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Property Owner Last Name First Name M.I. Social Security Number/ITIN 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 I am approved by the secretary of the United States Department of Veterans Affairs for assistance as the primary provider of personal care services for the veteran listed on this application who is an eligible veteran under the Program of Comprehensive Assistance for Family Caregivers, codified as United States Code, title 38, section 1720G. Yes No (Rev. 7/23 Homestead Exclusion for a Primary Family Caregiver of a Veteran with a Disability Applications are due by December 31. Read instructions before completing. Sign Here CR-HEC Veteran Information Signature of Applicant Signature of Spouse Date Daytime Phone I declare all information on this form is true, correct, and complete to the best of my knowledge and belief. Veteran’s Last Name Veteran’s First Name M.I. Social Security Number/ITIN Address Date of Birth City State Zip Code County Check all boxes that apply. The veteran must have a U.S. Government Form DD214 or other official military discharge papers, and must be certified by the U.S. Department of Veterans Affairs (VA) as having a service-connected disability of 70% or more. The veteran has been certified by the United States VA as having service-connected disability of 70% or more. I have attached documentation supporting this statement. The veteran has been certified by the United States VA as having a permanent service-connected disability of 100%. I have attached documentation supporting this statement. I have attached the appropriate documentation certifying that the veteran has been honorably discharged. I have attached the VA Caregiver Support Approval Letter verifying that I am the veteran’s Primary Family Caregiver. Please mail completed application and required attachments to your county assessor. For Office Use Only Approved Denied Name of applicant_ Assessor’s ---PAGE BREAK--- Who is Eligible? You may be eligible for a market value exclusion of up to: • $150,000 if you are the primary family caregiver of a United States military veteran with a service-connected disability of 70% or more • $300,000 if you are the primary family caregiver of a United States military veteran with a 100% and permanent service-connected dis- ability Homestead Property How to Apply • A letter from VA Caregiver Support documenting that you are the veteran’s primary family caregiver -