Fillable 11 22 Fillable (Harris County Appraisal District)

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11 22 Fillable (Harris County Appraisal District)

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Harris County Appraisal District
Exemption Center
13013 Northwest Fwy.
P. O. Box 922012
Houston, TX. 77292-2012
(713) 957-7800
Form 11.22 (09/2017)
Application for Disabled Veteran’s or
Survivor’s Exemption for ______
Step 1: Provide Name and Mailing Address of Property Owner
Year
Continue on Page 2
GENERAL INSTRUCTIONS:
This application is for use in claiming a disabled veterans’ or survivor’s exemption. A disabled veteran is dened as a veteran
of the armed services of the United States who is classied as disabled by the Veterans’ Administration or its successor or the branch of the armed services in
which the veteran served and whose disability is service-connected pursuant to Tax Code §11.22. A qualied individual is entitled to an exemption from taxation
of a portion of the assessed value of one property the applicant owns and designates on this form.
WHERE TO FILE: File the completed application and all required documents with the appraisal district for the county in which the property is located.
APPLICATION DEADLINES: This application covers property you owned on January 1 of this year. You must 
le the completed form between January 1
and April 30 of this year with the county appraisal district in the county in which the property is located. You may file a late exemption application if you file it
no later than five years after the delinquency date for the taxes on the property. Be sure to attach any additional documents requested. Return the completed
form and any attachments to the address above.
WHEN NEW APPLICATION REQUIRED: If the chief appraiser grants the exemption, you do not need to reapply annually, but you must reapply if the
chief appraiser requires you to do so.
DUTY TO NOTIFY: You must notify the chief appraiser in writing if and when your right to this exemption ends or your disability rating changes.
OTHER IMPORTANT INFORMATION
Pursuant to Tax Code §11.45, after considering this application and all relevant information, the chief appraiser may request additional information from you.
You must provide the additional information within 30 days of the request or the application is denied. For good cause shown, the chief appraiser may extend
the deadline for furnishing the additional information by written order for a single period not to exceed 15 days.
* The applicant’s driver’s license number, personal identication certicate number, or social security account number is required. Pursuant to Tax Code
Section 11.48(a), a driver’s license number, personal identication certicate number, or social security account number provided in an application for an
exemption led with a chief appraiser is condential and not open to public inspection. The information may not be disclosed to anyone other than an
employee of the appraisal ofce who appraises property, except as authorized by Tax Code Section 11.48(b).
Step 2: Describe the Property
Street Address if Different from Above, or Legal Description if No Address
Manufactured Home (give make, model, and identication number)
. Check the exemptions that apply to you and answer the questions.
. You may qualify for more than one exemption.
Disabled Veteran’s Exemption
Check here if this exemption applies to you
You may qualify for this exemption if you are a veteran of the armed services of the United States who is classied as disabled by the Veterans
Administration or your service branch. Your disability must be serviced-related and you must be a Texas resident.
You qualify for this exemption if you are a veteran of the U.S. Armed Forces and your service branch or the Veterans’ Administration has ofcially classied
you as disabled. Your disability must be service-related. You must be a Texas resident. Please give the information requested below, and attach
a letter or other document from the V.A. or service branch giving your most recent disability rating.
Name of Property Owner Driver’s License, Personal I.D. Certicate,
or Social Security Number*
Mailing Address
City, State, ZIP Code Phone (area code and number)
HCAD Account Number: _________________________________
11.22 (09/2013) Page 2
Continue on Page 3
Application for Disabled Veteran’s or Survivor’s Tax Exemption
Branch of Service: Disability Rating: Age: Serial Number:
Are you a Texas resident?
Check the box if you: Have lost the use of one or more limbs (service-related).
Are blind in either or both eyes (service-related).
Yes No
Surviving Spouse or Child of a Deceased Disabled Veteran
Check here if this exemption applies to you
You may qualify for this exemption if you are the surviving spouse or child of a deceased veteran of the U.S. armed services and the veteran’s service branch or
the Veterans’ Administration had ofcially classied the veteran as disabled before his/her death. The disability must have been service-related. You must be a
Texas resident. If you are a surviving spouse, you must not have remarried. If you are a surviving child, you must be under 18 years old and your disabled parent’s
spouse must not have survived your disabled parent. Please give the information requested below, and attach a letter or other document from the V.A. or service
branch giving the veteran’s most recent disability rating. Also attach a copy of a birth certicate or marriage license showing your relationship to the veteran.
Veteran’s Name: Branch of Service: Disability Rating: Age at Death: Serial Number:
Check the box if the veteran: had lost the use of one or more limbs (service-related).
was blind in either or both eyes (sevice-related).
Are you a Texas resident? Yes No
Are you a surviving spouse? Yes No
If you are a surviving spouse, have you remarried? Yes No
Are you a surviving child? Yes No
If you are a surviving child: are you under 18? Yes No
are you unmarried? Yes No
how many of your disabled parent’s children are under 18 and unmarried? ___________
Surviving Spouse or Child of an Armed Services Member Who Died on Active Duty
Check here if this exemption applies to you
You may qualify for this exemption if you are the surviving spouse or child of a person who died while on active duty with the U.S. armed services.
You must be a Texas resident. If you are a surviving child, you must be under 18 years old. Please give the information requested below, and attach
a letter or other document from the V.A. or service branch showing that the person died on active duty. Also attach a copy of a birth certicate or
marriage license showing your relationship to the armed forces member. A surviving spouse who claims this exemption may not also receive an
exemption as the surviving child of a deceased disabled veteran or armed forces member killed on active duty.
Are you a Texas resident? Yes No
Are you a surviving spouse? Yes No
If you are a surviving spouse, have you remarried? Yes No
Are you a surviving child? Yes No
If you are a surviving child: are you under 18? Yes No
are you unmarried? Yes No
how many of the member’s children are under 18 and unmarried? ____________
Veteran’s Name: Branch of Service: Disability Rating: Age at Death: Serial Number:
Step 4: Read, Sign, and Date
11.22 (09/2013) Page 3
Application for Disabled Veteran’s or Survivor’s Tax Exemption
Step 3: Check if Late Application
If you were eligible for this exemption last year, check this box and enter the prior tax year. You must have met all of the qualications above on January 1
of the prior tax year to receive the exemption for last year.
Application for exemption for prior tax year, _________ .
By signing this application, you certify that the information provided in this application is true and correct to the best of your knowledge and
belief.
Sign
here ________________________________________________________________________________ Date____________________________
Authorized Signature
If you make a false statement on this application, you could be found guilty of a Class A misdemeanor or a state jail felony under
Section 37.10, Penal Code.
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Completed 15 July 2020

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