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Home My Public Portal AboutApplication for Statutory Exemption -- Veteran 22 State Tax Form 96-4 The Commonwealth of Massachusetts Assessors’ Use only Revised 7/2017 Date Received Application No. Name of City or Town Parcel Id. VETERAN FISCAL YEAR _______ APPLICATION FOR STATUTORY EXEMPTION General Laws Chapter 59, § 5 THIS APPLICATION IS NOT OPEN TO PUBLIC INSPECTION (See General Laws Chapter 59, § 60) Return to: Board of Assessors Must be filed with assessors on or before April 1, or 3 months after actual (not preliminary) tax bills are mailed for fiscal year if later. INSTRUCTIONS: Complete the following. Please print or type. A. IDENTIFICATION. Complete this section fully. Name of Applicant ________________________________________________________________________________________ Telephone Number _________________________ Marital Status ________________________________ Legal Residence (Domicile) on July 1, ________ No. Street City/Town Zip Code Location of Property: Mailing Address (If different) No. of Dwelling Units: 1 2 3 4 Other Did you own the property on July 1, ? Yes No If yes, were you: Sole Owner Co-owner with Spouse Only Co-owner with Others Was the property subject to a trust as of July 1, ? Yes No If yes, please attach trust instrument including all schedules. Have you been granted any exemption in any other city or town (MA or other) for this year? Yes No If yes, name of city or town Amount exempted $ DISPOSITION OF APPLICATION (ASSESSORS’ USE ONLY) Ownership GRANTED Assessed Tax $ Occupancy DENIED Exempted Tax $ Status DEEMED DENIED Adjusted Tax $ Board of Assessors Date Voted/Deemed Denied Certificate No. Date Cert./Notice Sent Exemption: Clause Date: FILING THIS FORM DOES NOT STAY THE COLLECTION OF YOUR TAXES THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE B. EXEMPTION STATUS. Check the status that applies to you and complete the questions that follow. VETERAN VETERAN’S SPOUSE Veteran’s Name ___________________________________________ Was the property the veteran’s domicile as of July 1, ________? Yes No If no, where does the veteran reside?_________________________ VETERAN’S/SERVICEMEMBER’S/ NATIONAL GUARD MEMBER’S SURVIVING SPOUSE or SERVICEMEMBER’S SURVIVING PARENT Deceased Veteran’s/Servicemember’s/National Guard member’s Name ____________________________________________________ If first year of application, attach copy of death certificate. If you are surviving spouse, have you remarried? Yes No Date Enlisted/Inducted ____________________________ Date Discharged _______________________________________ Type of Discharge _________________________________ If first year of application, attach copy of discharge papers. Military Decorations or Awards _______________________________________________________________________________ Did the veteran/service/national guard member live in Massachusetts for at least 6 months before entering the service? Yes No If no, list places and dates where veteran or member lived during the last 6 years or if deceased, the 6 years before death (2 years if local option adopted - See Assessors) Address Dates Continue list on attachment in same format as necessary. If yes to any of the next 2 questions and if first year of application, (1) attach documentation from U.S. Dept. of Veterans Affairs, branch of service and (2) list above places and dates where surviving spouse has lived during the last 6 years (2 years if local option adopted – See Assessors) Is the servicemember or national guard member missing in action and presumed dead? Yes No Was the proximate cause of the veteran’s, servicemember’s or national guard member’s death due to an active duty injury or illness? Yes No If yes to next question and first year of application, attach Certificate of Disability from U.S. Dept. of Veterans Affairs or branch of service. Does the veteran have a 100% disability rating for service-connected blindness? Yes No If yes to any of the next 3 questions and If first year of application, attach Certificate of Disability from U.S. Dept. of Veterans Affairs or branch of service. If exemption granted previously, attach certificate only if disability rating is 100% or has changed. Does the veteran have a service-connected disability? Yes No Has the veteran acquired “specially adapted housing?” Yes No Is the veteran a paraplegic? Yes No GO ON TO SECTION C C. SIGNATURE. Sign here to complete the application. This application has been prepared or examined by me. Under the pains and penalties of perjury, I declare that to the best of my knowledge and belief, this return and all accompanying documents and statements are true, correct and complete. Signature Date If signed by agent, attach copy of written authorization to sign on behalf of taxpayer. TAXPAYER INFORMATION ABOUT PERSONAL EXEMPTIONS PERSONAL EXEMPTIONS. You may be eligible to reduce all or a portion of the taxes assessed on your domicile if you meet the qualifications for one of the personal exemptions allowed under Massachusetts law. Qualifications vary, but generally relate to age, ownership, residency, disability, income or assets. You may be eligible for an exemption if you fall into any of these categories: • Legally blind person • Veteran with a service-connected disability • Surviving spouse of servicemember, national guard member or veteran who died from active duty injury or illness • Surviving spouse • Minor child of a deceased parent • Senior citizen age 70 and older (65 and older by local option) More detailed information about the qualifications for each exemption may be obtained from your board of assessors. WHO MAY FILE AN APPLICATION. You may file an application if you meet all qualifications for a personal exemption as of July 1. You may also apply if you are the personal representative of the estate, or trustee under the will, of a person who qualified for a personal exemption on July 1. WHEN AND WHERE APPLICATION MUST BE FILED. Your application must be filed with the assessors on or before April 1, or 3 months after the actual bills were mailed for the fiscal year, whichever is later. An application is filed when (1) received by the assessors on or before the filing deadline, or (2) mailed by United States mail, first class postage prepaid, to the proper address of the assessors, on or before the filing deadline, as shown by a postmark made by the United States Postal Service. THIS DEADLINE CANNOT BE EXTENDED OR WAIVED BY THE ASSESSORS FOR ANY REASON. IF YOUR APPLICATION IS NOT TIMELY FILED, YOU LOSE ALL RIGHTS TO AN EXEMPTION AND THE ASSESSORS CANNOT BY LAW GRANT YOU ONE. PAYMENT OF TAX. Filing an application does not stay the collection of your taxes. In some cases, you must pay all preliminary and actual installments of the tax when due to appeal the assessors’ disposition of your application. Failure to pay the tax when due may also subject you to interest charges and collection action. To avoid any loss of rights or additional charges, you should pay the tax as assessed. If an exemption is granted and you have already paid the entire year’s tax as exempted, you will receive a refund of any overpayment. ASSESSORS DISPOSITION. Upon applying for an exemption, you may be required to provide the assessors with further information and supporting documentation to establish your eligibility. The assessors have 3 months from the date your application is filed to act on it unless you agree in writing before that period expires to extend it for a specific time. If the assessors do not act on your application within the original or extended period, it is deemed denied. You will be notified in writing whether an exemption has been granted or denied. APPEAL. You may appeal the disposition of your application to the Appellate Tax Board, or if applicable, the County Commissioners. The appeal must be filed within 3 months of the date the assessors acted on your application, or the date your application was deemed denied, whichever is applicable. The disposition notice will provide you with further information about the appeal procedure and deadline.