provided by Maine Revenue Services, Property Tax Division, Tel. (207) 287-2011

Application For Exemption From Local Taxation
WIDOW, MINOR CHILD OR WIDOWED MOTHER OF A VETERAN

1. Name_________________________________

2. Legal Residence________________________________________________________

3. Do you Receive a Pension from the United States Government as the

a) Unremarried Widow or the Minor Child of a Veteran?	___yes	___no
b) Unremarried Widowed Mother of a Veteran?	___yes	___no

4. If Minor Child or Widowed Mother, Date of Birth________________

5. Information Relating to Deceased Veteran who was the Husband, Son or Parent of Applicant:

a) Name of Veteran_____________________________

b) Date of Birth of Veteran________________________

c) Date of Decease of Veteran_____________________

d) Was Veteran's Death Service-connected?___________

e) Date of Entry into Armed Forces__________________

f) Legal Residence on Date of Entry into Armed Forces___________________________

g) Date of Discharge or Separation from Armed Forces___________________________

h) Was Veteran Receiving TOTAL Disability Pension or Compensation at Death?	___yes	___no
1. Did Veteran Receive a Grant from U.S. Government for Specially Adapted Housing as a Paraplegic?	___yes	___no

i) Veterans Administration Claim No. C-________________________

j) Military Service Serial Number______________________________

INSTRUCTIONS: All questions must be answered. This application must be filed with the assessors of the place where you reside on or before April 1 to be considered for this year. The assessors shall thereafter grant such exemption while you are so qualified and continue a legal resident of that place. This application must be accompanied by satisfactory documentary evidence to support answers to questions. If you are in doubt as to the way in which to answer any question or as to documentary evidence needed, consult your Board of Assessors.

I hereby apply for exemption from local taxation in accordance with Title 36, MRSA, section 653. No property upon which tax exemption may be claimed hereunder has been conveyed to me for the purpose of obtaining such exemption. The answers to the above questions are correct to the best of my knowledge and belief.

Date_______________

_________________________
Signature of Applicant

----------------------CERTIFICATE OF APPROVAL OF APPLICANT'S EXEMPT STATUS---------------------

Written proof of entitlement has accompanied this application which supports the statements here contained indicating that the applicant is entitled to exemption from property tax as indicated.

In determining the local assessed value of the exemption, the assessor shall multiply the amount of the exemption by the ratio of current just value upon which the assessment is based.

NOTE: Acceptable proof of entitlement is covered by, but not limited to, V.A. Form 20-5455a when Item 15 Tax Code indicates Code 2 or 3 or a copy of the certificate or letter issued by the V.A.

NOTE: When this form is used by a municipality the ratio to be used is that which was reported to the State Tax Assessor on the annual Municipal Valuation Return.

PTF-307
11/95