MARYLAND STATE DEPARTMENT OF ASSESSMENTS & TAXATION  
             APPLICATION FOR EXEMPTION FOR SURVIVING SPOUSES OF DISABLED VETERANS                                                           
 
                        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 Owner: ___________________________________________________________________________________  
  Address of property:  ________________________________________________________________________________________  
  County Account Number:  ____________________________________________________________________________________  
  (Baltimore City)  Ward _____________        Section _______________  Block _____________              Lot ________ 
  Description of Property: _____________________________________________________________________________________ 
  Date Property Acquired: _____________________ Veteran’s Name: ________________________________________________                               
  Veteran’s Date of Death: ____________________  Veteran’s Social Security Number: __________________________________                          
   
  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 and that I am the unremarried spouse of the veteran.  
 
  Signature   ofSurvivor: _____________________________________________________ Date:                  ____________________________                           
 
  Print Name: ________________________________________________  Email: _______________________________________                                    
 
  Mailing Address:________________________________________________________________  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 most recent rating decision of the veteran by the U.S. Department of Veterans Affairs (“V.A.”) or a
       document from the V.A. indicating that the veteran was 100% permanently and totally disabled or 100% permanently
       unemployable. This must include the disability effectivedate.       
     • Applicant must be a Maryland resident.   Driver’s license, voter’s registration or income taxes may be required as
       proof. 
        
                                       TO BE COMPLETED BY THE VETERANS ADMINISTRATION 
 
 The United States Veterans Administration The  United States Veterans Administration hereby certifies that the above named veteran,  
 prior to or after his/her death, was declared by the Veterans Administration to have 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  Disability  _______________________________          
  Adjudication / Service Officer___________________________________    Date               _______________________________________             
  Print Name _________________________________________________   Phone                    ________________________________________   
  Full  Address  _____________________________________________________________________________________________________ 
                                     THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION 
                                                  FOR ASSESSMENT OFFICE USE ONLY 
 Comments:  ________________________________________________________________________________________________  
 __________________________________________________________________________________________________________  
                  Approved  [      ]          Disapproved  [      ]       Code No.  _________     Effective _____________________  
  
 Supervisor’s Signature _______________________________________________________                         Date: ________________________ 
   
  SDATRP_EX4B    July 2021                                                                                                       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 /2023