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For Office Use Only Approved Name of applicant Assessment year Denied Assessor’s signature Date CR-HEV Homestead Exclusion for a Veteran with a Disability Applications are due by December 31. Read instructions before completing. Sign Here Check All That Apply Type or Print Last Name First Name M.I. Social Security Number/ITIN Spouse’s Last Name Spouse’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) Is this property your homestead? Yes No By signing below, I certify that the above information is true and correct to the best of my knowledge. Signature of Applicant Signature of Spouse Date Daytime Phone Please mail completed application and required attachments to your county assessor. (Rev. 7/23) Check all boxes that apply. You must have a U.S. Government Form DD214 or other military discharge papers, and must be certified by the U.S. Department of Veterans of Affairs as having a permanent service-connected disability of 70 percent or more or a service- connected disability of 100 percent total and permanent. I have been certified by the U.S. Department of Veteran Affairs as having a service connected disability of 70 percent or more. I have been certified by the U.S. Department of Veteran Affairs as having 100% total and permanent service-connected disability. I have attached the appropriate documentations verifying that I have been honorably discharged and verifying my disability status. ---PAGE BREAK---