MARYLAND STATE DEPARTMENT OF ASSESSMENTS & TAXATION 
                                      APPLICATION FOR EXEMPTION FOR 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 a disabled veteran’s exemption on the indicated property. Failure to provide 
 this information will result in denial of your application. However, some of this information would be considered a "personal 
 record" as defined   inGeneral Provisions         Article, §4-501.     Consequently,youhavethe            statutory right   toinspectyourfile    and   tofile a   
 written request to correct or amend any information you believe to be inaccurate or incomplete. Additionally, personal 
 information provided to the State Department   ofAssessments and                      Taxation   is not  generallyavailable       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   Property:of                                                                                                                     
 County Account  Number:                                                                                                                   
 (Baltimore City) Ward                   Section                          Block                   Lot               
 Description of Property:                                                                                                                
    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   Veteran:of                                                                          Date:                                     
 Print Name:                                                            Social Security Number:                                                               
 Mailing Address:                                                                                                                              
 Phone:                                                       Email Address:                                                            
      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 is 100%                               permanently and
          totally disabled or 100% permanently unemployable.This must i                             ncludethedisability effective date. 
      •   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 hereby            certifies    that the above      named    veteran     has been declared    by   the             
 Veterans    Administration     to have a service-connected disability,               which  was not incurred       through   misconduct;  that  the said 
 disability is       % disabling.    Is the disability    permanentin      character?            _. Is thedisabilityreasonably      certain to continue for 
 the life ofthe veteran? _               _. Is the veteran 100%permanently unemployable?                               . Is the said veteran receiving 
                                                                                                                                                           
 disability payments as allowed for reasons of                 % disability, or                  % unemployability. 
                    
 The  character     of the disability is asfollows:                                                                                                          
 Effective Date 
                                                                                                                                                
 of Disability                                     Adjudication/Service Officer 
                                                                                                                                   
 Address: 
                                                                                                                       
 Phone:                                                                               Date:               
                                                 THIS APPLICATION      IS NOT OPEN      FOR PUBLIC    INSPECTION                                            
                                                          FOR   ASSESSMENT            OFFICE   USE ONLY                                                     
         
 Comments                                                                                                                                   
                                                                                                                                                
 Approved     [  ]    Re-Application  [  ]        Disapproved    [  ]                 Code No. __________          Effective ________________ 
 Supervisor’s Signature                                                                     Date 
                                                                                                                                                                    

                                                                      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