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RP-458-a (1/03 (rev. 8/06)) NYS BOARD OF REAL PROPERTY SERVICES APPLICATION FOR ALTERNATIVE VETERANS EXEMPTION FROM REAL PROPERTY TAXATION (General information and instructions for completing this form are contained in Form RP-458-a-Ins) 1. Name and telephone no. of owner(s) 2. Mailing address of owner(s) Day No. ( Evening No. ( ) 3. Location of property (see instructions) Street address Village (if any) City/Town Property identification (see tax bill or assessment roll) Tax map number or 4. Is the owner a veteran who served in the active military, naval or air service of the United States? __Yes __No If No, indicate the relationship of the owner to veteran who rendered such service: If Yes, is the veteran also the unremarried surviving spouse of a veteran? ____Yes 5. Indicate branch of veterans service and dates of active service: (Attach written evidence) 6. Was the veteran discharged or released from the active service under honorable conditions? ___Yes ___No (Attach written evidence) 7. Did the veteran serve in a combat zone or combat theater? ___Yes ___No If Yes, where did the veteran serve and when was such service (Attach written evidence) 8. Has the veteran received, or did the veteran receive prior to his/her death, a compensation rating from the United States Veteran’s Administration or from the United States Department of Defense as a result of a service connected disability? If Yes, what is (was) the veteran’s compensation rating? (Attach written evidence showing the date such rate was established) check if rating is permanent? If No, did the veteran die in service of a service connected disability or in the line of duty while serving during wartime? ____Yes (Attach written evidence) 9. Is the property the primary residence of the veteran, unremarried surviving spouse of the veteran or Gold Star parent? ____Yes If No, is the veteran, unremarried surviving spouse of the veteran or Gold Star parent the owner of the property and absent from the property due to medical reasons or institutionalization? ____Yes Explain: 10. Is the property used exclusively for residential purposes? If No, describe the non-residential use of this property and state what portion is so used. ---PAGE BREAK--- RP-458-a (1/03 (rev. 8/06)) 2 11. Date title to this property was acquired: (attach copy of deed) 12. Has the owner(s) ever received or is the owner(s) now receiving a veterans exemption based on eligible funds on property in New York State? If yes, the amount of eligible funds used in the purchase was The location of the property was or is: as in question 3) or Street address: Village City/Town School I (we) hereby certify that all statements made on this application are true and correct to the best of my (our) knowledge and belief and I (we) understand that any willful false statement made herein will subject me (us) to the penalties prescribed therefore in the Penal Law. ALL OWNERS MUST SIGN APPLICATION Signature of owner(s) Date Signature of owner(s) Date SPACE BELOW FOR ASSESSOR’S USE ONLY Alternative veterans exemption (RP-458-a) Assessment Period of war active service or expeditionary medal recipient (15% or ceiling Max.) approved ___Yes ___No Combat zone service (including expeditionary medal) (10% or ceiling Max.) approved ___Yes ___No Service connected disability rating 50% or ceiling Max.) approved ___Yes ___No Total Village of Town/City of County of Assessor’s signature Date