Department of Taxation and Finance
                                                                                              DTF-75
                                        Employee Affidavit for the                                                (12/21)

                                        Hire a Veteran Credit

                                                                          certifies under penalty of perjury that:
 (Name of employee)

1.  I reside at                                                                                                             .

2.  I will begin employment with                                                              
                                                                          (Name of employer)
    on                                 .
       (Date employment will start)

3.  I have served on active duty or in the reserves in the United States Army, Navy, Air Force, Marine Corps, or Coast 
    Guard, or served in active military service of the United States as a member of the Army National Guard, Air National 
    Guard, New York Guard, or New York Naval Militia.

4.  I was released from active duty by general or honorable discharge after September 11, 2001. I have provided the 
    employer an opportunity to see the original certification verifying my discharge (for example, DD Form 214, Certificate 
    of Release or Discharge from Active Duty, issued by the National Archives and Records Administration, discharge 
    papers, or letters of separation); or
    I received a letter issued by the New York State Division of Veterans’ Services (NYS DVS) verifying that I meet the 
    character of discharge eligibility requirements for all benefits, programs, and services covered under the Restoration of 
    Honor Act, effective on November 12, 2020.

5.  I have not been employed for 35 or more hours during any week in the 180-day period immediately prior to the date 
    on which I begin employment with the employer.

6.  I am (mark an  Xin the appropriate box):

       not a disabled veteran as defined below.

       a disabled veteran as defined in paragraph (b) of subdivision one of section 85 of the New York State Civil Service 
       Law and have, upon request, provided the employer an opportunity to see acceptable documentation from the 
       Department of Veterans Affairs or a military department stating a disability determination, rated at 10% or more. 
       (See page 2 for definitions of disabled veteran and acceptable documentation.) 

 Employee signature                                                            Date signed

Page 2 of 2 DTF-75 (12/21) 

                                          Instructions

General information
This affidavit, Form DTF-75, is completed by an employee 
and given to the employer to certify that the employee is 
a qualified veteran for the purpose of the Hire a Veteran 
Credit. For more information about the credit, see 
TSB-M-13(9)C, (8)I, Hire a Veteran Credit.
Form DTF-75 must be completed and signed by the 
employee prior to or upon beginning employment. 
The employee must also allow the employer to review 
documentation verifying veteran status and proof of 
disability, if applicable, as specified in the affidavit.
Employers must keep the completed affidavits in their 
records and make them available to the Tax Department 
upon request.

Definitions 
A disabled veteran is an individual who:
•  has been certified by the United States Department of 
  Veterans Affairs or a military department as entitled to 
  receive disability payments upon the certification by the 
  Department of Veterans Affairs or military department 
  for a disability incurred by the veteran in the course of 
  the veteran’s service and in existence at the time of 
  hiring; and
•  has a certificate from the Department of Veterans Affairs 
  stating that:
  –  the veteran has been examined by a medical officer 
  of the Department of Veterans Affairs within one 
  year of the date of hiring, and at the time of the 
  examination, the disability described in the certificate 
  was found to exist and the disability is rated at 10% 
  or more; or
  –  a permanent stabilized condition of disability exists 
  to an extent of 10% or more, whether or not the 
  veteran has been examined by a medical officer of 
  the Department of Veterans Affairs within one year of 
  the date of hiring. 
Acceptable documentation is a letter issued by the 
Department of Veterans Affairs (VA) on VA letterhead or 
bearing the Agency Stamp, with signature, certifying that 
the veteran has a service-connected disability rated at 
10% or more.