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Robert S. Wertz, Jr. Web loudoun.gov/COR Phone [PHONE REDACTED] Mailing Address PO Box 8000, Leesburg, VA 20177-9804 In-person Service Leesburg - 1 Harrison Street SE, 1st Floor Sterling - 46000 Center Oak Plaza Disabled Veteran Real Estate and/or Vehicle Tax Exemption Application Tax Exemption Qualification & Request I am a veteran who has been determined by the U.S. Department of Veterans Affairs to have a 100% service-connected, total and permanent disability, and I am applying for the: Real estate tax exemption [ ] [ ] Yes No Vehicle tax exemption [ ] [ ] [ ] Yes No - is the veteran's vehicle: leased [ ] owned by a business other: Disabled Veteran Applicant Name SSN [ ] Date of Birth Daytime Phone Email Mailing Address City State Zip Disability determination letter from the Department of Veteran's Affairs is attached. [ ] Spouse (if married) Name [ ] [ ] [ ] SSN Date of Birth Daytime Phone Email Is the spouse also a 100% service-connected totally and permanently Disabled Veteran? Yes No If yes, disability determination letter from the Department of Veteran's Affairs is attached. Real Estate to Receive Tax Exemption Parcel Street Address City Zip Ownership Do you already own the property? [ ] [ ] Yes No If no, provide the estimated date of settlement: Do you need a pre-qualification letter Yes ? [ ] [ ] No Is the property titled in the name of a Trust? [ ] [ ] [ ] Yes No If yes, copy of the Trust & amendments is attached. Is the property co-owned with a non-spouse? [ ] [ ] Yes No If yes, provide information about the co-owner(s): Name SSN Date of Birth Name SSN Date of Birth Occupancy Do you currently occupy the property as your principal residence? [ ] [ ] Yes No If no, please provide an explanation: Do you receive an exemption on another residence in Virginia based on Disabled Veteran status or occupancy? [ ] [ ] Yes No If yes, provide the address of that residence : Address 1 I TED3-1025 ---PAGE BREAK--- Disabled Veteran Real Estate and/or Vehicle Tax Exemption Application Vehicle to Receive Tax Exemption Is the address where the vehicle is regularly parked/garaged also the real estate parcel address? [ ] [ ] Yes No If no, at what address is the vehicle parked? Street City Zip Vehicle Year Make Model VIN What name(s) are on the Vehicle Title? [ ] [ ] [ ] Disabled Veteran Spouse Other Is this vehicle registered in Loudoun County? [ ] [ ] Yes No If no, when will it be registered? Is this vehicle used primarily by/for the Disabled Veteran? [ ] [ ] Yes No Is the vehicle registered with the Department of Motor Vehicles for personal use? [ ] [ ] Yes No Is the registered gross weight of this vehicle in excess of 10,000 pounds? [ ] Yes [ ] No [ ] A copy of the driver's license of all applicants is attached. Certification By signing this application, I/we understand and affirm: [ ] that the statements contained in this application are true and correct to the best of my/our knowledge and belief. my/our responsibility to notify the Office of the Commissioner of the Revenue of any changes to the real estate and/or vehicle use/occupancy, ownership, or the disabled veteran's total and permanent disability status. [ ] [ ] that if my/our qualification status changes, such that I/we do not qualify for the exemption(s), I/we may lose the exemptions and may become liable for taxes due and any other penalties provided under the laws of the Commonwealth of Virginia. Disabled Veteran Signature Date Spouse's Signature Date Co-Owner's Name Signature Date Co-Owner's Name Signature Date Office Use Only Date Received [ ] [ ] [ ] [ ] [ ] Accepted by Reviewed by Documents Received VA Disability Spouse's VA Disability Marriage Cert Death Cert Trust [ ] POA [ ] Other FM Land Value PIN VA Effective Date 3rd Acre Value Acres PP Account # Land Use Value Purchase Date VH GVW Ineligible Land RE Exemption Start Date PP Exemption Start Date Ineligible Structures Notes Total Ineligible 2 I Loudoun County I Office of the Commissioner of the Revenue I TED3-1 025 SIGN SIGN SIGN SIGN ---PAGE BREAK--- Disabled Veteran Real Estate and/or Vehicle Tax Exemption Application General Information Virginia law provides two types of tax exemptions for a disabled veteran and their spouse (if applicable). Both real estate and vehicle exemptions are provided on an annual basis and must be requested by the veteran/spouse seeking the exemption(s) The real estate tax exemption is based on qualifying disability, ownership, and occupancy. The vehicle tax exemption is for one vehicle only and is based on qualifying disability, ownership, and use. Vehicles that are leased, titled to a business, or over 10,000 pounds gross weight do not qualify. This application does not need to be filed annually; however, a form will be mailed to existing program participants by March 1 each year so that any changes can be reported. Review relevant info at loudoun.gov/TaxRelief-Veterans. You can find online forms at loudoun.gov/COR-Forms. Use this form to apply for real estate and/or vehicle tax exemption based on your status as a veteran with a 100% service-connected, total and permanent disability. Need help? Staff assistance is available Monday through Friday, during County business hours. To reduce your wait time, we encourage scheduling an appointment. We are open 8:30 AM to 5:00 PM in: Leesburg 1 Harrison St. SE, 1st Floor Sterling 46000 Center Oak Plaza For assistance with a specific topic, email or call: Residential Real Estate [EMAIL REDACTED] [PHONE REDACTED], option 3 Tax Relief, Exemptions & Deferrals [EMAIL REDACTED] [PHONE REDACTED] Vehicle Personal Property [EMAIL REDACTED] [PHONE REDACTED], option 1 Accommodations: If you require a reasonable accommodation for any type of disability or need language assistance in order to access this form, please contact [EMAIL REDACTED]. Three business days advance notice is requested. Privacy: This Office protects records according to applicable Virginia statutes and U.S. federal laws. Any personal information we collect and maintain is retained in compliance with statute. Instructions 1. Complete each section of the application. Provide identification and contact information for the veteran with disability and, if married, the spouse. For real estate, provide the address, ownership, and occupancy information. The exemption cannot be applied to more than one property at a time. For the vehicle, provide ownership, use, and vehicle information. The certification must be signed by all real estate and/or vehicle owners. 