Form Ptf 653-2a - Application For Veteran Exemption For Cooperative Housing Shareholders

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APPLICATION FOR VETERAN EXEMPTION FOR COOPERATIVE HOUSING SHAREHOLDERS
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 must file
st
for the Veteran Exemption with the municipal assessor no later than April 1
. This form will be included with the cooperative
st
st
housing corporation’s Veteran Exemption application which must be filed by April 1
. Forms filed after April 1
of any year will
be applied to the subsequent year tax assessment.
1.
Name of Applicant: _________________________________ Telephone #: _____________________
2.
Mailing Address: ____________________________________________________________________
3.
Legal Residence: __________________________________
4.
Date of Birth:________________
***************************************************************************************************************************
5.
Date of Entry into Armed Forces:_________________
6.
Legal Residence on Date of Entry into Armed Forces:_______________________________
7.
Date of Discharge or Separation from Armed Forces:________________________________
8.
Military Service Serial Number:__________________________________________
***************************************************************************************************************************
9.
Do you receive a 100% disability pension or compensation from the U.S. Government as a Veteran?
Yes
No.
If yes, is your disability based on:
a) Service in the U.S. Armed Forces during any Federally recognized War Period?
Yes
No
b) Injury or disease incurred in the line of duty during active military service?
Yes
No
c) Veterans Administration Claim Number: C-___________________________________
**************************************************************************************************************************
10. Did you receive a grant from the U.S. Government for Specially Adapted Housing as a Paraplegic?
Yes
No
**************************************************************************************************************************
11. Is the property in a revocable living trust with you as the beneficial owner of that trust?
Yes
No
12. Description of the property (map, lot, location, unit #, etc): __________________________________
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: _____________________
______________________________________________

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