial Number:____________________________________________
I hereby declare, aware of penalties for perjury that the answers to the above are true, correct and complete to
the best of my/our knowledge and belief. Any person who knowingly files false information for the purpose of
obtaining a homestead exemption is guilty of a criminal offense.
Signature of Cooperative Housing Shareholder(s) _________________________________________
Date: _____________________
_________________________________________