2. Attach copies of supporting documentation. Applications without supporting documentation may be denied. • Disability Letter from the U.S. Department of Veterans Affairs confirming the veteran has a 100% service-connected, total and permanent disability and the date the total and permanent disability became effective. • If married, the Marriage License or Marriage Certificate. • If the property is titled in the name of a Trust, provide the entire Trust agreement and any amendments. • If applicable, the Power of Attorney to request relief on behalf of the veteran or spouse. • Driver’s license for all applicants, and if applicable, a detailed explanation explaining why the address on the license is not the same as the address for the real estate exemption, if it is being requested. 3. Submit this form in person at one of the locations listed above or: Upload it to: loudoun.gov/COR-Upload Mail it to: Tax Exemptions and Deferrals PO Box 8000, Leesburg, VA 20177-9804 Find webforms at: loudoun.gov/COR-Forms 3 I Loudoun County I Office of the Commissioner of the Revenue I TED3-1 025 ---PAGE BREAK--- Disabled Veteran Real Estate and/or Vehicle Tax Exemption Application Effective Date Real Estate - The real estate tax exemption will be deemed effective the later of: • The effective date of the total and permanent disability per the VA letter; or • The date the deed was recorded in Land Records in the name of the disabled veteran; or • The date the disabled veteran or surviving spouse first occupied the property as their principal residence; or • January 1, 2011. Vehicle - According to state law, the vehicle tax exemption can only be applied for the current year and three prior years. The vehicle tax exemption will be deemed effective at the later of: • The effective date of the total and permanent disability per the VA letter; or • The date the vehicle is registered in Loudoun County; or • Three years prior to the date of application. Real Estate Exemption Qualifications Disability – As determined by the U.S. Department of Veterans Affairs, the veteran must have a 100% service-connected, total and permanent disability or a total disability rating based on individual unemployability due to a service-connected disability. Documentation from the Department of Veterans Affairs must be provided with the application. Property Ownership – The property must be owned by the disabled veteran requesting the exemption or jointly owned with the veteran’s spouse. Real estate co-owned by the veteran and other individuals, not all of whom are entitled to the exemption, may receive a partial exemption based on the percentage of ownership by the veteran and those entitled to the exemption. The property may be deeded to a Trust and receive an exemption. A copy of the entire Trust and any amendments must be provided with the application. A life estate granted to a veteran may also qualify for the exemption. Manufactured homes (mobile homes) may qualify; however, the land on which the manufactured home is located will not qualify for the exemption if it is not owned by the disabled veteran. Use/Occupancy – The property must be occupied as the principal residence of the veteran requesting the exemption. Additional structures that are used to house or cover motor vehicles may qualify for the exemption. In-ground pools are not eligible. Please note the veteran is required to file a new application for the real estate exemption if the principal place of residence changes. Ownership and/or Occupancy Changes – Notify this Office immediately of any ownership or occupancy changes. The real estate tax exemption will be adjusted if 1) the qualifying dwelling is sold, 2) the title is transferred to a non-qualifying owner, 3) the property ceases to be occupied by the veteran or surviving spouse as their principal residence, 4) the last qualifying owner dies, or 5) you are receiving a real estate tax exemption on another residence. Vehicle Exemption Qualifications Disability – As determined by the U.S. Department of Veterans Affairs, the veteran must have a 100% service-connected, total and permanent disability or a total disability rating based on individual unemployability due to a service-connected disability. Documentation from the Department of Veterans Affairs must be provided with the application. Property Ownership – The motor vehicle (car, pickup or panel truck) must be owned by the veteran and/or spouse. The following motor vehicles do not qualify: trucks with a registered gross weight in excess of 10,000 pounds, leased vehicles and vehicles owned by a business or LLC. The motor vehicle must be used primarily by or for a qualifying veteran and registered with the Department of Motor Vehicles for personal use. Ownership and/or Use Changes – Notify the Tax Exemptions and Deferrals Division within 30 days of the disabled veteran passing away. The vehicle exemption ceases the day of the veteran's passing. For any other vehicle changes, submit a Disabled Veteran Vehicle Tax Exemption Change Request form to move the vehicle tax exemption during the year if the vehicle being used primarily by/for the veteran changes. 4 I Loudoun County I Office of the Commissioner of the Revenue I TED3-1 025