MARYLAND STATE DEPARTMENT OF ASSESSMENTS & TAXATION 
                   APPLICATION FOR EXEMPTION FOR SURVIVING SPOUSES OF A DISABLED VETERANS 
 
                  Application to be filed with the Supervisor of Assessments at the appropriate office; a list of offices is attached. 
                                                                     
     This form seeks information for the purpose of an exemption for the surviving spouse of a disabled veteran on the indicated property. 
     Failure to provide this information will result in denial of your application. However, some of this information would be a “personal 
     record” as defined in General Provisions Article, §4-501. 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. 
      
     Full Name of Titled Property  Owner(s): ___________________________________________________________________________  
     Address of property: ________________________________________________________________________________________  
     County Account Number: ___________________________ (Baltimore City) Ward _____    Section _____ Block _____   Lot _____  
     Description of Property: _____________________________________________________________________________________  
     Date Property Acquired: __________   Former Address If purchased after Veterans Death: ________________________________ 
   Veteran’s Name: _____________________________________   Date of Death: _______  State Death Occurred _____________ 
   Has the applicant remarried? (Yes/No): _______ Was the veteran a Maryland resident at time of death? (Yes/No): _________ 
                                                                                                                                        
     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 Surviving Spouse: _______________________________________________      Date: ____________________________  
      
     Printed Name: _______________________________________________      Email:         _______________________________________ 
     Mailing Address: _____________________________________________  Daytime Phone: _______________________________   

     ☐  Check to apply for a refund of any property tax paid for which you may be eligible under Tax Property Article 7-208.   
 
     • Attach a copy of the Veteran’s Honorable Discharge or a copy of DD-Form 214 as required by law. (Maryland 
       Annotated Code, Tax-Property Article, § 7-208)  
     • Attach a copy of the veteran’s most recent rating  decision by the U.S. Department of Veterans Affairs (V.A.). 
       Document from the V.A. must indicate that the veteran’s final service connected disability rating was 100% permanent 
       and total or 100% permanently unemployable. This document must include the disability rating’s effective date and 
       date of the V.A. rating’s decision. 
     • Applicant must be a Maryland resident.  Attach copy of a current Maryland driver’s license, voter’s registration,   or
        redacted previous year Maryland income taxes as proof of residency.  
               IF V.A. RATING DOCUMENT IS NOT AVAILABLE, THIS  SECTION MUST BE COMPLETED BY THE V.A. 
 
 The United States Veterans Administration (V.A.) hereby certifies that the above named veteran, prior to or after his/her death, was 
 declared by the V.A. to have had a service-connected disability, which was not incurred  through  misconduct;  that  the said disability 
 was               % disabling, permanent in character, and reasonably certain to have continued throughout the life of the said 
 veteran; had been receiving disability payments as allowed for reasons of             % disability, or          % unemployability. 
  
  The character of the disability is as follows: _____________________________________________________________________  
  _______________________________________________________________________________________________________  
  Effective Date of Final  Disability Rating: ________    Date of V.A. Final Rating Decision: _____________  
  Adjudication/Service Officer Name: _________________________________________ Date _______________________ 
  Mailing Address: __________________________________________________________________________________________     
  Daytime Phone __________________________________                  Email: _____________________________________   
                                                                    
                                         THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION  
                                                 FOR ASSESSMENT OFFICE USE ONLY  
                                                                    
 Office Comments: _______________________________________________________________________________________________________ 
                  Approved  [   ]          Disapproved  [   ]       Effective Date: _____________________  
  
 Supervisor’s Signature _______________________________________________________                      Date: ________________________ 

  SDATRP_EX4B    Rev July 2023                                                                                                http://dat.maryland.gov  
 

                                                                      MARYLAND STATE DEPARTMENT OF            ASSESSMENTS   & TAXATION 
                                                                                        REAL PROPERTY DIVISION  
                                                                  Listed below are the mailing addresses      for local assessment offices 
 
