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Last Name Homestead Exclusion for a Surviving Spouse of a Veteran who was Permanently Disabled or a Service Member Who Died While in Active Service Applications are due by December 31. Read instructions before completing. First Name Property Owner M.I. Social Security Number/ITIN Deceased Veteran’s Last Name Deceased Veteran’s First Name M.I. Social Security Number/ITIN Address (Cannot be a P.O. Box Number) City State ZIP Code County Property ID Number (From Property Tax Statement): Date of Death of Veteran (Rev. 7/23) Sign Here Approved Denied For Office Use Only Name of applicant year Assessor’s signature CR-HESS Applicant Information Signature of Applicant Date Daytime Phone I declare all information on this form is true, correct, and complete to the best of my knowledge and belief. Please mail completed application and required attachments to your county assessor. Yes No Is this property your homestead? Yes No Do you hold the legal or beneficial title to the homestead property? Yes No Have you received this exclusion on a previous property? Yes No If yes, please provide the address of the previous property: Check all boxes that apply. Surviving Spouses of Veterans with a Permanent and Total Disability Rating: I am the surviving spouse of a veteran who was receiving the Market Value Exclusion for Permanently and Totally Disabled Veterans on this property. I have attached verification of my benefits as a surviving spouse of a veteran with a 100% and permanent disability. Yes No I am the surviving spouse of a veteran who did not qualify prior to death, but was certified as 100 percent totally and permanently dis- abled at the time of death or after. I have attached verification of my benefits as a surviving spouse of a totally and permanently disabled veteran. I certify that, since my spouse’s death, I have not remarried, nor sold, transferred, or otherwise disposed of the property. Yes No Surviving Spouses of Service Members Who Have Died While Serving in Active Duty: I am the surviving spouse of a service member of a branch of the United States Armed Forces that passed away due to a service connected cause while serving honorably in active duty. I have attached U.S. Government Form DD1300 or DD2064. Yes No I have been awarded Dependency and Indemnity Compensation. I have attached verification of my benefits as a surviving spouse receiv- ing Dependency and Indemnity Compensation. I certify that. since my spouse’s death, I have not remarried, nor sold, transferred, or otherwise disposed of the property. Surviving Spouse's Email SIGN SIGN ---PAGE BREAK--- Who is Eligible? You may be eligible for a market value exclusion of up to $300,000 if either of the following apply: • You are the surviving spouse of a United States military veteran with 100% and permanent service-connected disability or you have been awarded dependency and indemnity compensation. • You are the surviving spouse of a member of the United States Armed Forces who died due to a service connected cause while serving honorably in active duty, as indicated on U.S. Government Form DD1300 or DD2064. You must be able to verify that you are a surviving spouse of a veteran with a 100% and permanent disability rating or a service member who died while serving in active duty. Homestead Property This application is not a homestead application. You must apply for and be granted homestead on a qualifying property prior to applying for this market value exclusion. How to Apply Mail the completed application with all required documentation to your county assessor by December of the current year to be eligible for the exclusion in the next payable tax year . Please attach all required documentation to verify that you qualify for this exclusion. We use the information on this form to properly identify you and determine if you qualify for this market value exclusion. Your Social Secu- rity number is required. If you do not provide the required information, your application will be denied. Making false statements on this application is against the law. Minnesota Statutes, section 609.41, states that anyone giving false information the Department of Revenue’s website at www.revenue.state.mn.us.