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RP- 458-a (1/16) Department of Taxation and Finance Office of Real Property Tax Services Application for Alternative Veterans Exemption from Real Property Taxation See instructions, Form RP-458-a-I, for assistance in completing this form. 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 No 5. Indicate branch of veteran’s service and dates of active service: If Yes, 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 performed? 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? Yes No If Yes, what is (was) the veteran’s compensation rating? Attach written evidence showing the date such rate was established. Mark an X in the box if the 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; if Yes, attach written evidence Yes No 9. Is the property the primary residence of the veteran, unremarried surviving spouse of the veteran, or Gold Star parent? Yes No 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 No Explain: 1. Name(s) of owner(s) 2. Mailing address of owner(s) (number and street or PO box) 3. Location of property (street address) City, village, or post office State ZIP code City, town, or village State ZIP code Daytime contact number Evening contact number Date of purchase of real property E-mail address Tax map number of section/block/lot: Property identification (see tax bill or assessment roll) Name(s) of any non-owner spouse(s) Address(es) of primary residence(s) if different from above: ---PAGE BREAK--- 10. Is the property used exclusively for residential purposes? Yes No If No, describe the non-residential use of this property and state what portion is so used: 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? Yes No If Yes, the amount of eligible funds used in the purchase was $ Does that eligible funds exemption cover the same property listed on page 1? Yes No If No, enter the location: If Yes, are you submitting this application only because you are seeking a school tax exemption? (Check Yes if you want to apply for a new school tax exemption without having any changes made to your existing eligible funds exemption; check No if you want your existing eligible funds exemption to be replaced with the alternative veterans exemption.) Yes No Page 2 of 2 RP-458-a (1/16) Alternative veterans exemption (RP-458-a) Assessment Total 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 Village Town/City County School district For Assessor’s Use Only Street address Village City/Town School district Certification 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 Signature of owner(s) Date Signature of owner(s) Date Name of assessor Assessor’s signature Date