                                                ASSESSMENT OFFICE MAILING ADDRESSES                                                           PHONE           FAX        EMAIL 
 Allegany County Assessments 112 Baltimore Street, 3rd Floor, Cumberland, MD 21502                                                      (301) 777-2108  (301) 777-2052   sdat.alle@maryland.gov 
 Anne Arundel County Assessments 45 Calvert St., 3rd Floor, Annapolis, MD 21401                                                         (410) 974-5709  (410) 974-5738   sdat.aa@maryland.gov  
 Baltimore City Assessments Wm. Donald Schaefer Tower, 6 Saint Paul Street, 11th Floor, Baltimore, MD 21202                             (410) 767-8250  (410) 333-4626   sdat.baltcity@maryland.gov 
 Baltimore  County Assessments Hampton Plaza, 300 E Joppa Road, Suite 602, Towson, MD 21286                                             (410) 512-4900  (410) 321-4148   sdat.blco@maryland.gov  
 Calvert County Assessments State Office Bldg. 200 Duke Street, Room 1200, Prince Frederick, MD 20678                                   (443) 550-6840  (443) 550-6850   sdat.calv@maryland.gov 
 Caroline County Assessments Denton Multi-Service Center,  207 South 3rd St, Denton, MD 21629                                           (410) 819-4450  (410) 819-4441   sdat.crln@maryland.gov  
 Carroll County Assessments 15 E Main Street, Suite 229, Westminster, MD 21157                                                          (410) 857-0600  (410) 857-0128   sdat.carl@maryland.gov  
 Cecil  County Assessments District Court Multi-Service Center, 170 East Main Street, Elkton, MD 21921                                  (410) 996-2760  (410) 996-2770   sdat.cec@maryland.gov  
 Charles  County Assessments Southern Maryland Trade Center, 101 Catalpa Drive Suite 101A, LaPlata, MD 20646                            (301) 932-2440  (301) 932-2189   sdat.char@maryland.gov  
 Dorchester County Assessments 501 Court Lane, PO Box 488, Cambridge, MD 21613                                                          (410) 228-3380  (410) 228-3704   sdat.dor@maryland.gov  
 Frederick  County Assessments 5310 Spectrum Dr, Suite E, Frederick, MD 21703                                                           (301) 815-5350  (301)  663-8941  sdat.fred@maryland.gov  
 Garret County Assessments County Courthouse 317 East Alder St., Room 106, PO BOX 388, Oakland, MD 21550                                (301) 334-1950  (301) 334-5018   sdat.gar@maryland.gov  
 Harford County Assessments  Mary E.W. Risteau District Court Multi-Service Center, 2 South Bond Street, Suite 400, Belair, MD 21014    (410) 836-4800  (410) 838-5914   sdat.harf@maryland.gov  
 Howard County Assessments District Court Multi-Service Center, 3451 Court House Dr, Ellicott City, MD 21043                            (410) 480-7940  (410) 480-7960   sdat.how@maryland.gov 
 Kent  County Assessments 114-A Lynchburg Street, Chestertown, MD 21620                                                                 (410) 778-1410  (410) 778-1525   sdat.kentco@maryland.gov  
 Montgomery County Assessments 30 W. Gude Drive, Suite 400, Rockville MD 20850                                                          (240) 314-4510  (301)424-3864    sdat.mont@maryland.gov 
 Prince George's County Assessments 14735 Main Street, Suite 354B, Upper Marlboro, MD 20772                                             (301) 952-2500  (301) 952-2955   sdat.princeg@maryland.gov 
 Queen Anne's County Assessments  Carter M. Hickman District Court Multi-Service Center, 120 Broadway Suite 7, Centreville, MD 21617    (410) 819-4160  (410) 819-4170   sdat.qaco@maryland.gov  
 St Mary's County Assessments Carter Building, 23110 Leonard Hall Drive, Room  2059, PO Box 1509 Leonardtown, MD 20650                  (301) 880-2900  (301)475-4856    sdat.stm@maryland.gov  
 Somerset  County Assessments 11545 Somerset Avenue, Princess Anne, MD 21853                                                            (410) 651-0868  (410) 651-1995   sdat.som@maryland.gov  
 Talbot County Assessments 29466 Pintail Drive, Suite 12, Easton, MD 21601                                                              (410) 819-5920  (410) 822-0048   sdat.talb@maryland.gov 
 Washington County Assessments 3 Public Square, Hagerstown, MD 21740                                                                    (301) 791-3050  (301) 791-2925   sdat.wash@maryland.gov  
 Wicomico  County Assessments Salisbury District Court Multi-Service Center, 201 Baptist Street, Box 8 Salisbury, MD 21801              (410) 713-3560  (410) 713-3570   sdat.wic@maryland.gov  
 Worcester County Assessments One West Market Street, Rm. 1202, Snow Hill, MD 21863                                                     (410) 632-1196  (410) 632-1366   sdat.wor@maryland.gov  
                                                                                                         
                                                          ALL ASSESSMENT OFFICES ARE OPEN MONDAY   -          FRIDAY 8:00 AM – 4:30 PM, 
                                                                  EXCEPT BALTIMORE CITY WHICH IS OPEN 8:00 AM   – 5:00 PM 
                                  For a complete list of office locations visit http://dat.maryland.gov/realproperty/Pages/Maryland-Assessment-Offices.aspx 
 
        Revised: 3/23    

               SDATRP_EX-4A  March 2023                                                                                                                                  https://dat.maryland.gov